Self-efficacy and antenatal depression mediate the relationship between third-trimester maternal health literacy and adverse pregnancy outcomes

Vollständiger Abstract

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Abstract This study aims to investigate the mechanisms through which maternal health literacy (MHL) influences adverse pregnancy outcomes (APOs), and to examine the mediating roles of self-efficacy (SE) and pre-pregnancy depression (AD) within this relationship for the first time. This cross-sectional survey recruited 322 pregnant women in the third trimester using a two-stage sampling method. Standardized instruments were used to collect data, including the Edinburgh Postnatal Depression Scale (EPDS), the MHL questionnaire, the General Self-Efficacy Scale (GSES), as well as self-reported information on demographic characteristics and indicators of APOs. Structural equation modeling (SEM) was applied to analyze the relationships and mediating pathways among the variables. Statistical significance was set at a P-value of 0.05. The incidence of APOs was 57.45%, while only 4.04% of the participants met the criteria for MHL. SEM revealed that MHL exerted a direct effect on APOs (β = -0.122, p < 0.01) and also indirectly influenced APOs through the mediating roles of SE and AD, with an indirect effect of -0.070, jointly explaining 36.46% of the association between MHL and APOs. Additionally, SE had a direct effect on APOs (β = -0.147, p < 0.01) and indirectly influenced APOs through AD, with an indirect effect of -0.046, accounting for 17.90% of the total effect. In contrast, AD had only a direct effect on APOs (β = 0.181, p < 0.01). MHL has the potential to mitigate the risk of APOs by enhancing SE and alleviating AD. These findings substantiate the theoretical pathway of “health literacy - psychological factors - pregnancy outcomes”. A multi-dimensional intervention system combining MHL promotion, SE training, and AD screening is recommended for more targeted and effective APO prevention and management.