Associations of Objective Functional and Subjective Health Literacy with Reproductive Health Knowledge and Preconception Preparedness Among Pregnant Women in Hungary

Background/Objectives: Adequate reproductive health knowledge and preconception preparedness may support informed health-related decisions during pregnancy and before conception. Health literacy may influence the ability to access, understand, and use health information; however, its association with reproductive health knowledge and preconception preparedness among pregnant women remains insufficiently explored. This study assessed objective functional and subjective health literacy among pregnant women in Hungary and examined their associations with a composite measure of reproductive health knowledge and preconception preparedness after adjustment for sociodemographic and obstetric characteristics. Methods: This cross-sectional study included 346 pregnant women in Hungary. Objective functional and subjective health literacy were assessed using the Newest Vital Sign (NVS) and Brief Health Literacy Screening Tool (BRIEF), respectively. The primary outcome was a researcher-developed, non-validated composite measure comprising four theoretically distinct domains: nutrition and lifestyle knowledge during pregnancy, smoking-related knowledge, preconception preparedness, and knowledge of risks associated with advanced maternal and paternal age. Domain scores were standardised to a 0–100 scale and equally weighted. Associations were examined using chi-square tests, Kruskal–Wallis tests, analysis of variance, and hierarchical multiple linear regression. In the final model, BRIEF and NVS scores were entered simultaneously as continuous variables, with adjustment for age, educational attainment, residence, gestational age, parity, pregnancy planning, and financial situation. Results: Composite scores differed significantly across objective functional health literacy categories (F(2, 343) = 9.618; p < 0.001; η2 = 0.053), with higher scores observed among participants with adequate objective functional health literacy. Subjective health literacy was also associated with the composite score (F(2, 343) = 4.93; p = 0.008; η2 = 0.028). In the fully adjusted hierarchical regression model, objective functional health literacy was positively associated with the composite outcome ((B = 1.732; SE = 0.553; β = 0.271; p = 0.001), whereas subjective health literacy was not statistically significantly associated with the outcome (B = 0.244; SE = 0.203; β = 0.088; p = 0.227). The simultaneous addition of both health literacy measures increased explained variance by 7.7 percentage points (ΔR2 = 0.077; ΔF = 7.121; p = 0.003), with the final model explaining 15.1% of the variance. Conclusions: Objective functional health literacy was positively associated with the composite measure of reproductive health knowledge and preconception preparedness among pregnant women in Hungary, whereas subjective health literacy was not significantly associated with the outcome after simultaneous adjustment. The findings indicate that objective and subjective health literacy capture partly different aspects relevant to reproductive health-related knowledge and preparedness. Given the cross-sectional design and the non-validated, researcher-developed outcome measure, causal conclusions cannot be drawn. Further research using validated multidimensional instruments and longitudinal or intervention designs is warranted.