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Am J Perinatol 2017; 34(09): 927-934
DOI: 10.1055/s-0037-1601307
Original Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Characterizing Literacy and Cognitive Function during Pregnancy and Postpartum

Lynn M. Yee
1   Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
,
Leslie A. Kamel
1   Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
,
Zara Quader
1   Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
,
Priya V. Rajan
1   Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
,
Shaneah M. Taylor
1   Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
,
Rachel O'Conor
2   Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
,
Michael S. Wolf
2   Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
3   Department of Learning Sciences, Northwestern University, Evanston, Illinois
,
Melissa A. Simon
1   Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
4   Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
5   Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois
› Author Affiliations
Further Information

Publication History

16 January 2017

09 January 2017

Publication Date:
22 March 2017 (online)

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Abstract

Objective The objective of this study was to characterize health literacy and cognitive function in a diverse cohort of pregnant women.

Methods Pregnant and postpartum women underwent in-depth assessments of health literacy/numeracy and the cognitive domains of verbal ability, working memory, long-term memory, processing speed, and inductive reasoning. Differences by demographic characteristics and gestational age were assessed using chi-square tests and multivariable logistic regression.

Results In this cohort of pregnant (N = 77) or postpartum (N = 24) women, 41.6% had limited health literacy/numeracy. Women were more likely to score in the lowest quartile for literacy and verbal ability if they were less educated, younger, nonwhite or had Medicaid. These factors were associated with low scores for long-term memory, processing speed, and inductive reasoning. Although there were no differences in literacy or cognitive function by parity or gestational age, postpartum women were more likely to score in the lowest quartile for processing speed (adjusted odds ratio [aOR]: 3.79, 95% confidence interval [CI]: 1.32–10.93) and inductive reasoning (aOR: 4.07, 95% CI: 1.21–13.70).

Conclusion Although postpartum status was associated with reduced inductive reasoning and processing speed, there were no differences in cognitive function across pregnancy.

Practice Implications Postpartum maternal learning may require enhanced support. In addition, cognitive skills and health literacy may be a mediator of perinatal outcomes inequities.

Keywords

cognitive function - decision - health literacy - memory - pregnancy brain - processing speed - health inequity

Note

This work was presented as a poster presentation at the 2015 Society for Reproductive Investigation 62nd Annual Meeting in San Francisco, CA, March 2015.


 

  • References

  • 1 National Healthcare Quality & Disparities Reports. Agency for Healthcare Research and Quality. Available at: www.ahrq.gov/research/findings/nhqrdr/index/html . Accessed 2016
    PubMedGoogle Scholar
  • 2 Dehlendorf C, Bryant AS, Huddleston HG, Jacoby VL, Fujimoto VY. Health disparities: definitions and measurements. Am J Obstet Gynecol 2010; 202 (03) 212-213
    CrossrefPubMedGoogle Scholar
  • 3 Dewalt DA, Berkman ND, Sheridan S, Lohr KN, Pignone MP. Literacy and health outcomes: a systematic review of the literature. J Gen Intern Med 2004; 19 (12) 1228-1239
    CrossrefPubMedGoogle Scholar
  • 4 Baker DW, Parker RM, Williams MV, Clark WS. Health literacy and the risk of hospital admission. J Gen Intern Med 1998; 13 (12) 791-798
    CrossrefPubMedGoogle Scholar
  • 5 Mancuso CA, Rincon M. Impact of health literacy on longitudinal asthma outcomes. J Gen Intern Med 2006; 21 (08) 813-817
    CrossrefPubMedGoogle Scholar
  • 6 Schillinger D, Grumbach K, Piette J. , et al. Association of health literacy with diabetes outcomes. JAMA 2002; 288 (04) 475-482
    CrossrefPubMedGoogle Scholar
  • 7 Wolf MS, Knight SJ, Lyons EA. , et al. Literacy, race, and PSA level among low-income men newly diagnosed with prostate cancer. Urology 2006; 68 (01) 89-93
    PubMedGoogle Scholar
  • 8 Osborn CY, Cavanaugh K, Wallston KA. , et al. Health literacy explains racial disparities in diabetes medication adherence. J Health Commun 2011; 16 (Suppl. 03) 268-278
    CrossrefPubMedGoogle Scholar
  • 9 Lindau ST, Basu A, Leitsch SA. Health literacy as a predictor of follow-up after an abnormal Pap smear: a prospective study. J Gen Intern Med 2006; 21 (08) 829-834
    CrossrefPubMedGoogle Scholar
  • 10 Berkman ND, Sheridan SL, Donahue KE, Halpern DJ, Crotty K. Low health literacy and health outcomes: an updated systematic review. Ann Intern Med 2011; 155 (02) 97-107
    CrossrefPubMedGoogle Scholar
  • 11 Scott TL, Gazmararian JA, Williams MV, Baker DW. Health literacy and preventive health care use among Medicare enrollees in a managed care organization. Med Care 2002; 40 (05) 395-404
    CrossrefPubMedGoogle Scholar
  • 12 Dolan NC, Ferreira MR, Davis TC. , et al. Colorectal cancer screening knowledge, attitudes, and beliefs among veterans: does literacy make a difference?. J Clin Oncol 2004; 22 (13) 2617-2622
    CrossrefPubMedGoogle Scholar
  • 13 Mõttus R, Johnson W, Murray C, Wolf MS, Starr JM, Deary IJ. Towards understanding the links between health literacy and physical health. Health Psychol 2014; 33 (02) 164-173
    CrossrefPubMedGoogle Scholar
  • 14 Serper M, Patzer RE, Curtis LM. , et al. Health literacy, cognitive ability, and functional health status among older adults. Health Serv Res 2014; 49 (04) 1249-1267
    CrossrefPubMedGoogle Scholar
  • 15 Wolf MS, Curtis LM, Wilson EAH. , et al. Literacy, cognitive function, and health: results of the LitCog study. J Gen Intern Med 2012; 27 (10) 1300-1307
    CrossrefPubMedGoogle Scholar
  • 16 Cho RN, Plunkett BA, Wolf MS, Simon CE, Grobman WA. Health literacy and patient understanding of screening tests for aneuploidy and neural tube defects. Prenat Diagn 2007; 27 (05) 463-467
    CrossrefPubMedGoogle Scholar
  • 17 You WB, Wolf M, Bailey SC. , et al. Factors associated with patient understanding of preeclampsia. Hypertens Pregnancy 2012; 31 (03) 341-349
    CrossrefPubMedGoogle Scholar
  • 18 Yee LM, Simon MA. The role of health literacy and numeracy in contraceptive decision-making for urban Chicago women. J Community Health 2014; 39 (02) 394-399
    CrossrefPubMedGoogle Scholar
  • 19 WhatToExpect.com. Forgetfulness during pregnancy or Pregnancy Brain. Available at: http://www.whattoexpect.com/pregnancy/symptoms-and-solutions/forgetfulness.aspx . Accessed August 24, 2016
    PubMed
  • 20 Glynn LM. Increasing parity is associated with cumulative effects on memory. J Womens Health (Larchmt) 2012; 21 (10) 1038-1045
    CrossrefPubMedGoogle Scholar
  • 21 Sharp K, Brindle PM, Brown MW, Turner GM. Memory loss during pregnancy. Br J Obstet Gynaecol 1993; 100 (03) 209-215
    CrossrefPubMedGoogle Scholar
  • 22 Brussé I, Duvekot J, Jongerling J, Steegers E, De Koning I. Impaired maternal cognitive functioning after pregnancies complicated by severe pre-eclampsia: a pilot case-control study. Acta Obstet Gynecol Scand 2008; 87 (04) 408-412
    CrossrefPubMedGoogle Scholar
  • 23 de Groot RH, Vuurman EF, Hornstra G, Jolles J. Differences in cognitive performance during pregnancy and early motherhood. Psychol Med 2006; 36 (07) 1023-1032
    CrossrefPubMedGoogle Scholar
  • 24 de Groot RH, Hornstra G, Roozendaal N, Jolles J. Memory performance, but not information processing speed, may be reduced during early pregnancy. J Clin Exp Neuropsychol 2003; 25 (04) 482-488
    CrossrefPubMedGoogle Scholar
  • 25 Henry JD, Rendell PG. A review of the impact of pregnancy on memory function. J Clin Exp Neuropsychol 2007; 29 (08) 793-803
    CrossrefPubMedGoogle Scholar
  • 26 Keenan PA, Yaldoo DT, Stress ME, Fuerst DR, Ginsburg KA. Explicit memory in pregnant women. Am J Obstet Gynecol 1998; 179 (3 Pt 1): 731-737
    CrossrefPubMedGoogle Scholar
  • 27 Farrar D, Tuffnell D, Neill J, Scally A, Marshall K. Assessment of cognitive function across pregnancy using CANTAB: a longitudinal study. Brain Cogn 2014; 84 (01) 76-84
    CrossrefPubMedGoogle Scholar
  • 28 Hoekzema E, Barba-Müller E, Pozzobon C. , et al. Pregnancy leads to long-lasting changes in human brain structure. Nat Neurosci 2017; 20 (02) 287-296
    CrossrefPubMedGoogle Scholar
  • 29 Christensen H, Leach LS, Mackinnon A. Cognition in pregnancy and motherhood: prospective cohort study. Br J Psychiatry 2010; 196 (02) 126-132
    CrossrefPubMedGoogle Scholar
  • 30 Weiss BD, Mays MZ, Martz W. , et al. Quick assessment of literacy in primary care: the Newest Vital Sign. Ann Fam Med 2005; 3 (06) 514-522
    CrossrefPubMedGoogle Scholar
  • 31 Osborn CY, Weiss BD, Davis TC. , et al. Measuring adult literacy in health care: performance of the Newest Vital Sign. Am J Health Behav 2007; 31 (Suppl. 01) S36-S46
    CrossrefPubMedGoogle Scholar
  • 32 Grober E, Sliwinski M. Development and validation of a model for estimating premorbid verbal intelligence in the elderly. J Clin Exp Neuropsychol 1991; 13 (06) 933-949
    CrossrefPubMedGoogle Scholar
  • 33 Cherry KE, Park DC. Individual difference and contextual variables influence spatial memory in younger and older adults. Psychol Aging 1993; 8 (04) 517-526
    CrossrefPubMedGoogle Scholar
  • 34 Kluger A, Ferris SH, Golomb J, Mittelman MS, Reisberg B. Neuropsychological prediction of decline to dementia in nondemented elderly. J Geriatr Psychiatry Neurol 1999; 12 (04) 168-179
    CrossrefPubMedGoogle Scholar
  • 35 Salthouse TA. What do adult age differences in the Digit Symbol Substitution Test reflect?. J Gerontol 1992; 47 (03) 121-128
    PubMedGoogle Scholar
  • 36 Raven J. The Raven's Progressive Matrices: change and stability over culture and time. Cognit Psychol 2000; 41 (01) 1-48
    CrossrefPubMedGoogle Scholar
  • 37 Raven J. Standard Progressive Matrices: Sets A, B, C, D and E. San Antonio, TX: Harcourt Assessment; 1976
    Google Scholar
  • 38 Rowlands G. Health literacy and public health: a framework for developing skills and empowering citizens. Perspect Public Health 2012; 132 (01) 23-24
    CrossrefPubMedGoogle Scholar
  • 39 Nielsen-Bohlman L, Panzer AM, Kindig DA. Health Literacy: A Prescription to End Confusion. Washington, DC: The National Academies Press; 2004
    Google Scholar