Latino Health Disparities Start Before Birth

It’s party time in the lobby of an AltaMed obstetrical clinic in Central Santa Ana, where pregnant women in their third trimester have gathered for a combination health class and baby shower.

Amid cupcakes and streamers, the women are briefed in Spanish on the importance of dental care during pregnancy and the advantages of breastfeeding. A hospital rep promises diaper giveaways to the moms-to-be delivering at her facility.

Chances are the deliveries will go smoothly, particularly among the patients from Mexico. Data show the rates of infant mortality and birth complications such as preterm delivery and low birth weight are low among Mexican-born women in the U.S.

It’s one more facet of the immigrant health paradox, a medical theory stating that low-income immigrants arrive in the U.S. in good health, often better than that of the overall population.

Orange County seems to be consistent with that pattern. The county’s Latina mothers fare better than their white counterparts in key indicators of healthy birth. In fact, the city with the highest rate of underweight newborns -- 8.8 percent -- is affluent Newport Beach.

But over time immigrants experience a decline in their physical well-being on a number of measures, including birth outcomes, despite gains in earning and in some cases access to medical care. This decline continues into the next generation, sometimes resulting in key health disparities between white and Latino populations.

Next Generation Pregnancy

It’s a decline well known to Pam Pimentel, CEO of Moms Orange County, a prenatal assistance organization serving low-income pregnant women and mothers of newborns.

“We think of the first generation as those who immigrated. The next generation is far more at risk, far more at risk. You see it all the time,” Pimentel said.

As Latina birth outcomes worsen, they fall more in line with standards in the U.S., where one of nine births is preterm, part of a trend toward babies being born sooner and smaller and facing greater health problems as a result.

“People born here become Americans. In America, we have done a good job of making sure pregnant women receive prenatal care and have access to it,” she said. But access to doctors isn’t always the sole key to good pregnancy health, she said.

“The reason we see our birth outcomes worsening in the U.S. has nothing to do with medical care. It’s obesity, diabetes and hypertension. Those are the three things that are the direct result of lifestyle,” she said. Mexican-born women are also less likely to drink alcohol and smoke during pregnancy than their American-born counterparts.

Other lifestyle patterns putting pregnancies at greater risk are “working two jobs and missing doctors’ appointments, not getting enough rest, eating fast food,” Pimentel said.

Remedies are not always complicated, she said. “It’s exercise, eating a fruit and vegetables every day, getting off their feet for a little while, not overfilling your bladder [which is linked to early contractions]. … Some of the moms we serve have jobs where they can’t take a bathroom break. There are still jobs like that.”

The immediate problems associated with babies being delivered too early or underweight — that is, less than 5 pounds, 8 ounces — are their vulnerability to developmental setbacks in learning, vision and respiratory function. Preterm births are the leading cause of long-term neurological difficulties and are linked to 35 percent of infant deaths. And the medical costs of preterm, underweight infants are high.

Additional Consequences

Looking beyond these developmental problems, scientists are investigating how the conditions of pregnancy have additional long-term impacts. A growing body of research, epigenetics, focuses on the influence of the mother’s lifestyle on the developing fetus’ genetic expression, that is, the way that genes function for the rest of the infant’s life.

“We know that embryos and fetuses do not develop in a vacuum; the fetus gets input from its environment,” said Dr. Pathik Wadhwa, an epidemiologist and physician at UC Irvine who leads an international team of researchers investigating the connection between social environment during pregnancy and lifelong health.

Specifically, research is showing a link between the poor diet and serious stress associated with poverty to a lifelong metabolism that is prone to obesity and chronic conditions like diabetes and asthma, he said.

So a pregnant woman who is food-deprived or eating heavily but not getting needed nutrients and is also highly stressed may pass these stresses on to her fetus. The fetus, in turn, might respond to this environment by programming its own cells for weight retention to compensate.

Such a development is known is scientific circles as a “thrifty phenotype,” that is, a predisposition to hold onto calories in response to the stresses and possible malnourishment experienced in pregnancy.

While any pregnant woman can experience stress, the challenges of low-income life can make everyday living particularly stressful. For example, low-income patients at an AltaMed clinic in Santa Ana consistently rate transportation to doctor’s offices among their key challenges to good prenatal health care, according to clinic surveys.

Another source of stress unique to Orange County’s lower-income communities is living in highly congested apartments shared by numerous families and sometimes strangers.

Stress is high in crowded apartments, because children are living in the company of strangers, and because increased mold and viruses trigger asthma flare-ups and make other sicknesses more likely. A recent study noted that 25,908 school children in Orange County are living doubled-up or tripled-up in their homes, compared with 926 in hotels or motels and 106 in shelters.

Taking Steps

Despite the stresses of poor housing and lack of transportation, low-income pregnant women who can maintain a healthy diet can improve delivery and maybe even their baby’s lifelong health, according to Samar McGregor, senior nutritionist at the Special Supplemental Nutrition Program for Women, Infants, and Children or WIC.

The program subsidizes healthful foods for pregnant women and young children, and the agency also teaches clients about the importance of breastfeeding as a long-term health strategy.

In addition to passing on a mother’s immunities to help infants ward off disease, breastfeeding has been linked to a reduction in obesity and diabetes later in an infant’s life, McGregor said.

Experts believe breastfeeding is more nutritious and less expensive than formula and it fosters better eating habits in the long term by allowing infants to eat according to hunger rather than finish a full serving of formula.

“Babies that are breastfed know when to stop eating,” McGregor said. “Breastfeeding is the first line of defense against the likelihood of obesity.”

Jennifer’s Story

Jennifer Vasquez, 22, said she is “100 percent for breastfeeding now” after learning about its merits in her prenatal health classes. Now in her third trimester, Vasquez attended a recent baby shower for pregnant women at an AltaMed clinic in Santa Ana.

Vasquez is young and healthy with no diabetes in the family, but she’s well aware that gestational diabetes can set in during pregnancy and complicate birth. That has given her more reason to avoid fast food, she said. She’s been trying to improve her health in order to avoid preterm delivery, which she knows is under less than 37 weeks.

Before becoming pregnant, she said, she had little regard for vegetables and harbored a special disdain for carrots. “I never touched them,” she said, “but ever since I got pregnant, I’m cleaning up my diet.”

If being better informed about her pregnancy offers any peace of mind to Vasquez, then her classes may have gone a long way toward promoting her baby’s health. The reason is that stress reduction during pregnancy might have long-term health benefits to infants, scientists now believe. Luckily for Vasquez and her baby, “I’m more excited than stressed,” she said.

Amy DePaul’s reporting on immigrant health was undertaken as part of the California Endowment Health Journalism Fellowship, a program of USC’s Annenberg School for Communication & Journalism. You can reach her directly at depaula@uci.edu.

This story was originally published on October 2, 2013, by the Voice of OC.