[Obstetric Care for Gestational Diabetes in Refugee and Immigrant Women in Comparison to Non-Immigrant Women in Berlin: an Analysis of Quantitative Data of the Pregnancy and Obstetric Care for Refugees (PROREF)-study]. / Geburtsmedizinische Versorgung bei Gestationsdiabetes von geflüchteten und immigrierten Frauen im Vergleich zu nicht-immigrierten Frauen in Berlin: Eine Analyse quantitativer Daten der Pregnancy and Obstetric Care for Refugees (PROREF)-Studie.

RESEARCH QUESTION: Are there differences in the frequency of gestational diabetes between women of self-defined refugee status (SDRS), immigrant women, and women born in Germany? Does the perinatal data of women with gestational diabetes (GDM) differ depending on the migration status? METHOD: For the Pregnancy and Obstetric Care for Refugees (ProRef) study between June 2020 and April 2022, data was collected with the Migrant Friendly Maternity Care Questionnaire (MFMCQ) among women on the postpartum ward in three perinatal centers in Berlin. The data concerning GDM was statistically analyzed. RESULTS: Women of SDRS were tested for GDM (3.2%, p=0.0025) significantly less often than immigrant women (1.4%) or women born in Germany (0.6%). The rate of GDM was higher among immigrant women (19.6%, p=0.001) than among women born in Germany (15.0%) and women of SDRS (14.1%). The rate of GDM varied depending on the country of origin. Vietnam (OR 3.41) and Turkey (OR 2.18) as countries of origin, corrected for age and body mass index, increased the chance of gestational diabetes. The perinatal outcome data among women with GDM did not differ depending on the migration status. CONCLUSION: As women of SDRS are tested for GDM less frequently, this potentially suggests a supply gap in the health care system. However, the perinatal outcome data does not differ for women of SDRS.

Preoperative Uterine Artery Embolization in Women Undergoing Uterus-Preserving Myomectomy for Extensive Fibroid Disease: A Retrospective Analysis.

OBJECTIVES: The aim of this study was to determine if a long versus short interval between preoperative uterine artery embolization (PUAE) and subsequent myomectomy impact perioperative blood loss and the complication rate in cases of enlarged multi-fibroid uterus. DESIGN: In cases of an enlarged multi-fibroid uterus, operative myomectomy can lead to heavy blood loss and consequently increases the risk for transfusion and hysterectomy. PUAE can possibly contribute to a reduction of these risks. Our study was designed to determine if a long versus short interval between PUAE and subsequent surgery impacts perioperative blood loss and complication rate. PARTICIPANTS AND METHODS: PUAE was performed 24 h before the planned myoma enucleation in 21 patients between January 2011 and March 2016 (group 1) or 19 days before the operation in 23 patients from March 2016 to May 2018 (group 2). A comparison was made to a historical sample of 57 patients with large myomas (>10 cm) without PUAE (group 3). Perioperative blood loss, need for postoperative blood transfusion, and postoperative complications were recorded. Subjective improvement of myoma-related symptoms was assessed for each group by a questionnaire. RESULTS: PUAE was carried out successfully without complications in all patients. Conversion to hysterectomy was not needed in any of the PUAE patients but was necessary in one of the control patients. In the three groups' comparison, there was a significant lower risk for high blood loss (≥500 mL) in group 1 and a lower but not significant lower risk in group 2 compared to group 3 without an embolization preoperatively. Also, a significant lower risk for postoperative blood transfusion for group 1 (OR 0.02; 0.001-0.328; p = 0.01) and 2 (OR 0.02; 0.001-0.277; p = 0.01) compared to group 3 was observed. The postoperative complication risk was lower in group 2 (model 1: OR 0.12; 0.016-0.848; p = 0.03; model 2 OR 0.07; 0.009-0.588; p = 0.01) compared to group 3. In the context of the postoperative questionnaire, 10 of 11 patients in group 1, 12 of 12 patients in group 2, and 31 of 36 patients from the control group reported an improvement of their complaints. CONCLUSION: PUAE is beneficial for uterus-preserving removal of myomas from patients with a substantially enlarged uterus. There is a significant reduction of high blood loss (≥500 mL), need for postoperative blood transfusion, and postoperative complications in patients with extensive fibroid disease after PUAE compared to no intervention before myoma enucleation.

Influence of appropriate emergency department utilization and verbal communication on physicians' (dis)satisfaction with doctor-patient interactions with special consideration of migrational backgrounds.

In recent years, utilization of emergency departments (EDs) has increased continuously, both in Germany and internationally. Inappropriate use of EDs is believed to be partly responsible for this trend. The topic of doctor-patient interaction (DPI) has received little attention in research. However, successful DPI is not only important for adherence and treatment success, but also for the satisfaction of medical staff. This non-interventionl cross-sectional study attempts to identify factors influencing physicians' satisfaction with DPIs, with a particular focus on the appropriate utilization of EDs and verbal communication. We carried out tripartite data collection in three EDs of major referral hospitals in Berlin between July 2017 and July 2018. Migration experience, communication and language problems, level of education, and a large gap between physicians' and patients' perceived urgency regarding the utilization of EDs influence the quality of the doctor-patient relationships and interactions.

[Violence Against Staff in Delivery Rooms - Results of an Online-Survey and Structured Interviews in Obstetric Clinics in Berlin]. / Gewalt gegen Kreißsaalpersonal ­ Ergebnisse einer Online-Befragung und von Leitfadeninterviews an Berliner Geburtskliniken.

INTRODUCTION: Violence against medical staff is a known problem in emergency departments. Nevertheless, there is little empirical data about physical and verbal violence against staff members in delivery rooms in Germany. METHODS: This study comprises both quantitative and qualitative analyses. For the quantitative part, midwives and doctors working in delivery rooms in Berlin were asked to fill out a questionnaire about their experiences with violence within the last 6 months; this survey was completed between 15 November 2019 and 15 February 2020. For the qualitative part, structured interviews were conducted to investigate individual experiences of violence in more detail. RESULTS: Out of 173 participants in total, 148 (86%) reported to have experienced verbal violence and 82 (47%) reported to have experienced physical violence. Midwives and younger staff seem to be more often affected by violence. 70% of the participants did not feel sufficiently prepared for situations of violence. In a total of 36 interviews, the participants specifically named communicative problems, too high expectations of the pregnant women and their companion, as well as language barrier and cultural differences as reasons for furthering violence. CONCLUSION: Violence against staff is a relevant problem in delivery rooms in Berlin. Participants would welcome training to deal with violence and professional help for coming to terms with experiences of violence. Improved information about pregnancy and delivery, institutionalized translation, and more staff could possibly help to decrease frequency of violence.

[Use of emergency rooms by so-called multiple users: results of a prospective study with special consideration of the migration status]. / Inanspruchnahme von Notaufnahmen durch sog. Mehrfachnutzer/-innen: Ergebnisse einer prospektiven Studie unter besonderer Berücksichtigung des Migrationsstatus.

Objectives: Can we identify predictive factors for the group of so-called multiple users (MU; 4 and more uses of an emergency department [ED] in the past 12 months)? Are people with a migration background more likely to be classified in the MU group? Methodology: Included were consecutive patients who visited three EDs in Berlin from July 2017 to July 2018. Using a questionnaire, diseases, reasons for visiting the ED and socioeconomic factors were recorded. Comparisons between migrants (1st generation), their descendants (2nd generation) and nonmigrants were assessed using logistic regression. Results: A total of 2339 patients were included in the evaluation (repeat rate 56%), of which 901 had a migration background. Young women (<30 years), chronically ill, pregnant women, patients with severe complaints and people with (self-assessed) moderate and poor health quality as well as those without medical referral had a greater chance of multiple use of ED. Conclusion: MU burden the already increasing patient volume of ED. However, they represent a heterogeneous group of patients, among whom people with a migration background are not common. Further research is warranted to better understand the factors that lead to frequent use and to develop effective strategies to address the complex health needs of MUs.

Evaluation of Biomarkers in Myoma Patients: A Prospective Study Investigating the Role of LDH, CA 125, and IGF-1 after Uterus-Preserving Surgical Therapy.

OBJECTIVE: Myomas are one of the most common tumors of the lower abdomen in women. At present, sonography and clinical examination are the prevalent diagnostic standards for these tumors, and no biomarkers have been established yet. The primary aim of this study was to determine if the surgical removal of myomas leads to a drop of lactate dehydrogenase (LDH), CA 125, and/or insulin-like growth factor (IGF-1) and therefore if these parameters are suitable as potential biomarkers for the presence or recurrence of a myoma. STUDY DESIGN: The blood levels of LDH, CA 125, and IGF-1 were determined in 83 patients (age 18-50) with a verified diagnosis of myomas and surgical therapy at 3 different timepoints: preoperative (T0), 2 days postoperative (T1), and 6 months postoperative (T2). Vaginal sonography was performed preoperatively and once again at 6 months postoperatively. RESULTS: The median (Q1-Q3) LDH values dropped significantly postoperatively: 239 (217-266) U/L at T0 versus 217 (190-255) U/L at T1, p < 0.001. The median (Q1-Q3) IGF-1 values also dropped: 140.4 (118.6-179.0) ng/mL versus 112.4 (99.5-143.0), p < 0.001. By contrast, the CA 125 values rose slightly but not significantly. At 6 months (n = 34), the LDH values were not significantly different from either the preoperative or the immediate postoperative values. This was observed both in patients with and without a recurrence of myoma. In contrast, the median (Q1-Q3) IGF-1 level at T2 was significantly elevated both in patients with sonographic evidence of new myomas (129.0 [116.0-163.1] ng/mL, p = 0.023) and in patients with sonographic proof of no new myomas (161.0 [130.2-198.5] ng/mL, p < 0.001). CONCLUSION: Both LDH and IGF-1 dropped significantly in the immediate postoperative days in women with myomas after uterus-preserving surgeries were performed. The postoperative concentration of IGF-1 was correlated with the evidence of new myomas and can be potentially used for further monitoring. Future studies should be able to confirm these results. This study concludes that myomas do influence LDH and IGF-1 and could possibly be suitable as biomarkers.

Effects of epigallocatechin gallate-enriched green tea extract capsules in uterine myomas: results of an observational study.

PURPOSE: The daily ingestion of green tea extract (GTE) capsules in women with oligo- or asymptomatic uterine myomas was monitored over 6 months with regard to their quality of life, myoma-associated complaints and side effects. METHODS: The participants were interviewed and examined at the beginning of the study (T1) and then again after 6 months (T3). Quality of life was assessed using a SF-12 questionnaire while their myoma-associated complaints were ascertained by using a self-developed myoma symptom questionnaire. Changes in the size of the myomas were evaluated by vaginal sonography. Side effects after 3 months (T2) and 6 months were documented by systematic interviews. RESULTS: Overall; 25 participants (median 45 years) have been enrolled. The analysis of the SF-12 questionnaire showed a significant improvement of the physical cumulative score of the SF-12 during the 6 month GTE capsule ingestion (T1: mean value (M) = 52.731; 95% confidence interval (KI95%): 49.791-55.671; T3: M = 55.862; KI95%%: 55.038-56.685; p = 0.019). However, the mental cumulative score of the SF-12 did not change significantly (p = 0.674). No significant correlation could be established between the capsule ingestion and changes in the symptom questionnaire, the laboratory parameters nor the myoma size. No relevant adverse side effects were reported. CONCLUSION: Women who took GTE capsules showed a significant improvement in their physical cumulative score on the SF-12, but not in the global QoL score. Myoma size or other objective parameters did not change.

[Perinatal Data of Women with and without Refugee Status in Berlin - Results of a Comparative Cross-Sectional Study]. / Perinataldaten von Frauen mit und ohne Flüchtlingsstatus in Berlin ­ Ergebnisse einer vergleichenden Querschnittstudie.

INTRODUCTION: In Germany,1.2 million asylum seekers have entered the country in 2015-2016. More than a third of these asylum seekers were women. To understand the situation of asylum seekers' pregnancies, we examined the primary health care of this particular group to understand what, if anything, needs to improve to make the German health system more accessible to pregnant asylum seekers. METHODOLOGY: we examined 960 cases of pregnant women who delivered in 2 large maternity clinics in Berlin-Charité between January 2016-August 2017. In our comparative cross-sectional study, we compared 480 asylum-seeking women with 480 local German women. For both patient populations we acquired data on various parameters. RESULTS: We found only two significant differences: (1) The number of antenatal appointments attended by refugee women during their pregnancy was lower than that of the control group. The average number of antenatal appointments in the local control group was 10.6 (Max.: 27, SD 2.85, Min: 2); the refugee women attended on average 8.0 appointments (Max.: 20, SD 3.385, Min: 0) (p=0.000, adjusted relative risk 0.77 95% CI 0.74-0.81). (2) The mean Hb value in the local control group was 11.1 g/dl, while in the asylum-seeking women's group it was 10.6 g/dl (p= 0.00, adjusted difference 0.54 95% CI -0.77 to -0.34). CONCLUSIONS: This study showed that the German health care system is capable of treating asylum-seeking women. Nevertheless, it is possible that our results do not necessarily reflect the ability of the health care system but stem from other selection parameters of the health condition of our subjects, such as the "healthy migrant effect."

[Effects of hyperemesis gravidarum on the course of pregnancy and birth, with special attention to the risk factor of migration background]. / Auswirkungen einer Hyperemesis gravidarum auf Schwangerschaftsverlauf und Geburtsausgang unter besonderer Berücksichtigung des Risikofaktors Migrationshintergrund.

MAIN QUESTIONS: In this investigation of hospitalized cases of HG and subsequent births, we examine differences between patients who have and who have not experienced migration as well as the effect of HG on perinatal outcome. METHODS: Retrospective quantitative data of hospitalized patients suffering from HG (1997-2015) was analyzed. Also analyzed was a retrospective record of perinatal data on a subgroup of patients (2002-2016), and a control group (matched pairs) based on the register of births created. RESULTS: 1103 women with HG were hospitalized; in 434 cases birth outcome data could be evaluated as well. Migrants suffer from HG earlier in pregnancy; they are, however, less frequently exposed to psychosocial stress (according to anamnestic data). HG patients are younger and have more multiple pregnancies; the newborns are lighter (-70g) but have fewer congenital malformations (aOR 0.32, 95% CI 0.11-0.96) and are less frequently in need of treatment on the neonatology ward (aOR 0.59, 95% CI 0.36-0.97). CONCLUSION: Pregnant migrants are a special risk group for HG, possibly because of migration-caused stress. With severe HG, there are no adverse outcomes on the rest of the pregnancy.

[Pregnant Women with Gestational Diabetes in Berlin - An Analysis of Perinatal Data Especially Regarding Immigration Background]. / Schwangere mit Gestationsdiabetes in Berlin ­ Perinataldatenanalyse mit besonderer Berücksichtigung des Migrationsstatus.

To date there has not been a systematic analysis of pregnant patients with an immigrant background and gestational diabetes in Germany, even though the number of these patients has been rising continuously since the 1980s. METHODS: The case number estimate for this prospective study targeted 160 patients with gestational diabetes with and without an immigrant background. A questionnaire on socio-economic status, immigrant background, acculturation, and food intake was developed. The birth parameters and pre- and postpartum parameters were regularly documented. RESULTS: In our study we included 198 patients with gestational diabetes, consisting of 110 patients with an immigrant background and 88 patients without an immigrant background. The number of labor inductions for the suspected diagnosis of fetal macrosomia was almost the same in both groups (immigrant background 3.6% vs. without immigrant background 4.6%, p=1.0; OR 1.73; 95% CI; 0.79-3.89, p=0.17). The study patients with an immigrant background were more likely to give birth spontaneously than via cesarean section or vaginal-operative birth. The perinatal outcome of children from our study patients with and without an immigrant background were similar. CONCLUSION: We show that regardless of their immigrant background gestational diabetes patients have similar and homogeneous patient-centered care at our clinic.

The influence of migration on women's use of different aspects of maternity care in the German health care system: Secondary analysis of a comparative prospective study with the Migrant Friendly Maternity Care Questionnaire (MFMCQ).

INTRODUCTION: Approximately 21% of Germany's inhabitants or their parents have been born abroad. There is evidence that immigrant women are starting antenatal care later than nonimmigrants. In Berlin, equality in health care access had improved until 2011-2012, leaving only women with Low German language proficiency and an insecure residence status particularly at risk. With the recent influx of refugees, we analyzed whether access to antenatal and postpartum care differs depending on immigration, residence status, income, and education. METHODS: At our Berlin tertiary care center, a modified version of the Migrant Friendly Maternity Care Questionnaire was administered to women who delivered in the first half of 2017. Multivariate modeling compared nonimmigrant women, immigrants, and women who are direct descendants of immigrants. RESULTS: The study included 184 nonimmigrant women, 214 immigrant women, and 62 direct descendants of immigrants. Germany is relatively good in prenatal care for immigrant women, as most are getting adequate prenatal care. However, 21% of immigrants compared with 11% of nonimmigrant women started pregnancy care after the first trimester (P = .03). Low income was a more powerful predictor than immigration status for starting prenatal care after the first trimester. Immigrant women (23%) were less informed on postpartum care availability than nonimmigrants (3%) and used less postpartum midwifery care. CONCLUSIONS: When designing health care interventions for immigrant women, not only migration-specific factors should be considered but also low income as a barrier to access to maternity care.

Are Social Status and Migration Background Associated with Utilization of Non-medical Antenatal Care? Analyses from Two German Studies.

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.

[Is There a Negative Night or Weekend Effect on the Child's Postnatal State Among Migrant Women?] / Gibt es einen negativen Nacht- oder Wochenendeffekt auf den kindlichen postnatalen Zustand bei Frauen mit Migrationshintergrund?

RESEARCH QUESTION: Is neonatal morbidity of women with a migration background (= a proxy variable for an increased risk of cultural/linguistic communication problems) increased in the sense of a "weekend effect"? METHODS: Data was collected at 3 Berlin maternity hospitals directly in the delivery room based on standardized interviews (questions on sociodemographics, care aspects, migration) and supplemented by maternal and clinical perinatal data. Surrogate markers for the child's morbidity were the Apgar score and umbilical cord pH value or transfer to a children's hospital. Descriptive and logistic regression analyses were carried out. RESULTS: The data sets of 2,014 1st-generation migrants, 771 2nd-generation migrants, and 2,564 women without a migrant background were included, including 39.7% so-called day-births (Monday - Friday, 7 a.m.-6 p.m.). In 2 models, the influence of birth time and various other parameters was examined for the 2 proxy parameters of childhood morbidity. The chances of unfavorable Apgar or umbilical pH levels were increased in births in the evening, at night, on weekends and public holidays (OR 1.84, 95% CI 1.23-2.76, p=0.003), in operative vaginal births (OR 3.36, 95% CI 2.07-5.46, p<0.001) or a secondary cesarean section (OR 1.94; 95% CI 1.28-2.96, p=0.002). The migration status of the woman giving birth was irrelevant. SUMMARY: Despite possible intercultural and linguistic communication problems, women with a migration background are treated as well as pregnant women without a migration background irrespective of the time of day or day of the week.

PO2 oscillations induce lung injury and inflammation.

BACKGROUND: Mechanical ventilation can lead to ventilator-induced lung injury (VILI). In addition to the well-known mechanical forces of volutrauma, barotrauma, and atelectrauma, non-mechanical mechanisms have recently been discussed as contributing to the pathogenesis of VILI. One such mechanism is oscillations in partial pressure of oxygen (PO2) which originate in lung tissue in the presence of within-breath recruitment and derecruitment of alveoli. The purpose of this study was to investigate this mechanism's possible independent effects on lung tissue and inflammation in a porcine model. METHODS: To separately study the impact of PO2 oscillations on the lungs, an in vivo model was set up that allowed for generating mixed-venous PO2 oscillations by the use of veno-venous extracorporeal membrane oxygenation (vvECMO) in a state of minimal mechanical stress. While applying the identical minimal-invasive ventilator settings, 16 healthy female piglets (weight 50 ± 4 kg) were either exposed for 6 h to a constant mixed-venous hemoglobin saturation (SmvO2) of 65% (which equals a PmvO2 of 41 Torr) (control group), or an oscillating SmvO2 (intervention group) of 40-90% (which equals PmvO2 oscillations of 30-68 Torr)-while systemic normoxia in both groups was maintained. The primary endpoint of histologic lung damage was assessed by ex vivo histologic lung injury scoring (LIS), the secondary endpoint of pulmonary inflammation by qRT-PCR of lung tissue. Cytokine concentration of plasma was carried out by ELISA. A bioinformatic microarray analysis of lung samples was performed to generate hypotheses about underlying pathomechanisms. RESULTS: The LIS showed significantly more severe damage of lung tissue after exposure to PO2 oscillations compared to controls (0.53 [0.51; 0.58] vs. 0.27 [0.23; 0.28]; P = 0.0025). Likewise, a higher expression of TNF-α (P = 0.0127), IL-1ß (P = 0.0013), IL-6 (P = 0.0007), and iNOS (P = 0.0013) in lung tissue was determined after exposure to PO2 oscillations. Cytokines in plasma showed a similar trend between the groups, however, without significant differences. Results of the microarray analysis suggest that inflammatory (IL-6) and oxidative stress (NO/ROS) signaling pathways are involved in the pathology linked to PO2 oscillations. CONCLUSIONS: Artificial mixed-venous PO2 oscillations induced lung damage and pulmonary inflammation in healthy animals during lung protective ventilation. These findings suggest that PO2 oscillations represent an independent mechanism of VILI.

Advanced cervical dilatation as a predictor for low emergency cesarean delivery: a comparison between migrant and non-migrant Primiparae - secondary analysis in Berlin, Germany.

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.

Do social factors and country of origin contribute towards explaining a "Latina paradox" among immigrant women giving birth in Germany?

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.

Effects of maternal obesity, excessive gestational weight gain and fetal macrosomia on the frequency of cesarean deliveries among migrant and non-migrant women - a prospective study.

Background Maternal obesity, excessive gestational weight gain and fetal macrosomia may affect the health of the mother and the newborn, and are associated with cesarean delivery. Pregnant women with a migration background have a higher risk of obesity but nevertheless a lower frequency of cesarean deliveries than women from the majority population. This study assesses which of these factors most influence the risk of a cesarean delivery and whether their prevalence can explain the lower cesarean rates in migrant women. Methods A total of 2256 migrant women and 2241 non-immigrant women subsequently delivering in three hospitals of Berlin/Germany participated. Multivariate logistic regression analysis was conducted to assess the effects of obesity, excessive gestational weight gain and macrosomia on cesarean delivery. Standardized coefficients (STB) were used to rank the predictors. Results Obesity was more frequent in immigrant than among non-immigrant women. The mean gestational weight gain was independent of migration status. The frequency of macrosomia increased with maternal weight. Obesity and excessive gestational weight gain were the most important predictors of cesarean besides older age; fetal macrosomia played a much smaller role. Despite similar distributions of the three risk factors, the frequency of cesarean deliveries was lower in migrant than in non-immigrant women. Conclusion The presence of obesity and/or excessive gestational weight gain is associated with an increased risk of a cesarean delivery; fetal macrosomia does not increase the risk when obesity and weight gain are considered. The distribution of these risk factors is similar in migrant and non-immigrant women, so they cannot explain the lower frequency of cesarean deliveries in migrant women.

The impact of migration background on maternal near miss.

PURPOSE: (1) To evaluate the association between immigration background and the occurrence of maternal near miss (MNM). (2) To identify medical co-factors, health-care utilization, and health-care disparities as explanations of a possibly higher risk of MNM among immigrants. METHODS: We compared perinatal outcomes between immigrant women (first- or second-generation) versus non-immigrant women, delivering at three maternity hospitals in Berlin, Germany, 2011-2012. Near-miss events were defined as: HELLP syndrome, eclampsia, the occurrence or threat of uterine rupture, postpartum hemorrhage (PPH) > 1000 ml, sepsis, peripartal hysterectomy, cardiovascular complications, lung embolism. Logistic regression analyses were performed to determine the associations of immigration status, acculturation, and language competency with near-miss events, and of near-miss events with the perinatal outcomes. RESULTS: The databank included 2647 first-generation immigrants, 889 second-generation immigrants, and 3231 women without an immigration background (total N = 6767). Near-miss events occurred in 141 women. The likelihood of near-miss events was lower among multiparous women (OR 0.6; 95% CI 0.42-0.87; p = 0.01). No other factors had a statistically significant influence. Near-miss events are associated with an elevated likelihood for an unfavorable perinatal condition: the ORs ranged from 2.15 for an arterial umbilical cord pH value < 7.1-2.47 for premature delivery. CONCLUSIONS: Immigration status does not change the risk of near-miss events. Besides parity, no medical or socio-demographic factors were identified that were associated with an elevated likelihood for the occurrence of severe peripartal complications.

[How does the Degree of Acculturation Influence the Intention to Breastfeed, Breastfeeding Frequency, and Breastfeeding Duration in Migrant Women? A Review of the Publications from 2014-2018]. / Wie beeinflusst der Akkulturationsgrad Stillabsicht, Stillhäufigkeit und Stilldauer bei Migrantinnen? Ein Review der Publikationen der Jahre 2014­2018.

The breastfeeding behavior of women is influenced by social, demographic and cultural factors, yet little is known about the influence of migration and acculturation. A systematic search using the electronic databases LIVIVO and MEDLINE (PubMed) was conducted followed by a manual search in the bibliographies of all selected articles. Quantitative studies from industrialized countries, published from 01.01.2014 to 30.05.2018, in English or German were included. A total of 77 studies could be identified; 17 of them met the required inclusion criteria. Migrant mothers, excluding those from Southeast Asia, tended to have a higher breastfeeding prevalence than mothers without a migrant background. In addition, migrant women in Southern Europe, Ireland, and Taiwan were observed to have a longer breastfeeding period, whereas migrant women in Canada and women of non-Scandinavian origin in northern Europe showed shorter breastfeeding duration. With increasing acculturation, there was also a tendency of decreased breastfeeding apparent in women with a migrant background.