A significant jump in preterm births to Latina mothers living in the U.S. occurred in the nine months following the November 8, 2016 election of President Donald Trump, according to a study led by a researcher at the Johns Hopkins Bloomberg School of Public Health.
The study, published July 19 in JAMA Network Open, was prompted by smaller studies that had suggested adverse, stress-related health effects among Latin Americans in the U.S. after the Trump election.
The new analysis, based on U.S. government data on more than 33 million live births in the country, found an excess of 2,337 preterm births to U.S. Latinas compared to what would have been expected given trends in preterm birth in the years prior to the election.
This is roughly 3.5 percent more preterm births than expected given projections from pre-election data.
Preterm birth, defined as birth before 37 weeks of gestation, is associated with a wide range of negative health consequences, from a greater risk of death in infancy to developmental problems later in life.
“The 2016 election, following campaign promises of mass deportation and the rollback of policies such as DACA, the Deferred Action for Childhood Arrivals program, may have adversely affected the health of Latinas and their newborns,” says study first author Alison Gemmill, Ph.D., MPH, assistant professor in the Department of Population, Family and Reproductive Health at the Bloomberg School.
Researchers know that stress in pregnant women can bring an elevated risk of preterm birth.
Prior studies also suggest that anti-immigrant policies or actions can stress immigrant women and/or make them less likely to seek prenatal care.
Moreover, although most Latinas living in the U.S. are citizens or otherwise documented immigrants and would not be directly threatened by tighter policies for undocumented immigrants, they are very likely to have close friends or family members who would be threatened by such policies.
The new study was prompted by a smaller study in 2018 by other researchers, who found a moderately elevated rate of preterm births to foreign-born Latina women in New York City from September 1, 2015 to July 31, 2016 compared to January 1, 2017 to August 31, 2017.
Gemmill and her colleagues decided to investigate this issue on a national level, using more rigorous methodology that would account, for example, for the slow rise in the national preterm rate that has been observed since 2014.
In their analysis, Gemmill and colleagues used a database from the Centers for Disease Control and Prevention that covers essentially all live births in the U.S. First, the researchers tracked preterm births to self-identified Latina women over the previous adminstration, January 2009 to October 2016.
They then used those data to generate an estimate of expected preterm births during the following nine months, from November 2016 to July 2017.
Next, the authors compared those expected numbers to the actual numbers of preterm births to Latina women during the nine months after the election.
The researchers found there were 1,342 preterm births of male infants above the expected number of 36,828, and 995 preterm births of female infants above the expected 30,687.
The analysis also revealed peaks in excess preterm births in February and July of 2017 for both male and female infants, which hints that infants conceived or in the second trimester of gestation at the time of the election may have been particularly vulnerable to maternal stress.
“We’ve known that government policies, even when they’re not health policies per se, can affect people’s health, but it’s remarkable that an election and the associated shift in presidential tone appears to have done so,” says Gemmill.
Gemmill and her colleagues suggest that future research should be done to determine more precisely the mechanisms by which policies and government messages can negatively affect population health outcomes.
Preterm birth (PTB), defined as birth before 37 completed weeks of gestation, is an important public health problem (CDC, 2013).
Significant and persistent racial disparities in PTB exist, such that it is the 2nd leading cause of infant mortality overall, but is the leading cause of infant death among African Americans (Martin et al., 2013).
While the reasons for this racial disparity are unknown, traditional biologic and behavioral risk factors do not account for the disproportionate burden of PTB among African Americans (Misra et al., 2017).
Researchers estimate that if every PTB occurring in an urban area occurred just one week later, 25 million dollars in initial hospital costs could be saved (Hall & Greenberg, 2016).
More research is warranted on specific exposures that increase the risk of PTB and are disproportionately experienced by African Americans, as this information could inform future interventions (Burris et al., 2016).
Stress is defined as the psycho-physiological outcome of any event that challenges an individual’s ability to cope (Shapiro et al., 2013).
Differential stress exposure may explain the increased risk for PTB among African American women, given their unique exposures to life-course stressors in the U.S. context (e.g., racism, discrimination, and neighborhood disadvantage) (Williams & Collins, 2001).
While there is growing evidence that stress during childhood increases risk for adverse birth outcomes, including complications of pregnancy and PTB (Smith et al., 2016, Hillis et al., 2004, Christiaens et al., 2015), existing studies have not had adequate sample size to conduct race-specific analyses or to examine potential effect heterogeneity by other social factors.
Evidence suggests that disproportionate exposure to adverse childhood experiences (or ACEs) may predispose African American women to poor birth outcomes (Lu et al., 2010), and that early-life neighborhoods impact the development of the stress response system (Theall et al., 2013).
For instance, stressors occurring in childhood have been shown to exacerbate stress responsivity during stressful experiences in adulthood (Kuras et al., 2017), and have been associated with significant antepartum and postpartum maternal stress development (Christiaens et al., 2015).
Further, childhood adversity predicts greater emotional reactivity to stress in adulthood (Shonkoff et al., 2012), which increases risk for inflammatory-based conditions and diseases (Lewis et al., 2010).
Importantly, inflammatory mechanisms have been causally linked to PTB (Romero et al., 2007).
Joint associations between current subjective neighborhood characteristics (social disorder, walkability, food availability, and safety) and educational attainment, on risk of PTB in African American women have been previously reported (Sealy-Jefferson et al., 2015).
To our knowledge, the joint association of early-life neighborhood and current perceived psychosocial stressors on PTB risk in African American women has not been quantified.
An examination of the joint association between stressors from different sources, including neighborhood contextual and psychosocial factors would increase our understanding of the etiology of PTB, among African Americans (Reagan and Salsberry, 2005, Pickett et al., 2002, Ahern et al., 2003).
To fill this gap in the literature, we used data from the Life-course Influences on Fetal Environments (LIFE) study to examine whether positive and negative aspects of early-life neighborhood context modify the association between perceived stress and PTB, among African American women.
Our research questions are based on the widely adopted integrated perinatal health framework (Misra, Guyer, & Allston, 2003), which emphasizes a life-course approach with a multiple determinants model, and prior work indicating that perceptions of positive and negative features of the current residential environment, are associated with PTB rates (Sealy-Jefferson et al., 2015).
We hypothesized that subjective measures of early-life neighborhood social disorder (defined as “visible cues indicating no order and lack of social control”) (Ross & Mirowsky, 2001) would magnify (potentially through the stress pathway), and early-life neighborhood social control (which refers to the enforcement of behavioral norms by community members) (Kramer, 2000) would buffer against the influence of current perceived psychological stress on PTB risk (potentially through behavioral mechanisms), among African American women.
More information: Alison Gemmill et al. Association of Preterm Births Among US Latina Women With the 2016 Presidential Election, JAMA Network Open (2019). DOI: 10.1001/jamanetworkopen.2019.7084
Journal information: JAMA Network Open
Provided by Johns Hopkins University Bloomberg School of Public Health
