Secondary Logo

Institutional members access full text with Ovid®

Cohort Analysis of Immigrant Rhetoric on Timely and Regular Access of Prenatal Care

Chu, Derrick M., PhD; Aagaard, Joshua; Levitt, Ryan; Whitham, Megan, MD; Mastrobattista, Joan, MD; Rac, Martha, MD; Eppes, Catherine, MD; Gandhi, Manisha, MD; Belfort, Michael A., MD, PhD; Aagaard, Kjersti M., MD, PhD

doi: 10.1097/AOG.0000000000003023
Contents: Health Disparities: Original Research

OBJECTIVE: To assess whether recent anti-immigration rhetoric is significantly associated with inadequate prenatal care.

METHODS: This was a population-based cohort study (2011–2017). In their native language, patients were consented and queried regarding country of origin and time in the United States. Additional variables were collected or abstracted from the medical record, including documentation and timing of prenatal visits. Based on relevance and prevalence during the study period, publicly available Google search trends were mined for the terms “Make America Great Again,” “Mexico Wall,” and “Deportation” by geographic region. The time of first deviation from the mode Google search popularity value for each term was ascertained (mode inflection date). Perinatal data was averaged over 15 days moving windows, and the Adequacy of Prenatal Care Utilization Index was used to categorically define inadequate prenatal care by validated standards.

RESULTS: Twenty-four thousand nine hundred thirty-three deliveries occurred during the study period. A mode inflection date was extrapolated from Google trend analytics and used to define the period before change in trends use pre (before rhetoric) and post (after rhetoric). Coincident to the rhetoric change, there was a significant increase in days until the first prenatal visit, fewer prenatal visits, and a decreased trend of mean hemoglobin nadir among U.S. non-native Hispanic women (P<.001). Immigrant status was an independent predictor of inadequate prenatal care as defined by the Adequacy of Prenatal Care Utilization Index standard, with increased adjusted odds among Hispanic women (adjusted odds ratio 1.581, 95% CI 1.407–1.777 [1.4–1.8]) coincident with anti-immigration rhetoric.

CONCLUSION: Our findings are of likely significant public health importance and suggest that recent anti-immigrant rhetoric is associated with adequate, timely, and regular access to prenatal care among nearly 25,000 deliveries in Houston, Texas.

There is a temporal association between increased anti-immigrant political rhetoric and inadequate prenatal care among U.S. native and U.S. non-native gravidae.

Departments of Obstetrics & Gynecology, Divisions of Maternal-Fetal Medicine, Baylor College of Medicine & Texas Children’s Hospital, Houston, Texas; St. Olaf College, Northfield, Minnesota; the University of Texas at Austin, Austin, Texas; and the National School for Tropical Medicine at Baylor College of Medicine, and the Department of Molecular & Human Genetics at Baylor College of Medicine, Houston, Texas.

Corresponding author: Kjersti M. Aagaard, MD, PhD, Division of Maternal-Fetal Medicine, Department of Obstetrics & Gynecology, Baylor College of Medicine, 1709 Dryden Road, Suite 1100, Houston, TX 77030; email:

Supported by the Baylor College of Medicine Medical Scientist Training Program (Derrick M. Chu and Kjersti M. Aagaard, National Institute of Health HIGMS T32 GM007330), the National Institute of General Medical Sciences (Derrick M. Chu, T32GM088129), and the Baylor Research Advocates for Student Scientists (Derrick M. Chu).

Financial Disclosure The authors did not report any potential conflicts of interest.

Presented at the Society for Maternal-Fetal Medicine’s Annual Pregnancy Meeting, January 29–February 3, 2018, Dallas, Texas.

Each author has confirmed compliance with the journal's requirements for authorship.

Peer reviews and author correspondence are available at

© 2018 by the American College of Obstetricians and Gynecologists. Published by Wolters Kluwer Health, Inc. All rights reserved.