Intergenerational Transmission of Health Disparities Among Turkish-origin Immigrants in Germany: Study Protocol of a Multi-centric Cohort Study (BaBi-stress and BaBeK Study)

Overview

Journal BMC Pregnancy Childbirth

Publisher Biomed Central

Specialty Gynecology & Obstetrics

Date 2020 Mar 14

PMID 32164606

Citations 3

Authors

Jacob Spallek

Laura Scholaske

Medlin Kurt

Denise Lindner-Matthes

Sonja Entringer

Affiliations

Soon will be listed here.

Abstract

Background: Immigrants in Germany exhibit higher levels of social disadvantage when compared to the non-immigrated population. Turkish-origin immigrants constitute an important immigrant group in Germany and show disparities in some health domains that are evident from birth onwards. Several studies have shown the mechanisms by which social disadvantage is biologically embedded to affect health over the lifespan. Relatively little, however, is still known about if and how the maternal social situation is transmitted to the next generation. This study therefore aims to analyse the effects of maternal socioeconomic status and migration status on stress-related maternal-placental-fetal (MPF) biological processes during pregnancy on infant birth and health outcomes.

Methods: This longitudinal cohort study of N = 144 child-mother dyads is located at two study sites in Germany and includes pregnant women of Turkish origin living in Germany as well as pregnant German women. During pregnancy, MPF stress biology markers from maternal blood and saliva samples, maternal socio-economic and migration-related information, medical risk variables and psychological well-being are assessed. After birth, infant anthropometric measures and developmental outcomes are assessed. The same measures will be assessed in and compared to Turkish pregnant women based on a collaboration with BABIP study in Istanbul.

Discussion: This is the first study on intergenerational transmission of health disparities in Germany with a focus on women of Turkish-origin. The study faces similar risks of bias as other birth cohorts do. The study has implemented various measures, e.g. culturally sensitive recruitment strategies, attempt to recruit and follow-up as many pregnant women as possible independent of their social or cultural background. Nevertheless, the response rate among lower-educated families is lower. The possibility to compare results with a cohort from Turkey is a strength of this study. However, starting at different times and with slightly different recruitment strategies and designs may result in cohort effects and may affect comparability of the sub-cohorts.

Trial Registration: N.A. (Observational study, no clinical trial, no interventions on human participants).

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References

Adler N, Stewart J . Health disparities across the lifespan: meaning, methods, and mechanisms. Ann N Y Acad Sci. 2010; 1186:5-23. DOI: 10.1111/j.1749-6632.2009.05337.x. View

Wadhwa P . Psychoneuroendocrine processes in human pregnancy influence fetal development and health. Psychoneuroendocrinology. 2005; 30(8):724-43. DOI: 10.1016/j.psyneuen.2005.02.004. View

David M, Pachaly J, Vetter K . Perinatal outcome in Berlin (Germany) among immigrants from Turkey. Arch Gynecol Obstet. 2006; 274(5):271-8. DOI: 10.1007/s00404-006-0182-7. View

Petersen J, Paulitsch M, Guethlin C, Gensichen J, Jahn A . A survey on worries of pregnant women--testing the German version of the Cambridge worry scale. BMC Public Health. 2009; 9:490. PMC: 2811709. DOI: 10.1186/1471-2458-9-490. View

Wingenfeld K, Spitzer C, Mensebach C, Grabe H, Hill A, Gast U . [The German Version of the Childhood Trauma Questionnaire (CTQ):Preliminary Psychometric Properties.]. Psychother Psychosom Med Psychol. 2010; 60(8):e13. DOI: 10.1055/s-0030-1253494. View

Cohen S, Kamarck T, Mermelstein R . A global measure of perceived stress. J Health Soc Behav. 1983; 24(4):385-96. View

Entringer S, Buss C, Wadhwa P . Prenatal stress and developmental programming of human health and disease risk: concepts and integration of empirical findings. Curr Opin Endocrinol Diabetes Obes. 2010; 17(6):507-16. PMC: 3124255. DOI: 10.1097/MED.0b013e3283405921. View

Wadhwa P, Sandman C, Garite T . The neurobiology of stress in human pregnancy: implications for prematurity and development of the fetal central nervous system. Prog Brain Res. 2001; 133:131-42. DOI: 10.1016/s0079-6123(01)33010-8. View

Coutinho R, David R, Collins Jr J . Relation of parental birth weights to infant birth weight among African Americans and whites in Illinois: a transgenerational study. Am J Epidemiol. 1997; 146(10):804-9. DOI: 10.1093/oxfordjournals.aje.a009197. View

10.

Jasienska G . Low birth weight of contemporary African Americans: an intergenerational effect of slavery?. Am J Hum Biol. 2008; 21(1):16-24. DOI: 10.1002/ajhb.20824. View

11.

Morawa E, Erim Y . Acculturation and depressive symptoms among Turkish immigrants in Germany. Int J Environ Res Public Health. 2014; 11(9):9503-21. PMC: 4199032. DOI: 10.3390/ijerph110909503. View

12.

Cox J, Holden J, Sagovsky R . Detection of postnatal depression. Development of the 10-item Edinburgh Postnatal Depression Scale. Br J Psychiatry. 1987; 150:782-6. DOI: 10.1192/bjp.150.6.782. View

13.

Bongard S, Pogge S, Arslaner H, Rohrmann S, Hodapp V . Acculturation and cardiovascular reactivity of second-generation Turkish migrants in Germany. J Psychosom Res. 2002; 53(3):795-803. DOI: 10.1016/s0022-3999(02)00347-1. View

14.

Hobel C, Dunkel-Schetter C, Roesch S, Castro L, Arora C . Maternal plasma corticotropin-releasing hormone associated with stress at 20 weeks' gestation in pregnancies ending in preterm delivery. Am J Obstet Gynecol. 1999; 180(1 Pt 3):S257-63. DOI: 10.1016/s0002-9378(99)70712-x. View

15.

de Hoog M, van Eijsden M, Stronks K, Gemke R, Vrijkotte T . Overweight at age two years in a multi-ethnic cohort (ABCD study): the role of prenatal factors, birth outcomes and postnatal factors. BMC Public Health. 2011; 11:611. PMC: 3171368. DOI: 10.1186/1471-2458-11-611. View

16.

Kleiser C, Mensink G, Neuhauser H, Schenk L, Kurth B . Food intake of young people with a migration background living in Germany. Public Health Nutr. 2009; 13(3):324-30. DOI: 10.1017/S1368980009991030. View

17.

Spallek J, Arnold M, Hentschel S, Razum O . Cancer incidence rate ratios of Turkish immigrants in Hamburg, Germany: A registry based study. Cancer Epidemiol. 2009; 33(6):413-8. DOI: 10.1016/j.canep.2009.10.006. View

18.

Sariaslan S, Morawa E, Erim Y . [Mental distress in primary care patients: German patients compared with patients of Turkish origin]. Nervenarzt. 2013; 85(5):589-95. DOI: 10.1007/s00115-013-3767-y. View

19.

Reeske A, Zeeb H, Razum O, Spallek J . Differences in the Incidence of Gestational Diabetes between Women of Turkish and German Origin: An Analysis of Health Insurance Data From a Statutory Health Insurance in Berlin, Germany (AOK), 2005-2007. Geburtshilfe Frauenheilkd. 2014; 72(4):305-310. PMC: 4168342. DOI: 10.1055/s-0031-1280428. View

20.

Ujcic-Voortman J, Baan C, Seidell J, Verhoeff A . Obesity and cardiovascular disease risk among Turkish and Moroccan migrant groups in Europe: a systematic review. Obes Rev. 2011; 13(1):2-16. DOI: 10.1111/j.1467-789X.2011.00932.x. View