932: Words Matter: Measured Impact of Political Rhetoric on Timely & Regular Access of Prenatal Care Among Latino & Hispanic Women in Houston, Texas from 2011-2017

Abstract

Timely & regular access to prenatal care (PNC) is a long accepted global predictor of decreased maternal & infant morbidity and mortality. In the US, recent vital statistics data suggest a concerning increase in maternal mortality; Texas has the highest rate in the developed world. Given the high number of both undocumented and uninsured residents in Texas, we sought to determine if recent political rhetoric might be a contributing factor lending to diminished PNC and resultant maternal morbidity. IRB approved population-based cohort study (8/2011-7/2017). In their native language, subjects were consented & queried regarding country of origin, time in US, insurance, education and household income. Up to 4900 additional variables were abstracted including documentation of prenatal visits (PNV), antenatal and intrapartum care & lab values. Publicly available google search trends were mined for search terms “Make America Great Again”, “Mexico wall” and “Deportation” in the southern US. The time of first deviation from the mode google search popularity value for each term was ascertained (mode inflection). Perinatal data was averaged over 15 day moving windows to determine mean days from conception to 1st PNV, number of PNVs, and intrapartum nadir hemoglobin (Hgb) as a proxy for likely iron deficiency and/or PPH. Linear regression and Student's t-tests were used to determine linear trends and mean differences before and after mode inflection. 24,933 occurred during the study period. A mode inflection date of 7/1/2015 was extrapolated from the google search analytics (Fig 1A). Coincident with the mode inflection, there was a significant increase in days until first PNV, fewer PNVs and a decreased trend of mean Hgb nadir (Fig 1B). These observations were notably significant among gravidae of Central American and Mexican origin, but not South Americans (Fig 1C). Our findings are of likely significant public health importance, and suggest that recent political rhetoric alters timely and regular access to PNC among nearly 25,000 deliveries in Texas. We speculate that such rhetoric lends to delayed and diminished PNC in vulnerable populations, and may contribute to maternal mortality in our region. These observations are worth of future causal analysis.