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Obstetric and perinatal outcomes among immigrant and non-immigrant women in Berlin, Germany

  • Maternal-Fetal Medicine
  • Published:
Archives of Gynecology and Obstetrics Aims and scope Submit manuscript

Abstract

Background

In Germany, regular immigrants and their descendants have legal and financial access to health care equal to the general citizenry. Nonetheless, some of their health outcomes are comparatively unfavorable, and that is only partially explained by their lower socioeconomic status (SES). The aim of this study was to assess whether this disparity exists also for obstetric and perinatal outcomes.

Methods

We compared obstetric and perinatal outcomes between immigrant women (first or second generation) and non-immigrant women, delivering at three maternity hospitals in Berlin, Germany, 2011–2012. Multivariable logistic regression analysis was used to assess immigrant status and other possible risk factors for the baby being delivered preterm, small for gestational age (SGA), or transferred to neonatal care.

Results

The final database retained 6702 women, of whom 53.1% were first- or second-generation immigrants. First-generation Turkish immigrant women had significantly lower odds of preterm birth (OR 0.37, P < 0.001), SGA (OR 0.60, P = 0.0079), and transfer of the newborn to neonatal care (OR 0.61, P = 0.0034). Second-generation immigrant women had significantly lower odds of preterm birth (OR 0.67, P = 0.0049) or transfer of the newborn to neonatal care (OR 0.76, P = 0.0312). Moreover, women with education below university level, age 35+, or smokers had higher odds for poor outcomes.

Conclusions

This study provides strong evidence that health disparities for obstetric and perinatal health outcomes do not exist in immigrants relative to native Germans, but exist instead in women without post-secondary-level education compared to women with such education, regardless of ethnicity or migration history.

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Abbreviations

ANC:

Antenatal care

BMI:

Body mass index

GW:

Gestation week

OR:

Odds ratio

SGA:

Small for gestational age

95% CI:

95% confidence interval

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Acknowledgements

We would like to thank Michael Hanna, Ph.D., (Mercury Medical Research and Writing) for revising the manuscript after the initial journal review.

Author information

Authors and Affiliations

  1. Department of Gynecology, Charité University Medicine Berlin, Campus Virchow-Klinikum, Augustenburger Platz 1, 13353, Berlin, Germany

    Matthias David & Silke Brenne

  2. Alice Salomon University of Applied Sciences, Berlin, Germany

    Theda Borde

  3. Department of Obstetrics, Vivantes Klinikum Neukölln, Berlin, Germany

    Babett Ramsauer

  4. Department of Obstetrics, Charité University Medicine Berlin, Campus Virchow-Klinikum, Berlin, Germany

    Wolfgang Henrich

  5. Department of Obstetrics, Charité University Medicine Berlin, Campus Charité Mitte, Berlin, Germany

    Wolfgang Henrich

  6. Department of Epidemiology and International Public Health, School of Public Health, Bielefeld University, Bielefeld, Germany

    Jürgen Breckenkamp & Oliver Razum

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  1. Matthias David
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Contributions

MD and OR wrote the draft of the paper. MD and TB contributed to the study design and data interpretation. SB assisted with data collection, data interpretation, and revisions to the manuscript. JB and OR contributed to the data analysis and data interpretation. BR and WH assisted with data collection. All authors contributed to revisions to the manuscript.

Corresponding author

Correspondence to Matthias David.

Ethics declarations

Funding

Funding was provided by German Research Council (Deutsche Forschungsgemeinschaft, DFG), reference: DA 1199/2-1.

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical standards

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Human and animal rights statement

This article does not contain any studies with animals performed by any of the authors.

Informed consent

Informed consent was obtained from all individual participants included in the study.

Appendices

Appendix 1

See Table 6.

Table 6 Countries of origin of first-generation migrants
Full size table

Appendix 2

See Table 7.

Table 7 Countries of origin of the parents of second-generation migrants
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Appendix 3

See Tables 8, 9, and 10.

Table 8 Alternative presentations of the analyses in Table 3, initial crude (unadjusted) regression model
Full size table
Table 9 Alternative presentations of the analyses in Table 3, abbreviated presentation of the final model
Full size table
Table 10 Alternative presentations of the analyses in Table 3, models for nullipara and multipara women separately
Full size table

Appendix 4

See Tables 11, 12, and 13.

Table 11 Alternative presentations of the analyses in Table 4, initial crude (unadjusted) regression model
Full size table
Table 12 Alternative presentations of the analyses in Table 4, abbreviated presentation of the final model
Full size table
Table 13 Alternative presentations of the analyses in Table 4, models for nullipara and multipara women separately
Full size table

Appendix 5

See Tables 14, 15, and 16.

Table 14 Alternative presentations of the analyses in Table 5, initial crude (unadjusted) regression model
Full size table
Table 15 Alternative presentations of the analyses in Table 5, abbreviated presentation of the final model
Full size table
Table 16 Alternative presentations of the analyses in Table 5, models for nullipara and multipara women separately
Full size table

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David, M., Borde, T., Brenne, S. et al. Obstetric and perinatal outcomes among immigrant and non-immigrant women in Berlin, Germany. Arch Gynecol Obstet 296, 745–762 (2017). https://doi.org/10.1007/s00404-017-4450-5

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