1
|
Ludwig A, Miani C, Breckenkamp J, Sauzet O, Borde T, Doyle IM, Brenne S, Höller-Holtrichter C, David M, Spallek J, Razum O. Are Social Status and Migration Background Associated with Utilization of Non-medical Antenatal Care? Analyses from Two German Studies. Matern Child Health J 2021; 24:943-952. [PMID: 32388767 PMCID: PMC7261266 DOI: 10.1007/s10995-020-02937-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OBJECTIVE Non-medical antenatal care (ANC) refers to a range of non-medical services available to women during pregnancy aiming at supporting women and prepare them for the birth and the postpartum period. In Germany, they include antenatal classes, breastfeeding classes and pregnancy-specific yoga or gymnastics courses. Studies suggest that various types of non-medical ANC carry benefits for both the women and their babies. Little is known about the uptake of non-medical ANC among different socioeconomic population subgroups, but one may expect lower utilization among socio-economically disadvantaged women. We analyzed factors contributing to the utilization of non-medical ANC in general and antenatal classes in particular. METHODS Baseline data of the Bielefeld BaBi birth cohort (2013-2016) and the Berlin perinatal study (2011-2012) were analyzed. Comparing the two cohorts allowed to increase the socio-economic and migration background variance of the study population and to capture the effect of the local context on uptake of services. Multivariate logistic regression analyses were performed to study associations between the uptake of non-medical ANC and socio-economic and migration status. RESULTS In Berlin and Bielefeld, being a first generation migrant and having lower levels of education were associated with lower non-medical ANC uptake. In Berlin, being a 2nd generation woman or having a low income was also associated with lower uptake. CONCLUSIONS FOR PRACTICE Our study suggests that non-medical ANC remains in some part the prerogative of non-migrant, well-educated and economically privileged women. Since differences in non-medical ANC have the potential to create inequalities in terms of birth outcomes and maternal health during pregnancy and post-partum, more efforts are needed to promote the use of non-medical ANC by all population groups.
Collapse
Affiliation(s)
- Angelique Ludwig
- Department of Epidemiology & International Public Health, School of Public Health, Bielefeld University, Bielefeld, Germany. .,Center for Innovation in Health Economics (ZIG OWL), Bielefeld, Germany.
| | - Céline Miani
- Department of Epidemiology & International Public Health, School of Public Health, Bielefeld University, Bielefeld, Germany
| | - Jürgen Breckenkamp
- Department of Epidemiology & International Public Health, School of Public Health, Bielefeld University, Bielefeld, Germany
| | - Odile Sauzet
- Department of Epidemiology & International Public Health, School of Public Health, Bielefeld University, Bielefeld, Germany.,Centre for Statistics, Bielefeld University, Bielefeld, Germany
| | - Theda Borde
- Alice Salomon Hochschule Berlin, University of Applied Sciences, Berlin, Germany
| | - Ina-Merle Doyle
- Institute for General Practice, Hannover Medical School, Hannover, Germany
| | - Silke Brenne
- Institute of General Practice, Medical Faculty, Otto-Von-Guericke-University, Magdeburg, Germany
| | - Chantal Höller-Holtrichter
- Department of Epidemiology & International Public Health, School of Public Health, Bielefeld University, Bielefeld, Germany
| | - Matthias David
- Clinic for Gynaecology, Charité University Medicine Berlin, Campus Virchow-Klinikum, Berlin, Germany
| | - Jacob Spallek
- Department of Public Health, Brandenburg University of Technology, Senftenberg, Germany
| | - Oliver Razum
- Department of Epidemiology & International Public Health, School of Public Health, Bielefeld University, Bielefeld, Germany
| |
Collapse
|
2
|
Kanatoula DD, Brenne S, David M. Wie beeinflusst der Akkulturationsgrad Stillabsicht, Stillhäufigkeit und Stilldauer bei Migrantinnen? Ein Review der Publikationen der Jahre 2014–2018. Z Geburtshilfe Neonatol 2019; 223:271-279. [DOI: 10.1055/a-0821-6070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
ZusammenfassungDas Stillverhalten von Frauen wird durch soziale, demografische und kulturelle Faktoren beeinflusst. Wenig ist darüber bekannt, welchen Einfluss Migration und Akkulturation darauf haben. Es wurden eine systematische Suche in den elektronischen Datenbanken LIVIVO und MEDLINE (PubMed) und eine manuelle Suche in den Literaturverzeichnissen aller ausgewählter Artikel durchgeführt. Eingeschlossen wurden englisch- und deutschsprachige quantitative Studien aus Industrieländern, die im Zeitraum vom 01.01.2014 bis 30.05.2018 publiziert wurden. Insgesamt konnten 77 Studien identifiziert werden, von denen 17 die Einschlusskriterien erfüllten. Tendenziell zeigte sich eine höhere Stillprävalenz für Migrantinnen als für einheimische Mütter, mit Ausnahme für Migrantinnen aus Südostasien. Eine längere Stilldauer wiesen Migrantinnen in Südeuropa, Irland und Taiwan auf und eine kürzere Migrantinnen in Kanada und Mütter nicht-skandinavischer Herkunft in Nordeuropa. Tendenziell zeigte sich auch ein stillhemmender Einfluss einer zunehmenden Akkulturation auf das Stillverhalten der Frauen mit Migrationshintergrund.
Collapse
Affiliation(s)
| | - Silke Brenne
- Institut für Allgemeinmedizin, Medizinische Fakultät, Otto-von-Guericke-Universität Magdeburg, Magdeburg
| | - Matthias David
- Gynäkologie, Campus Virchow-Klinikum, Carité – Universitätsmedizin Berlin, Berlin
| |
Collapse
|
3
|
Zolitschka KA, Miani C, Breckenkamp J, Brenne S, Borde T, David M, Razum O. Do social factors and country of origin contribute towards explaining a "Latina paradox" among immigrant women giving birth in Germany? BMC Public Health 2019; 19:181. [PMID: 30755186 PMCID: PMC6373125 DOI: 10.1186/s12889-019-6523-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2018] [Accepted: 02/08/2019] [Indexed: 11/12/2022] Open
Abstract
Background The “Latina paradox” describes the unexpected association between immigrant status, which is often correlated to low socioeconomic status, and low prevalence of unfavourable birth outcomes. Social (e.g. culture, religion) and/or non-social factors related to country of origin are potentially responsible for this paradox. Methods Questionnaire survey of 6413 women delivering in three large obstetric hospitals in Berlin (Germany) covering socioeconomic and migration status, country of origin (Turkey, Lebanon), and acculturation. Data was linked with routine obstetric data. Logistic regressions were performed to assess the effect of acculturation, affinity to religion and country of origin on preterm birth and small-for-gestational-age (SGA). Results Immigrant women with a low level of acculturation (reference) were less likely to have a preterm birth than those who were highly acculturated (aOR: 1.62, 95%CI: 1.01–2.59), as were women from Turkey compared to non-immigrants (aOR: 0.49, 95%CI: 0.33–0.73). For SGA, we found no epidemiologic paradox; conversely, women from Lebanon had a higher chance (aOR: 1.72, 95%CI: 1.27–2.34) of SGA. Affinity to religion had no influence on birth outcomes. Conclusions There is evidence that low acculturation (but not affinity to religion) contributes towards explaining the epidemiologic paradox with regard to preterm birth, emphasising the influence of socioeconomic characteristics on birth outcomes. The influence of Turkish origin on preterm birth and Lebanese origin on SGA suggests that non-social factors relating to the country of origin are also at play in explaining birth outcome differences, and that the direction of the effect varies depending on the country of origin and the outcome. Electronic supplementary material The online version of this article (10.1186/s12889-019-6523-9) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Kim Alexandra Zolitschka
- Department of Epidemiology and International Public Health, School of Public Health, Bielefeld University, Bielefeld, Germany.
| | - Céline Miani
- Department of Epidemiology and International Public Health, School of Public Health, Bielefeld University, Bielefeld, Germany
| | - Jürgen Breckenkamp
- Department of Epidemiology and International Public Health, School of Public Health, Bielefeld University, Bielefeld, Germany
| | - Silke Brenne
- Department of Gynaecology, Campus Virchow-Klinikum, Charité-Universitätsmedizin Berlin, Berlin, Germany.,Alice Salomon Hochschule, Berlin, Germany
| | | | - Matthias David
- Department of Gynaecology, Campus Virchow-Klinikum, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Oliver Razum
- Department of Epidemiology and International Public Health, School of Public Health, Bielefeld University, Bielefeld, Germany
| |
Collapse
|
4
|
Breckenkamp J, Läcke EM, Henrich W, Borde T, Brenne S, David M, Razum O. Advanced cervical dilatation as a predictor for low emergency cesarean delivery: a comparison between migrant and non-migrant Primiparae - secondary analysis in Berlin, Germany. BMC Pregnancy Childbirth 2019; 19:1. [PMID: 30606156 PMCID: PMC6318868 DOI: 10.1186/s12884-018-2145-y] [Citation(s) in RCA: 94] [Impact Index Per Article: 18.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2018] [Accepted: 12/12/2018] [Indexed: 02/07/2023] Open
Abstract
Background Cesarean rates are higher in women admitted to labor ward during early stages rather than at later stages of labor. In a study in Germany, crude cesarean rates among Turkish and Lebanese immigrant women were low compared to non-immigrant women. We evaluated whether these immigrant women were admitted during later stages of labor, and if so, whether this explains their lower cesarean rates. Methods We enrolled 1413 nulliparous women with vertex pregnancies, singleton birth, and 37+ week of gestation, excluding elective cesarean deliveries, in three Berlin obstetric hospitals. We applied binary logistic regression to adjust for social and obstetric factors; and standardized coefficients to rank predictors derived from the regression model. Results At the time of admission to labor ward, a smaller proportion of Turkish migrant women was in the active phase of labor (cervical dilation: 4+ cm), compared to women of Lebanese origin and non-immigrant women. Rates of cesarean deliveries were lower in women of Turkish and Lebanese origin (15.8 and 13.9%) than in non-immigrant women (23.9%). In the logistic regression analysis, more advanced cervical dilatation was inversely associated with the outcome cesarean delivery (OR: 0.76, 95%CI: 0.70–0.82). In addition, higher maternal age (OR: 1.06, 95%CI: 1.04–1.09), application of oxytocic agents (OR: 0.55, 95%CI: 0.42–0.72), and obesity (OR: 2.25, 95%CI: 1.51–3.34) were associated with the outcome. Ranking of predictors indicate that cervical dilatation is the most relevant predictor derived from the regression model. Conclusions Advanced cervical dilatation at the time of admission to labor ward does not explain lower emergency cesarean delivery rates in Turkish and Lebanese migrant women, despite the fact that this is the strongest among the predictors for emergency cesarean delivery identified in this study.
Collapse
Affiliation(s)
- Jürgen Breckenkamp
- School of Public Health, Department of Epidemiology & International Public Health, Bielefeld University, Bielefeld, Germany.
| | - Eileen Marie Läcke
- School of Public Health, Department of Epidemiology & International Public Health, Bielefeld University, Bielefeld, Germany
| | - Wolfgang Henrich
- Obstetrics Clinics, Charité University Medicine Berlin, Campus Virchow-Klinikum and Mitte, Berlin, Germany
| | - Theda Borde
- Alice Salomon Hochschule Berlin, University of Applied Sciences, Berlin, Germany
| | - Silke Brenne
- Clinic for Gynaecology, Charité University Medicine Berlin, Campus Virchow-Klinikum, Berlin, Germany.,Institute of General Medicine, Medical Faculty, Otto-von-Guericke-University Magdeburg, Magdeburg, Germany
| | - Matthias David
- Clinic for Gynaecology, Charité University Medicine Berlin, Campus Virchow-Klinikum, Berlin, Germany
| | - Oliver Razum
- School of Public Health, Department of Epidemiology & International Public Health, Bielefeld University, Bielefeld, Germany
| |
Collapse
|
5
|
Brenne S, Breckenkamp J, David M, Borde T, Razum O. [Influence of a Migration Background on the Implementation of Breastfeeding and Premature Weaning]. Z Geburtshilfe Neonatol 2018; 222:254-261. [PMID: 29969795 DOI: 10.1055/a-0641-6388] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
QUESTIONS Current studies on breastfeeding behavior that adequately consider migration aspects are not available from Germany. The following research questions should be answered with the help of a prospective study: What factors influence the probability of (premature) weaning and actual breastfeeding duration? What roles do migration background (MB) and generation play? Do observed effects persist after controlling for education, parity, etc.? PATIENT COHORT AND METHODOLOGY In a one-year study in 3 Berlin maternity hospitals, women were interviewed on socio-demografic details and migration aspects on admission to the delivery room. On the 2nd / 3rd day postpartum, another standardized interview was conducted that included questions on the beginning of breastfeeding and planned breastfeeding period. Six months postpartum, a sub-cohort was interviewed by telephone or other means about the actual breastfeeding period. Nursing behavior was analyzed using multivariate regression models. A Cox regression was used to analyze actual breastfeeding duration and possible influencing factors. RESULTS The pre-partum group included 7,100 women (57.9% with a migrant background), 6,884 women were interviewed on the maternity ward, and 605 women were in the sub-cohort questioned six months postpartum. 55.9% of first-generation migrant women, 32.9% of 2nd / 3rd-generation migrant women, and 52.9% of women with no MB were still breastfeeding 6 months postpartum (p<0.001). In the adjusted regression model, women with a migrant background were more likely to start breastfeeding than women with no MB. Cox's regression analysis examined the likelihood of breastfeeding within 6 months: The adjusted model showed no effect of migration status. CONCLUSION The migration background factor has only a small influence on breastfeeding behavior. Possible differences should take the migration generation into account.
Collapse
Affiliation(s)
- Silke Brenne
- Medizinische Fakultät, Institut für Allgemeinmedizin, Otto-von-Guericke-Universität Magdeburg, Magdeburg.,Klinik für Gynäkologie, Charité, Campus Virchow-Klinikum, Berlin
| | - Jürgen Breckenkamp
- Fakultät für Gesundheitswissenschaften / AG 3 Epidemiologie & International Public Health, Universität Bielefeld, Bielefeld
| | - Matthias David
- Klinik für Gynäkologie, Charité, Campus Virchow-Klinikum, Berlin
| | - Theda Borde
- Alice Salomon Hochschule Berlin, Public Health, Berlin
| | - Oliver Razum
- Fakultät für Gesundheitswissenschaften / AG 3 Epidemiologie & International Public Health, Universität Bielefeld, Bielefeld
| |
Collapse
|
6
|
Brenne S, Breckenkamp J, Borde T, David M, Razum O. Does the Degree of Acculturation Influence Breastfeeding Intention and Start or the Frequency of Early Weaning? Results of a Prospective Observational Study. Geburtshilfe Frauenheilkd 2018; 78:596-604. [PMID: 29962518 PMCID: PMC6018070 DOI: 10.1055/a-0601-6873] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2018] [Accepted: 04/05/2018] [Indexed: 10/28/2022] Open
Abstract
Objectives Recent breastfeeding studies from immigration countries have found that acculturation factors influence breastfeeding behaviour in women with a migration background. To date, there has been no systematic investigation for Germany. Therefore, we study whether and how the degree of acculturation within a population of migrant women influences the start, time and duration of breastfeeding. Patient Population and Methodology Pregnant women who were admitted to one of the three participating maternity clinics in Berlin for the birth of their child in the one-year study period were surveyed (including sociodemographic details, data on migration/acculturation). These women were interviewed again two or three days post partum (including start of breastfeeding, planned breastfeeding duration, reasons for not breastfeeding). In a subgroup, a telephone interview took place 6 months post partum about the actual breastfeeding duration, contraceptive behaviour post partum and availing of midwife services following delivery. Breastfeeding behaviour was analysed using multivariate regression models, among other things. Results The prepartum survey included 7100 women, 6884 women were contacted in the postnatal wards, and the subgroup six months after delivery comprised 605 women. No acculturation-related differences were found in the start of breastfeeding. In the adjusted model, a medium and higher degree of acculturation diminished the chance of planning a long breastfeeding period. More acculturated women show a greater risk of weaning within the first six months than less acculturated women. Conclusion The degree of acculturation has relevant significance for some aspects of breastfeeding behaviour in women with a migration background. This should be considered both in breastfeeding promotion programmes and in further national breastfeeding studies.
Collapse
Affiliation(s)
- Silke Brenne
- Otto-von-Guericke-Universität Magdeburg, Medizinische Fakultät, Institut für Allgemeinmedizin, Magdeburg, Germany.,Charité - Universitätsmedizin Berlin, Klinik für Gynäkologie, Campus Virchow-Klinikum, Berlin, Germany
| | - Jürgen Breckenkamp
- Universität Bielefeld, Fakultät für Gesundheitswissenschaften, AG 3 - Epidemiologie & International Public Health, Bielefeld, Germany
| | | | - Matthias David
- Charité - Universitätsmedizin Berlin, Klinik für Gynäkologie, Campus Virchow-Klinikum, Berlin, Germany
| | - Oliver Razum
- Universität Bielefeld, Fakultät für Gesundheitswissenschaften, AG 3 - Epidemiologie & International Public Health, Bielefeld, Germany
| |
Collapse
|
7
|
Razum O, Reiss K, Breckenkamp J, Kaufner L, Brenne S, Bozorgmehr K, Borde T, David M. Comparing provision and appropriateness of health care between immigrants and non-immigrants in Germany using the example of neuraxial anaesthesia during labour: cross-sectional study. BMJ Open 2017; 7:e015913. [PMID: 28827247 PMCID: PMC5629712 DOI: 10.1136/bmjopen-2017-015913] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
OBJECTIVE Research on health services for immigrants has mostly been concerned with access barriers but rarely with appropriateness and responsiveness of care. We assessed whether appropriateness and responsiveness of care depend on migration status, using provision of neuraxial anaesthesia (NA) during labour as indicator. In relation to their migration status, we analysed whether (1) women undergoing elective or secondary/urgent secondary caesarean sections (ESCS) appropriately receive NA (instead of general anaesthesia), (2) women delivering vaginally appropriately receive NA and (3) women objecting to NA, for example, for religious reasons, may deliver vaginally without receiving NA (provider responsiveness). DESIGN Cross-sectional study. SETTING Three obstetric hospitals in Berlin, Germany. METHODS Questionnaire survey covering 6391 women with migration history (first and second generations) and non-immigrant women giving birth; data linkage with routine obstetric data. We assessed the effects of migrant status, German language proficiency, religion and education on the provision of NA (primary outcome) after adjusting for other maternal and obstetric parameters. RESULTS The chance of receiving NA for elective/ESCS was independent of migrant status after controlling for confounding variables (adjusted OR (aOR) 0.93, 95% CI 0.65 to 1.33). In vaginal deliveries, first (but not second) generation women (aOR 0.79, 95% CI 0.65 to 0.95), women with low German language skills (aOR 0.77, 95% CI 0.58 to 0.99) and women with low educational attainment (aOR 0.62, 95% CI 0.47 to 0.82) had lower chances of receiving NA; there was no evidence of overprovision among women with strong affinity to Islam (aOR 0.77, 95% CI 0.63 to 0.94). CONCLUSIONS We found evidence for underprovision of care among first-generation immigrants, among women with low German language proficiency and particularly among all women with low educational attainment, irrespective of migration status. There was no evidence for overprovision of care to immigrant women, either inappropriately (general anaesthesia for ESCS) or because of low provider responsiveness (no opt-out for NA in vaginal delivery).
Collapse
Affiliation(s)
- Oliver Razum
- Department of Epidemiology and International Public Health, Bielefeld University, Bielefeld, Germany
| | - Katharina Reiss
- Department of Epidemiology and International Public Health, Bielefeld University, Bielefeld, Germany
- Healthy Start - Young Family Network, Federal Centre for Nutrition at Federal Office for Agriculture and Food, Bonn, Germany
| | - Jürgen Breckenkamp
- Department of Epidemiology and International Public Health, Bielefeld University, Bielefeld, Germany
| | - Lutz Kaufner
- Department of Anaesthesiology and Operative Intensive Care Medicine (CCM, CVK), Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Silke Brenne
- Department of Gynaecology, Campus Virchow-Klinikum, Charité-Universitätsmedizin Berlin, Berlin, Germany
- Alice Salomon Hochschule Berlin, Berlin, Germany
| | - Kayvan Bozorgmehr
- Department of General Practice and Health Services Research, University Hospital Heidelberg, Heidelberg, Germany
| | - Theda Borde
- Alice Salomon Hochschule Berlin, Berlin, Germany
| | - Matthias David
- Department of Gynaecology, Campus Virchow-Klinikum, Charité-Universitätsmedizin Berlin, Berlin, Germany
| |
Collapse
|
8
|
Sauzet O, Breckenkamp J, Borde T, Brenne S, David M, Razum O, Peacock JL. A distributional approach to obtain adjusted comparisons of proportions of a population at risk. Emerg Themes Epidemiol 2016; 13:8. [PMID: 27279891 PMCID: PMC4897957 DOI: 10.1186/s12982-016-0050-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2015] [Accepted: 05/27/2016] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Dichotomisation of continuous data has statistical drawbacks such as loss of power but may be useful in epidemiological research to define high risk individuals. METHODS We extend a methodology for the presentation of comparison of proportions derived from a comparison of means for a continuous outcome to reflect the relationship between a continuous outcome and covariates in a linear (mixed) model without losing statistical power. The so called "distributional method" is described and using perinatal data for illustration, results from the distributional method are compared to those of logistic regression and to quantile regression for three different outcomes. RESULTS Estimates obtained using the distributional method for the comparison of proportions are consistently more precise than those obtained using logistic regression. For one of the three outcomes the estimates obtained from the distributional method and from logistic regression disagreed highlighting that the relationships between outcome and covariate differ conceptually between the two models. CONCLUSION When an outcome follows the required condition of distribution shift between exposure groups, the results of a linear regression model can be followed by the corresponding comparison of proportions at risk. This dual approach provides more precise estimates than logistic regression thus avoiding the drawback of the usual dichotomisation of continuous outcomes.
Collapse
Affiliation(s)
- Odile Sauzet
- Department of Epidemiology and International Public Health, Bielefeld School of Public Health (BiSPH), Bielefeld University, Bielefeld, Germany
| | - Jürgen Breckenkamp
- Department of Epidemiology and International Public Health, Bielefeld School of Public Health (BiSPH), Bielefeld University, Bielefeld, Germany
| | - Theda Borde
- Alice Salomon Hochschule Berlin, University of Applied Sciences, Berlin, Germany
| | - Silke Brenne
- Department of Gynecology, Campus Virchow-Klinikum, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Matthias David
- Department of Gynecology, Campus Virchow-Klinikum, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Oliver Razum
- Department of Epidemiology and International Public Health, Bielefeld School of Public Health (BiSPH), Bielefeld University, Bielefeld, Germany
| | - Janet L Peacock
- Division of Health and Social Care Research, King's College London, London, UK ; NIHR Biomedical Research Centre at Guy's and St Thomas' NHS Foundation Trust and King's College London, London, UK
| |
Collapse
|
9
|
David M, Brenne S, Breckenkamp J, Razum O, Borde T. Postpartum Contraception: a Comparative Study of Berlin Women with and without Immigration Background. Geburtshilfe Frauenheilkd 2015; 75:915-922. [PMID: 26500367 DOI: 10.1055/s-0035-1557906] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Abstract
Research Questions: Are there differences in postpartum contraceptive use between women with and without immigration background? Do women more commonly use contraception following a high-risk pregnancy or caesarean section? What role does current breastfeeding play and, amongst immigrants, what is the effect of acculturation level on the frequency of contraceptive use? Study Population and Methods: Data collection was carried out as part of a larger study in three Berlin delivery units using standardised interviews (questionnaires covering e.g. sociodemographics, immigration history/acculturation and use of antenatal care); telephone interviews comprising 6 questions on postpartum contraception, breastfeeding and postpartum complications were conducted on a sample of the study population six months after delivery. Results: 247 women with, and 358 women without a background of immigration were included in the study (total study population n = 605, response rate 81.1 %). 68 % of 1st generation immigrants, 87 % of 2nd/3rd generation women and 73 % of women without immigration background (non-immigrants) used contraception. In the logistical regression analysis 1st generation immigrants were less likely than non-immigrants to be using contraception six months postpartum, and 1st generation immigrants with low acculturation level were significantly less likely to use contraception than 2nd/3rd generation women with low acculturation level. Conclusion: In the extended postpartum period there was no major difference in contraceptive use between immigrants in general and non-immigrants. It remains unclear whether the differing contraceptive behaviour of 1st generation immigrants is the result of less access to information, sociocultural factors or differing contraceptive requirements and further targeted, qualitative study is required.
Collapse
Affiliation(s)
- M David
- Charité Universitätsmedizin Berlin, Campus Virchow-Klinikum, Klinik für Gynäkologie, Berlin
| | - S Brenne
- Alice Salomon Hochschule Berlin, Berlin
| | - J Breckenkamp
- Universität Bielefeld, Fakultät für Gesundheitswissenschaften, AG Epidemiologie und International Public Health, Bielefeld
| | - O Razum
- Universität Bielefeld, Fakultät für Gesundheitswissenschaften, AG Epidemiologie und International Public Health, Bielefeld
| | - T Borde
- Alice Salomon Hochschule Berlin, Berlin
| |
Collapse
|
10
|
Razum O, Reiss K, Breckenkamp J, Borde T, Brenne S, David M. Contribution of overweight/obesity to adverse pregnancy outcomes in immigrant and non-immigrant women. Eur J Public Health 2015. [DOI: 10.1093/eurpub/ckv174.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
|
11
|
David M, Borde T, Brenne S, Henrich W, Breckenkamp J, Razum O. Caesarean Section Frequency among Immigrants, Second- and Third-Generation Women, and Non-Immigrants: Prospective Study in Berlin/Germany. PLoS One 2015; 10:e0127489. [PMID: 25985437 PMCID: PMC4435809 DOI: 10.1371/journal.pone.0127489] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2014] [Accepted: 02/10/2015] [Indexed: 11/22/2022] Open
Abstract
Objective The frequency of caesarean section delivery varies between countries and social groups. Among other factors, it is determined by the quality of obstetrics care. Rates of elective (planned) and emergency (in-labor) caesareans may also vary between immigrants (first generation), their offspring (second- and third-generation women), and non-immigrants because of access and language barriers. Other important points to be considered are whether caesarean section indications and the neonatal outcomes differ in babies delivered by caesarean between immigrants, their offspring, and non-immigrants. Methods A standardized interview on admission to delivery wards at three Berlin obstetric hospitals was performed in a 12-month period in 2011/2012. Questions on socio-demographic and care aspects and on migration (immigrated herself vs. second- and third-generation women vs. non-immigrant) and acculturation status were included. Data was linked with information from the expectant mothers’ antenatal records and with perinatal data routinely documented in the hospital. Regression modeling was used to adjust for age, parity and socio-economic status. Results The caesarean section rates for immigrants, second- and third-generation women, and non-immigrant women were similar. Neither indications for caesarean section delivery nor neonatal outcomes showed statistically significant differences. The only difference found was a somewhat higher rate of crash caesarean sections per 100 births among first generation immigrants compared to non-immigrants. Conclusion Unlike earlier German studies and current studies from other European countries, this study did not find an increased rate of caesarean sections among immigrants, as well as second- and third-generation women, with the possible exception of a small high-risk group. This indicates an equally high quality of perinatal care for women with and without a migration history.
Collapse
Affiliation(s)
- Matthias David
- Charité University Medicine Berlin, Clinic for Gynaecology, Campus Virchow-Klinikum, Berlin, Germany
- * E-mail:
| | - Theda Borde
- Alice Salomon Hochschule Berlin—University of Applied Sciences, Berlin, Germany
| | - Silke Brenne
- Charité University Medicine Berlin, Clinic for Gynaecology, Campus Virchow-Klinikum, Berlin, Germany
| | - Wolfgang Henrich
- Charité University Medicine Berlin, Obstetrics Clinics, Campus Virchow-Klinikum and Mitte, Berlin, Germany
| | - Jürgen Breckenkamp
- Bielefeld University, School of Public Health, Department of Epidemiology & International Public Health, Bielefeld, Germany
| | - Oliver Razum
- Bielefeld University, School of Public Health, Department of Epidemiology & International Public Health, Bielefeld, Germany
| |
Collapse
|
12
|
Brenne S, David M, Borde T, Breckenkamp J, Razum O. Werden Frauen mit und ohne Migrationshintergrund von den Gesundheitsdiensten gleich gut erreicht? Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2015; 58:569-76. [DOI: 10.1007/s00103-015-2141-6] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
|
13
|
Reiss K, Breckenkamp J, Borde T, Brenne S, David M, Razum O. Contribution of overweight and obesity to adverse pregnancy outcomes among immigrant and non-immigrant women in Berlin, Germany. Eur J Public Health 2015; 25:839-44. [PMID: 25868566 DOI: 10.1093/eurpub/ckv072] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Maternal excessive weight and smoking are associated with an increased risk of pregnancy complications and adverse pregnancy outcomes. In Germany, immigrant women have a higher prevalence of pre-pregnancy overweight/obesity compared with autochthonous women. We compared the contribution of pre-pregnancy overweight/obesity to adverse pregnancy outcomes among immigrant and autochthonous women in Berlin/Germany. METHODS Data from 2586 immigrant women (from Turkey, Lebanon, other countries of origin) and 2676 autochthonous women delivering in three maternity hospitals of Berlin within 12 months (2011/2012) was used. Cox regression models were applied to estimate the association between overweight/obesity and smoking with the outcomes large-for-gestational-age (LGA), small-for-gestational-age (SGA), preterm birth (PTB) and extreme preterm-birth (E-PTB). Population attributive fractions (PAF) were calculated to quantify the proportion of the outcomes attributable to overweight/obesity and smoking, respectively. RESULTS Prevalence of overweight and obesity was 33.4% among autochthonous and 53.6% among Turkish women. Prevalence risk ratios of excessive weight were highest for LGA infants among immigrant and autochthonous women. The PAFs were -11.8% (SGA), +16.3% (LGA), +3.6% (PTB) and +16.5% (E-PTB) for the total study population. CONCLUSIONS Overweight/obesity is strongly associated with an increased risk of delivering an LGA infant among both immigrant and autochthonous women. Compared with autochthonous women, the contribution of excessive weight to LGA is even higher among immigrant women, in whom PAFs of overweight/obesity even exceed those of smoking for some outcomes.
Collapse
Affiliation(s)
- Katharina Reiss
- 1 Department of Epidemiology & International Public Health, Bielefeld School of Public Health (BiSPH), Bielefeld University, Bielefeld, Germany
| | - Jürgen Breckenkamp
- 1 Department of Epidemiology & International Public Health, Bielefeld School of Public Health (BiSPH), Bielefeld University, Bielefeld, Germany
| | - Theda Borde
- 2 Alice Salomon Hochschule Berlin, University of Applied Sciences, Berlin, Germany
| | - Silke Brenne
- 3 Department of Gynecology, Campus Virchow-Klinikum, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Matthias David
- 3 Department of Gynecology, Campus Virchow-Klinikum, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Oliver Razum
- 1 Department of Epidemiology & International Public Health, Bielefeld School of Public Health (BiSPH), Bielefeld University, Bielefeld, Germany
| |
Collapse
|
14
|
Reiss K, Breckenkamp J, Borde T, Brenne S, David M, Razum O. Smoking during pregnancy among Turkish immigrants in Germany-are there associations with acculturation? Nicotine Tob Res 2014; 17:643-52. [PMID: 25468901 DOI: 10.1093/ntr/ntu237] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2014] [Accepted: 10/25/2014] [Indexed: 11/13/2022]
Abstract
INTRODUCTION We analyzed the association between different acculturation measures and smoking among pregnant immigrant women from Turkey and compared smoking rates between Turkish and German women. METHODS Perinatal data from a project on the influence of migration and acculturation on pregnancy and birth in Berlin was analyzed. An acculturation index (FRAKK) and two proxy measures (German language proficiency, length of stay in Germany) were used. We performed logistic regression models and calculated age-standardized prevalence ratios (SPR). RESULTS Smoking prevalence was 19.8% among pregnant Turkish women (n = 702) and 17.8% among German women (n = 2,999). The chance of being a smoker was significantly higher among Turkish women with a length of stay of ≥20 years compared to 0-4 years (OR = 3.63, 95% CI = 1.64-8.05); with good/very good language skills compared to none/minor skills; with high levels of acculturation compared to low levels (the latter only among 18-29-year-old women). Compared to German women, Turkish women with a short length of stay, low acculturation scores and none/minor language skills had lower smoking rates. This finding inverts with long length of stay, high acculturation scores and good/very good language skills (≥20 years: SPR = 2.14, 95% CI = 1.56-2.94). CONCLUSIONS Smoking among pregnant Turkish women increases with increasing acculturation. Additionally, immigrant women with a low acculturation level are less often smokers and women with a high level are more often smokers than German women. Prevention measures have to prevent women with a low acculturation from starting to smoke and to induce those with a high acculturation to quit. As smoking and acculturation are group phenomena, it is necessary to involve immigrant communities.
Collapse
Affiliation(s)
- Katharina Reiss
- Department of Epidemiology and International Public Health, Bielefeld School of Public Health, Bielefeld University, Bielefeld, Germany;
| | - Jürgen Breckenkamp
- Department of Epidemiology and International Public Health, Bielefeld School of Public Health, Bielefeld University, Bielefeld, Germany
| | - Theda Borde
- Alice Salomon Hochschule Berlin, University of Applied Sciences, Berlin, Germany
| | - Silke Brenne
- Department of Gynecology, Campus Virchow-Klinikum, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Matthias David
- Department of Gynecology, Campus Virchow-Klinikum, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Oliver Razum
- Department of Epidemiology and International Public Health, Bielefeld School of Public Health, Bielefeld University, Bielefeld, Germany
| |
Collapse
|
15
|
David M, Borde T, Brenne S, Breckenkamp J, Razum O. Differences in provision of epidural analgesia in childbirth among immigrant and non-immigrant women: prospective study from Berlin, Germany. Eur J Public Health 2014. [DOI: 10.1093/eurpub/cku161.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
|
16
|
David M, Borde T, Brenne S, Ramsauer B, Henrich W, Breckenkamp J, Razum O. Comparison of Perinatal Data of Immigrant Women of Turkish Origin and German Women - Results of a Prospective Study in Berlin. Geburtshilfe Frauenheilkd 2014; 74:441-448. [PMID: 25089056 DOI: 10.1055/s-0034-1368489] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2013] [Revised: 02/24/2014] [Accepted: 02/25/2014] [Indexed: 10/25/2022] Open
Abstract
Aims: The aim of the study was to compare obstetrical process indicators and outcomes for German women with women of Turkish origin residing in Germany. Do women of Turkish origin attend antenatal examinations as frequently as non-immigrant women? Are high-risk pregnancies and anemia more common among immigrant women? Are the rates for epidural analgesia (PDA) and combined spinal-epidural analgesia (CSE) during delivery the same for immigrant women compared to German women? Are there identifiable differences in the mode of delivery and in perinatal outcomes? Patient Population/Methods: Data were obtained from 3 maternity clinics in Berlin for the period 2011 to 2012. The questionnaires covered socio-demographic factors and information on prenatal care as well as immigration/acculturation. The data obtained from these questionnaires was supplemented by information obtained from the official maternal record of prenatal and natal care (Mutterpass) and perinatal data recorded by the clinic. Results: The response rate was 89.6 %; the data of 1277 women of Turkish origin who had immigrated to Germany or whose family had immigrated and of 2991 non-immigrant women in Germany were included in the study. Regression analysis showed no statistically significant difference in the number of antenatal examinations between immigrant and non-immigrant women. Women of Turkish origin born in Germany had a significantly higher risk of postpartum anemia. PDA/CSE rate, arterial umbilical cord pH and 5-minute Apgar scores did not differ. The incidence of cesarean sections (elective and secondary) was significantly lower in the population of immigrant women of Turkish origin. Conclusion: Outcomes for most perinatal parameters were comparable for immigrant and non-immigrant women. These results indicate that the achieved standards of antenatal care and medical care during pregnancy are similar for Turkish immigrant women compared to non-immigrant women in maternity clinics in Berlin. The higher rates of anemia among immigrant women should be targeted by preventive measures.
Collapse
Affiliation(s)
- M David
- Klinik für Gynäkologie, Charité Campus Virchow-Klinikum, Berlin
| | - T Borde
- Alice Salomon University of Applied Sciences, Berlin
| | - S Brenne
- Klinik für Gynäkologie, Charité Campus Virchow-Klinikum, Berlin
| | - B Ramsauer
- Klinik für Geburtsmedizin, Vivantes Klinikum Neukölln, Berlin
| | - W Henrich
- Kliniken für Geburtsmedizin, Charité Campus Virchow-Klinikum und Campus Mitte, Berlin
| | - J Breckenkamp
- AG Epidemiologie und International Public Health, Universität Bielefeld, Fakultät für Gesundheitswissenschaften, Bielefeld
| | - O Razum
- AG Epidemiologie und International Public Health, Universität Bielefeld, Fakultät für Gesundheitswissenschaften, Bielefeld
| |
Collapse
|
17
|
Hofen-Hohloch JV, Borde T, Razum O, Breckenkamp J, Brenne S, David M. Haben Migrantinnen oder ihre Neugeborenen ein ungünstiges perinatales Outcome? Z Geburtshilfe Neonatol 2013. [DOI: 10.1055/s-0033-1361321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
|
18
|
Razum O, Breckenkamp J, Brenne S, Borde T, David M. Pregnancy risks and birth outcomes in migrant and non-migrant women – the Berlin perinatal study. Eur J Public Health 2013. [DOI: 10.1093/eurpub/ckt126.314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
|