Lab Notes #14: The In Utero Impact of Anti-Immigration Rhetoric

Sticks and stones may break our bones, but the costs of anti-immigrant rhetoric during the 2016 US presidential election were borne especially by pregnant Latinas, according to a new report. Alison Gemmill, PhD, of Johns Hopkins University, and her colleagues shared their findings in mid-July on the Journal of American Medical Association website (all sources cited below).

Children of mainly Latino immigrant parents march to the Madison County Courthouse in Canton, Miss. (Rogelio V. Solis/AP)

Gemmill and her group regarded the first 94 months of the Obama administration as a relatively peaceful, even constructive, period of immigration policy and enforcement for Latinas in the U.S. For their study, then, January 2008 through October 2016 represented the pre-stressor period. Using data from the Centers for Disease Control, researchers established counts of live births by demographic characteristics during this period and, in turn, modeled the number of preterm births to Latinas, from November 1, 2016, to July 31, 2017, as if it were a non-election year. 

Their study then evaluated “whether an acute environmental stressor coincides with changes in the characteristics of an exposed population.” The policy and regulatory environment promised by Donald J. Trump during the 2016 presidential campaign serves as the stressor. The exposed population includes expectant self-identified Latinas, and the characteristic of note is preterm birth (i.e., birth before 37 weeks’ gestation). 

“We observed approximately 3.2% to 3.6% more preterm births to Latina women above expected levels of preterm births had the election not occurred,” concluded Gemmill and her colleagues. In real numbers, that’s 2,337 more preterm infants born to Latina families in the study’s nine-month period. 

“Such an increase—if truly associated with the election—is not trivial,” note Diana Montoya-Williams, MD, of the University of Pennsylvania, and Elena Fuentes-Afflick, MD, of the University of California, San Francisco, in an accompanying commentary. “It might represent nearly $200 million in added expenses to our health care system in a single year.” 

The report by Gemmill and her colleagues elaborates the findings of earlier studies on the impact legislation and policing on neonatal health. In 2017, Nicole Novak, of the University of Michigan, and colleagues reported how, after a federal immigration raid, the newborns of Latina mothers in the region faced a 24% greater risk of low birth weight. (No greater risk was borne by newborns of non-Latina mothers in the region.) In a separate study, Catlin Patler, of the University of California, Davis, and colleagues found that the Deferred Action for Childhood Arrivals (DACA) program (est. 2012), “improved the well-being of recipients and their children in the first three years after the program’s introduction.” In 2015, media reports of the indeterminate future of the DACA program correlated with poorer self-ratings of health, cardiometabolic risk factors, and inflammation for Latino/a families. 

Such uncertainty may also affect the rates at which Latinas seek adequate prenatal care. “Future research should investigate these potential mechanisms to uncover how the threat of punitive immigration laws and enforcement negatively affect population health outcomes,” note Gemmill and her group, “especially for pregnant women and their children.” 

With the announcement of his candidacy in June 2015, Trump established illegal immigration as a cornerstone of his campaign with his first reference to immigrant rapists. Three weeks later, he said, “Tremendous infectious disease is pouring across the border.” On Independence Day, frontrunner Jeb Bush chided Trump: “To make these extraordinarily kind of ugly comments is not reflective of the Republican Party.” The New York Times bestseller list suggested otherwise. That same day, Ann Coulter’s Adios, America: The Left’s Plan to Turn Our Country into a Third World Hellhole (Simon & Schuster) tallied its third week on the Times’ top-10 list of nonfiction books. These events were closely intertwined. Trump received an advance copy of Adios, America, which Coulter released on June 1. Six of the book’s 17 chapters focus on immigrants and rape. Referring to Adios, America, David Frum later suggested that “no single writer has had such immediate impact on a presidential election since Harriet Beecher Stowe.”

Whether national origins affected the impact of these events on expectant mothers has yet to be determined. “Did recently arrived immigrants or immigrants from Mexico and Central America experience greater changes in preterm birth rates?,” ask Montoya-Williams and Fuentes-Afflick. “This is not known.” What is known, though, is that preterm babies face higher rates of infant mortality, feeding difficulties, cerebral palsy, and hearing and vision problems. 

After nearly 10 years of steady decline, the preterm birth rate in the US rose in 2017 to 9.93%: nearly a full percentage point higher than the average rate of other developed nations. The chronic stress of racism drives the 49% difference of preterm birth rates between Black American women and women of other races and ethnicities in the U.S., as well as the nearly 2% gap between preterm birth rates for the U.S. and Canada.

With uncertainty persisting at the U.S.-Mexico border, along with Trump’s latest sortie against Democratic politicians of color, thousands of children born to Latina mothers and African American mothers, respectively, may continue to bear the undue effects of our indelicate and imperfect union.

Sources
Frum, D. “America’s Immigration Challenge.” The Atlantic. December 11, 2015.

Gemmill, A et al., “Association of Preterm Births Among US Latina Women With the 2016 Presidential Election” JAMA Netw Open. 2019; 2(7):e197084. DOI:10.1001/jamanetworkopen.2019.7084

Hensch, M., “Jeb: Trump’s Mexico Talk ‘Extraordinarily Ugly.’” The Hill. 2015, July 4.  

Montoya-Williams, D and E Fuentes-Afflick, “Political Determinants of Population Health” JAMA Netw Open. 2019;2(7):e197063. DOI:10.1001 / jamanetworkopen.2019.7063.

Neate, R. and J. Tuckman. “Donald Trump: Mexican migrants bring ‘tremendous infectious disease’ to US.” The Guardian. 2015. July 6. 

Novak, N et al., “Change in Birth Outcomes Among Infants Born to Latina Mothers After a Major Immigration Raid” Intl Jnl of Epidemiology. 2017; 46(3): 839–849, DOI: 10.1093/ije/dyw346.

Patler, C et al., “Uncertainty About DACA May Undermine Its Positive Impact on Health for Recipients and Their Children.” Health Aff. 2019; 38(5):738-745,  DOI:10.1377/hlthaff.2018.05495.

Prakesh S., et al., “The Canadian Preterm Birth Network: A Study Protocol for Improving Outcomes for Preterm Infants and Their Families” CMAJ Open. 2018; 6(1): E44-E49, DOI: 10.9778/cmajo.20170128.

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