Health Literacy and Its Determinants Among Pregnant Women in Portugal

Abstract Background Health literacy is a key determinant of health outcomes and equity, particularly during pregnancy, a period marked by increased information needs and critical health decisions. Despite its importance, data on health literacy among pregnant women in Portugal remain scarce. This study aimed to assess general health literacy levels and their associations with sociodemographic, health-related, and pregnancy-specific factors in a large sample of pregnant women from the district of Viseu, Portugal. Methods A cross-sectional study was conducted with 886 pregnant women aged 18 years or older, using the validated HLS19-Q12 instrument to measure general health literacy. Data collection occurred between October 2023 and May 2024 using a multimodal approach (online, interview, and paper-based). Health literacy was categorized into four levels and also dichotomized as limited versus not limited. Descriptive statistics, bivariate analyses, and binary logistic regression were performed to identify determinants of limited health literacy. Results The mean general health literacy score was 68.3 (SD ± 10.9). A total of 46.7% of participants were classified as having limited health literacy. Higher prevalence was observed among women aged 18–29, those born outside Portugal, with lower education, in undifferentiated professions, and facing financial hardship. In the final adjusted logistic regression model, significant predictors of limited health literacy included being born outside Portugal (adjusted OR 2.43; 95% CI: 1.56–3.80), having lower education (up to high school), holding lower-skilled occupations, financial difficulties, and rating current health as equal or worse. Body Mass Index prior to pregnancy was also associated with literacy levels. The model showed good discriminatory ability (area under the ROC curve = 0.78). Conclusions A considerable proportion of pregnant women demonstrated limited health literacy, especially among socioeconomically vulnerable groups. These findings highlight the need for literacy-sensitive prenatal care practices and targeted public health interventions that address both individual and structural determinants. Incorporating health literacy assessments and tailored communication strategies in antenatal care could support informed decision-making, promote equity, improve maternal and neonatal outcomes.