Archives of Gynecology and Obstetrics

, Volume 296, Issue 4, pp 745–762 | Cite as

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

  • Matthias David
  • Theda Borde
  • Silke Brenne
  • Babett Ramsauer
  • Wolfgang Henrich
  • Jürgen Breckenkamp
  • Oliver Razum
Maternal-Fetal Medicine



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.


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.


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.


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.


Immigrant Second-generation immigrant Pregnancy Obstetric outcomes Perinatal outcomes Education level Germany 



Antenatal care


Body mass index


Gestation week


Odds ratio


Small for gestational age

95% CI

95% confidence interval



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

Author 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.

Compliance with ethical standards


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.


  1. 1.
    Hemminki K (2014) Immigrant health, our health. Eur J Public Health 24(Suppl 1):92–95CrossRefPubMedGoogle Scholar
  2. 2.
    Mendoza FS (2009) Health disparities and children in immigrant families: a research agenda. Pediatrics 124:S187–S195CrossRefPubMedGoogle Scholar
  3. 3.
    Gualdi-Russo E, Toselli S, Masotti S, Marzouk D, Sundquist K, Sundquist J (2014) Health, growth, and psychosocial adaptation of immigrant children. Eur J Public Health 24(Suppl 1):16–25CrossRefPubMedGoogle Scholar
  4. 4.
    Bollini P, Pampallona S, Wanner P, Kupelnick B (2009) Pregnancy outcome of migrant women and integration policy: a systematic review of the international literature. Soc Sci Med 68:452–461CrossRefPubMedGoogle Scholar
  5. 5.
    Khanlou N, Haque N, Skinner A, Mantini A, Kurtz Landy C (2017) Scoping review on maternal health among immigrant and refugee women in canada: prenatal, intrapartum, and postnatal care. J Pregnancy 2017:8783294CrossRefPubMedPubMedCentralGoogle Scholar
  6. 6.
    Ostrach B (2013) “Yo no sabía…”—Immigrant women’s use of national health systems for reproductive and abortion care. J Immigr Minor Health 15:262–272CrossRefPubMedGoogle Scholar
  7. 7.
    Villalonga-Olives E, Kawachi I, von Steinbüchel N (2016) Pregnancy and birth outcomes among immigrant women in the US and Europe: a systematic review. J Immigr Minor Health. doi: 10.1007/s10903-016-0483-2
  8. 8.
    Mogos MF, Salinas-Miranda AA, Salemi JL, Medina IM, Salihu HM (2016) Pregnancy-related hypertensive disorders and immigrant status: a systematic review and meta-analysis of epidemiological studies. J Immigr Minor Health. doi: 10.1007/s10903-016-0410-6
  9. 9.
    Aveyard P, Cheng KK, Manaseki S, Gardosi J (2002) The risk of preterm delivery in women from different ethnic groups. BJOG 109:894–899CrossRefPubMedGoogle Scholar
  10. 10.
    Cacciani L, Asole S, Polo A, Franco F, Lucchini R, De Curtis M et al (2011) Perinatal outcomes among immigrant mothers over two periods in a region of central Italy. BMC Public Health 11:294. doi: 10.1186/1471-2458-11-294 CrossRefPubMedPubMedCentralGoogle Scholar
  11. 11.
    Essén B, Bödker B, Sjöberg NO, Langhoff-Roos J, Greisen G, Gudmundsson S et al (2002) Are some perinatal deaths in immigrant groups linked to suboptimal perinatal care services? BJOG 109:677–682CrossRefPubMedGoogle Scholar
  12. 12.
    Gissler M, Alexander S, MacFarlane A, Small R, Stray-Pedersen B, Zeitlin J et al (2009) Stillbirths and infant deaths among migrants in industrialized countries. Acta Obstet Gynecol Scand 88:134–148CrossRefPubMedGoogle Scholar
  13. 13.
    Ibison JM (2005) Ethnicity and mode of delivery in ‘low-risk’ first-time mothers, East London, 1988–1997. Eur J Obstet Gynecol Rep Biol 118:199–205CrossRefGoogle Scholar
  14. 14.
    von Katterfeld B, Li J, McNamara B, Langridge AT (2012) Perinatal complications and cesarean delivery among foreign-born and Australian-born women in Western Australia, 1998–2006. Int J Gynecol Obstet 116:153–157CrossRefGoogle Scholar
  15. 15.
    Ray JG, Vermeulen MJ, Schull MJ, Singh H, Shah R, Redelmeier DA (2007) Results of the recent immigrant pregnancy and perinatal long-term evaluation study (RIPPLES). CMAJ 176:1419–1426CrossRefPubMedPubMedCentralGoogle Scholar
  16. 16.
    Reiss K, Breckenkamp J, Borde T, Brenne S, Henrich W, David M, Razum O (2016) The association of pre-pregnancy overweight and obesity with delivery outcomes: a comparison of immigrant and non-immigrant women in Berlin, Germany. Int J Public Health 61:455–463CrossRefPubMedGoogle Scholar
  17. 17.
    Malmusi D (2015) Immigrants’ health and health inequality by type of integration policies in European countries. Eur J Public Health 25(2):293–299CrossRefPubMedGoogle Scholar
  18. 18.
    Page RL (2004) Positive pregnancy outcomes in Mexican immigrants: what can we learn? J Obstet Gynecol Neonatal Nurs 33:783–790CrossRefPubMedGoogle Scholar
  19. 19.
    Razum O, Jahn A, Blettner M, Reitmaier P (1999) Trends in maternal mortality ratio among women of German and non-German nationality in West Germany, 1980 to 1996. Int J Epidemiol 28:919–924CrossRefPubMedGoogle Scholar
  20. 20.
    Razum O, Reeske A, Spallek J (2011) Gesundheit von Schwangeren und Säuglingen mit Migrationshintergrund. Peter Lang Verlag, Frankfurt/MainGoogle Scholar
  21. 21.
    2011 Census (2013) Population of the Federal Republic of Germany on 9 May 2011. Federal Statistical Office (Ed.), WiesbadenGoogle Scholar
  22. 22.
    Amt für Statistik Berlin-Brandenburg (Ed.) Statistischer Bericht. Ergebnisse des Mikrozensus im Land Berlin 2015: Bevölkerung im Land Berlin 2008 bis 2015 nach Migrationsstatus, Geschlecht, Altersgruppen und Beteiligung am Erwerbsleben. p.50. Viewed on 4 June 2017.
  23. 23.
    Bundesinstitut für Bevölkerungsforschung. Altersspezifische Geburtenziffern deutscher und ausländischer Frauen in Deutschland, 1991 und 2015. Accessed 4 June 2017
  24. 24.
    Statistisches Bundesamt. Geburtenziffer 2015: Erstmals seit 33 Jahren bei 1,50 Kindern je Frau.;jsessionid=C8ED22B47F15096E4C1EF6F33DA62B74.cae1. Accessed 4 June 2017
  25. 25.
    Schenk L, Bau AM, Borde T, Butler J, Lampert T, Neuhauser H, Razum O, Weilandt C (2006) Mindestindikatorensatz zur Erfassung des Migrationsstatus. Empfehlungen für die epidemiologische Praxis. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 49:853–860CrossRefPubMedGoogle Scholar
  26. 26.
    Voigt M, Olbertz D, Rochow N, Hesse V, Schleusser E, Schneider KTM (2011) Geburtsgewichts-Perzentilwerte für Mädchen und Jungen unter Berücksichtigung von Körperhöhe und Körpergröße der Mütter (12 Gruppen). In: Zabransky S (ed) 9. Interdisziplinärer SGA/IUGR-Workshop 1.-2.7.2011 in Kloster Schöntal, Proceedingband 2011. Medizinischer Verlag Siegfried Zabransky. Accessed 25 Oct 2016
  27. 27.
    University of Michigan, Institute of Social Research, Survey Research Center (2014) IBEware—imputation and variance estimation. University of Michigan, Ann Arbor, MI, USA. Accessed 21 Aug 2015
  28. 28.
    The World Bank. World development indicators. Accessed 29 May 2017
  29. 29.
    Brenne S, David M, Borde T, Breckenkamp J, Razum O (2015) Werden Frauen mit und ohne Migrationshintergrund von den Gesundheitsdiensten gleich gut erreicht? Das Beispiel Schwangerenvorsorge in Berlin. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz. 58:569–576CrossRefPubMedGoogle Scholar
  30. 30.
    Walsh J, Mahony R, Armstrong F, Ryan G, O’Herlihy C, Foley M (2011) Ethnic variation between white European women in labour outcomes in a setting in which the management of labour is standardised—a healthy migrant effect? BJOG 118:713–718CrossRefPubMedGoogle Scholar
  31. 31.
    Auger N, Luo ZC, Platt RW, Daniel M (2008) Do mother’s education and foreign born status interact to influence birth outcomes? Clarifying the epidemiological paradox and the healthy migrant effect. J Epidemiol Community Health 62:402–409CrossRefPubMedGoogle Scholar
  32. 32.
    Hawkins SS, Lamb K, Cole TJ, Law C, Millennium Cohort Study Child Health Group (2008) Influence of moving to the UK on maternal health behaviours: prospective cohort study. BMJ 336:1052–1055CrossRefPubMedPubMedCentralGoogle Scholar
  33. 33.
    Luo ZC, Wilkins R, Kramer MS (2006) Effect of neighbourhood income and maternal education on birth outcomes: a population-based study. CMAJ 174:1429–1430CrossRefGoogle Scholar
  34. 34.
    Newburn-Cook CV, Onyskiw JE (2005) Is older maternal age a risk factor for preterm birth and fetal growth restriction? A systematic review. Health Care Women Int 26:852–875CrossRefPubMedGoogle Scholar
  35. 35.
    Shah PS, Zao J, Ali S, Knowledge Synthesis Group of Determinants of Preterm/LBW Births (2011) Maternal marital status and birth outcomes. A systematic review and meta-analyses. Matern Child Health J 15:1097–1109CrossRefPubMedGoogle Scholar
  36. 36.
    Urquia ML, Frank JW, Moineddin R, Glazier RH (2010) Immigrants’ duration of residence and adverse birth outcomes: a population-based study. BJOG 117:591–601CrossRefPubMedPubMedCentralGoogle Scholar
  37. 37.
    Pedersen GS, Mortensen LH, Gerster M, Rich-Edwards J, Andersen AM (2012) Preterm birth and birthweight-for-gestational age among immigrant women in Denmark 1978–2007: a nationwide registry study. Paediatr Perinat Epidemiol 26:534–542CrossRefPubMedGoogle Scholar
  38. 38.
    Margioula-Siarkou C, Petousis S, Kalogiannidis I, Dagklis T, Traianos V, Goutzioulis M et al (2013) Immigrants present improved obstetric and neonatal outcomes compared to native women. A northern greek population analysis. J Immigr Minor Health 15:249–254CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany 2017

Authors and Affiliations

  1. 1.Department of GynecologyCharité University Medicine BerlinBerlinGermany
  2. 2.Alice Salomon University of Applied SciencesBerlinGermany
  3. 3.Department of ObstetricsVivantes Klinikum NeuköllnBerlinGermany
  4. 4.Department of ObstetricsCharité University Medicine BerlinBerlinGermany
  5. 5.Department of ObstetricsCharité University Medicine BerlinBerlinGermany
  6. 6.Department of Epidemiology and International Public Health, School of Public HealthBielefeld UniversityBielefeldGermany

Personalised recommendations