Maternal health literacy as a potential determinant of infant and early childhood health: a systematic review.

Background: Maternal health literacy (MHL) represents a potentially modifiable public health determinant concentrated among socioeconomically disadvantaged populations. While 15-45% of pregnant women demonstrate inadequate health literacy, its impact across the full spectrum of infant and early childhood outcomes remains inadequately characterized, limiting understanding of its broader public health significance. Objective: To systematically synthesize evidence on associations between MHL and infant/child health outcomes from birth through age three, and to examine whether MHL functions as a systemic determinant across outcome domains. Methods: Following PRISMA guidelines, we searched MEDLINE, Embase, and Web of Science from inception through March 2025. Studies examining associations between validated MHL measures and any child health outcomes up to age three were included. Methodological quality was assessed using JBI checklists, and the certainty of evidence using the GRADE framework. Narrative synthesis was conducted. Results: Eight studies ( Conclusion: MHL shows promising systematic associations with infant outcomes across multiple domains spanning the early life course, operating primarily through behavioral pathways requiring maternal agency. This pattern supports conceptualizing MHL as a potential foundational public health determinant and equity-relevant intervention target. However, low certainty of evidence underscores the need for standardized measurement, longitudinal studies, and intervention trials to establish causality.