Host-interferon-stimulated gene response to virus-host recombinant variants of hepatitis E virus and enhanced viral replication.

Health literacy is a critical determinant of health outcomes [-], particularly for pregnant women who require adequate knowledge, motivation, and skills to access, understand, and apply health information [-]. Health literacy is defined as “the degree to which individuals have the capacity to obtain, process, and understand basic health information” to make health decisions []. In the pregnancy context, this construct operates through functional (reading or understanding information), interactive (provider communication), and critical (analytical, informed decision-making) levels [,]. Pregnant women have an increased need for adequate health literacy levels [,]. Despite the abundance of health information available during pregnancy, the prevalence of low health literacy among pregnant women remains concerning at 15%-44% [] with direct implications for health behaviors such as physical activity [], and prenatal care adherence []. This can negatively impact both maternal and fetal outcomes []. Low health literacy creates cascading effects throughout pregnancy care []—delayed prenatal care [,], poor comprehension of medical information [,], anxiety to ask questions [] or after test results [], and suboptimal postpartum behaviors such as reduced breastfeeding initiation [-]. These literacy challenges disproportionately affect racial and ethnic minorities, individuals with lower education and income, and nonnative English speakers [,] which contributes to maternal and neonatal health disparities [,]. Two psychological factors play a central role in shaping pregnancy health literacy—emotions and feelings of support. Pregnancy involves profound physiological and psychological changes [] that can influence how women engage with health information. Evidence suggests a bidirectional relationship between emotions and health literacy. For example, pregnancy stress negatively predicts health literacy, which in turn moderates depression risk []. In addition, emotions may shape health behaviors during pregnancy [-].