TY - GEN A1 - Löffler, Antje A1 - Grosser, Angelique A1 - Miani, Celine A1 - Doyle, Ina-Merle A1 - Razum, Oliver A1 - Spallek, Jacob T1 - Einflussfaktoren auf die Einführung von Beikost bei Säuglingen – Ergebnisse der BaBi-Geburtskohorte in Deutschland T2 - Gesundheitswesen 2019 N2 - Hintergrund: Im ersten Lebensjahr erfolgt ein schrittweiser Übergang von Muttermilch bzw. Säuglingsmilchnahrung zur Familienkost, wobei die erste Gabe von Beikost zwischen 5. und 7. Lebensmonat erfolgen soll. Es ist wenig bekannt über soziodemographische bzw. klinische Einflussfaktoren auf die Beikosteinführung. Methodik: Datengrundlage der vorliegenden Untersuchung waren Baseline und erstes Follow-Up der Bielefelder Geburtskohorte BaBi (2013 – 2016, n = 777). Angaben zur Stilldauer, Einführung von Beikost sowie der Getränkegabe vor und während der Einführung von Beikost wurden telefonisch erhoben, als die Säuglinge zwischen neun und 12 Monaten alt waren. Einflussfaktoren auf die Beikosteinführung wurden mittels bi-und multivariater Datenanalyse untersucht. Ergebnisse: Bei Einführung der Beikost waren die Säuglinge im Mittel 5,4 ± 1,2 Monate alt. 2,6% der Säuglinge waren jünger als vier Monate, 12,5% der Säuglinge waren älter als 6,5 Monate. Lineare Regressionsanalysen zeigten eine direkte Assoziation zwischen der ausschließlichen Stilldauer bzw. dem Säuglingsalter bei letzter Mutter-/Säuglingsmilchgabe und dem Beikostbeginn (b = 0,31 [95%KI = 0,26 – 0,36; p ≤ 0,001; b = 0,12 [95% KI 0,07 – 0,18], p ≤ 0,001). Mütterliche Determinanten wie Alter, Bildungsstatus, Migrationsstatus, Familienstand, Parität, pränataler BMI und Rauchstatus vor und während der Schwangerschaft hatten keinen Einfluss auf den Beginn der Beikostgabe. 73,6% der befragten Frauen gaben an, schon einmal Probleme mit dem Füttern seit Beginn der Beikosteinführung gehabt zu haben. Diskussion: In der vorliegenden Analyse erfolgte der Beikostbeginn unabhängig von soziodemographischen und klinischen Parametern, jedoch führte längeres ausschließliches Stillen bzw. längere Mutter-/Säuglingsmilchgabe zu einem späteren Beikostbeginn. Weitere Untersuchungen sind notwendig, um Art, Umfang und mögliche Auswirkungen berichteter Probleme bei der Beikosteinführung bzw. eines verzögerten Beikostbeginns auf Mutter und Kind zu quantifizieren. KW - Beikost Y1 - 2019 U6 - https://doi.org/10.1055/s-0039-1694423 VL - 81 IS - 08/09 SP - 686 EP - 686 PB - Georg Thieme Verlag KG CY - Stuttgart ER - TY - GEN A1 - Wandschneider, Lisa A1 - Sauzet, Odile A1 - Breckenkamp, Jürgen A1 - Spallek, Jacob A1 - Razum, Oliver T1 - Kleinräumige Merkmale und ihr Einfluss auf ein niedriges Geburtsgewicht – eine theoriegeleitete Analyse T2 - 14. Jahrestagung der DGEpi, 11-13. September, Ulm N2 - Hintergrund: Der Wohnort kann eine Dimension sozialer Ungleichheiten darstellen, und es gibt Hinweise dafür, dass sich dieser bereits auf die perinatale Entwicklung auswirken könnte. Die zugrunde liegenden Wirkmechanismen sind nach wie vor unbekannt; theorie-basierte und hypothesengeleitete Analysen fehlen. Um diesen Herausforderungen zu begegnen, untersucht diese Studie, inwieweit kleinräumige Merkmale zu einem niedrigen Geburtsgewicht beitragen, unabhängig von individuellen Merkmalen. Auf der Grundlage eines konzeptionellen Modells1 wurden kleinräumige Merkmale ausgewählt, erhoben und deren Auswirkungen auf niedriges Geburtsgewicht analysiert. Methoden: Die Individualdaten stammen aus der Geburtskohortenstudie „Gesundheit von Babys und Kindern in Bielefeld“. Die Stichprobe besteht aus 958 Frauen und ihren Säuglingen, verteilt auf 80 statistische Bezirke in Bielefeld. Kleinräumige Daten wurden anhand von lokalen Lärmkarten, dem Emissionskataster, Google Street View und dem Melderegister erhoben. Zur Quantifizierung des Einflusses kleinräumiger Merkmale wurde eine lineare Mehrebenenanalyse mit einer Zwei-Ebenen-Struktur (Individuen, die in statistische Bezirke eingebettet sind) durchgeführt. Ergebnisse: Insgesamt sind die Auswirkungen der ausgewählten kleinräumigen Merkmale gering bis nicht existent, es zeigen sich keine signifikanten Effekten für niedriges Geburtsgewicht. Tendenziell weisen Neugeborene aus ästhetisch weniger ansprechenden und subjektiv unsicher wahrgenommenen Stadtteilen einen höheren Anteil an niedrigem Geburtsgewicht auf. Schlussfolgerungen: Die Analyse liefert keine eindeutigen Hinweise auf negative Auswirkungen kleinräumiger Faktoren auf ein niedriges Geburtsgewicht. Auf methodischer Seite bestätigt die Studie, dass ein angemessener Stichprobenumfang, eine zuverlässige Expositionsabschätzung und die Operationalisierung des kleinräumigen Kontextes mit Blick auf die verfügbaren Daten die zentralen Herausforderungen des Forschungsfeldes darstellen. KW - Geburtsgewicht Y1 - 2019 UR - https://www.eventclass.org/contxt_dgepi2019/online-program/session?s=AG13%7C1 SP - 113 EP - 113 ER - TY - GEN A1 - Grosser, Angelique A1 - Doyle, Ina-Merle A1 - Löffler, Antje A1 - Breckenkamp, Jürgen A1 - Spallek, Jacob A1 - Razum, Oliver A1 - Miani, Celine T1 - The impact of psychosocial factors on breastfeeding duration in the BaBi-Study. Analysis of a birth cohort study in Germany T2 - Gesundheitswesen 2019 N2 - Background: Breastfeeding is beneficial for both mother and child. In Germany, national guidelines recommend fully breastfeeding for at least 4 months, which has only been reached by 34% in 2012. The WHO's aim of exclusively breastfeeding for six months was reached by 19% only. Socio-economic status and migration background have been identified to be associated with duration of breastfeeding but little is known about the impact of psychosocial factors e.g. personality traits and social support. We hypothesized that there are differences in the psychosocial profiles of mothers regarding the duration of breastfeeding. Methods: Baseline and follow up data of the Bielefeld BaBi birth cohort (2013 – 16) were analysed. Bivariate and multivariate analyses were performed in order to identify psychosocial determinants for fully breastfeeding for four and six months. Results: Out of 780 BaBi study participants, 548 fully breastfeed for four months (70.3%) and 279 continued until at least six months (35.8%). Logistic regression analyses shows that fully breastfeeding for at least four or six months is independently associated with the intention to breastfeed (OR 7.3 [C.I. 4.54.-11.21) and the attendance of antenatal class (OR 1.4 [C.I. 1.01.-2.06). Personality characteristics, social status und migration background showed no significant association with breastfeeding duration. Conclusion: Our study results suggest to promote individuals' breastfeeding intention and the attendance of antenatal classes to increase breastfeeding duration. Since differences in breastfeeding practices have the potential to create inequalities in mother and child health, more efforts are needed to intensify research on modifiable factors influencing breastfeeding duration. KW - Breastfeeding Y1 - 2019 U6 - https://doi.org/10.1055/s-0039-1694422 VL - 81 IS - 08/09 SP - 686 EP - 686 PB - Georg Thieme Verlag CY - Stuttgart ER - TY - GEN A1 - Miani, Celine A1 - Ludwig, A. A1 - Breckenkamp, Jürgen A1 - Sauzet, Odile A1 - Doyle, Ina-Merle A1 - Höller-Holtrichter, Chantal A1 - Spallek, Jacob A1 - Razum, Oliver T1 - Socioeconomic and migration status as predictors of emergency caesarean section: a birth cohort study T2 - BMC pregnancy and childbirth N2 - BACKGROUND: Women with a migration background are reportedly at a higher risk of emergency caesarean section. There is evidence that this is due in part to suboptimal antenatal care use and quality of care. Despite the fact that migrant women and descendants of migrants are often at risk of socioeconomic disadvantage, there is, in comparison, scarce and incomplete evidence on the role of socioeconomic position as an independent risk factor for emergency caesarean delivery. We therefore investigate whether and how migration background and two markers of socioeconomic position affect the risk of an emergency caesarean section and whether they interact with each other. METHODS: In 2013-2016, we recruited women during the perinatal period in Bielefeld, Germany, collecting data on health and socioeconomic and migration background, as well as routine perinatal data. We studied associations between migration background (1st generation migrant, 2nd/3rd generation woman, no migration background), socioeconomic status (educational attainment and net monthly household income), and the outcome emergency caesarean section. RESULTS: Of the 881 participants, 21% (n = 185) had an emergency caesarean section. Analyses showed no association between having an emergency caesarean section and migration status or education. Women in the lowest (< 800€/month) and second lowest (between 800 and 1750€/month) income categories were more likely (aOR: 1.96, CI: 1.01-3.81; and aOR: 2.36, CI: 1.27-4.40, respectively) to undergo an emergency caesarean section than women in the higher income groups. CONCLUSIONS: Migration status and education did not explain heterogeneity in mode of birth. Having a low household income, however, increased the chances of emergency caesarean section and thereby contributed towards producing health disadvantages. Awareness of these findings and measures to correct these inequalities could help to improve the quality of obstetric care. KW - Acculturation KW - Birth cohort KW - Caesarean section KW - Education KW - Emergency KW - Germany KW - Income KW - Migration KW - Obstetric care KW - Socioeconomic determinants Y1 - 2020 U6 - https://doi.org/10.1186/s12884-020-2725-5 SN - 1471-2393 VL - 20 ER - TY - GEN A1 - Miani, Céline A1 - Razum, Oliver A1 - Spallek, Jacob T1 - Health of the offspring of immigrants: the BaBi birth cohort study T2 - Public Health Forum N2 - Children with a migration background are more at risk of health-related problems than those without a migration background. The German health system still does not adequately meet the challenges of on increasingly heterogeneous population, not least due to a lack of adequate epidemiological data and models. The BaBi study contributes to gaining new insights in the development of health inequalities due to cultural diversity in Germany, with a focus on pregnancy and early childhood. KW - cohort study KW - early childhood KW - migration KW - quantitative analysis KW - social epidemiology Y1 - 2019 UR - https://www.degruyter.com/view/j/pubhef.2019.27.issue-4/pubhef-2019-0062/pubhef-2019-0062.xml U6 - https://doi.org/10.1515/pubhef-2019-0062 SN - 1876-4851 SN - 0944-5587 VL - 27 IS - 4 SP - 298 EP - 300 ER - TY - GEN A1 - Grosser, Angelique A1 - Doyle, Ina-Merle A1 - Löffler, Antje A1 - Breckenkamp, Jürgen A1 - Spallek, Jacob A1 - Razum, Oliver A1 - Miani, Celine T1 - The impact of psychosocial factors on breastfeeding duration in the BaBi cohort study, Germany T2 - European Journal of Public Health N2 - Background: Breastfeeding is considered beneficial for both mother and child. In Germany, national guidelines recommend fully breastfeeding for at least 4 months, a goal reached by only 34% of mothers in 2012. The WHO’s recommendation of exclusively breastfeeding for six months was met by 19% only. Hardly modifiable factors such as socio-economic status and migration background have been associated with duration of breastfeeding but little is known about the impact of psychosocial factors such as personality traits and social support. We hypothesise that there are differences in the psychosocial profiles of mothers regarding the duration of breastfeeding. Methods: We analyse baseline and follow-up data of the Bielefeld BaBi birth cohort (2013-16). They include detailed migration and socio-economic backgrounds, as well as three measures of psychological characteristics: the optimism scale, the Big Five inventory and the locus of control scales. We perform bivariate and multivariate analyses in order to identify psychosocial determinants of fully breastfeeding for four and six months. Results: Out of 780 BaBi study participants, 548 fully breastfed for four months (70.3%), of which 279 continued until at least six months (35.8%). Logistic regression analyses show that fully breastfeeding for at least four or six months is independently associated with the intention to breastfeed and the attendance of antenatal class during this or previous pregnancies. Personality characteristics, social status and migration background show however no significant association with breastfeeding duration. Conclusions: Our study results support the promotion of individuals’ breastfeeding intention and attendance to antenatal classes to increase breastfeeding duration. Since differences in breastfeeding practices have the potential to create inequalities in maternal and child health, more efforts are needed to intensify research on modifiable factors influencing breastfeeding duration. KW - breastfeeding KW - cohort study KW - psychosocial Y1 - 2019 U6 - https://doi.org/10.1093/eurpub/ckz187.122 SN - 1464-360X SN - 1101-1262 VL - 29 IS - 4 ER - TY - GEN A1 - Sauzet, Odile A1 - Zolitschka, Kim Alexandra A1 - Spallek, Jacob A1 - Breckenkamp, Jürgen A1 - Razum, Oliver T1 - An ego-centred approach for the evaluation of health inequalities in urban areas T2 - European Journal of Public Health N2 - Background: Neighbourhood possesses attributes, structural, physical and social, for which pathways to health inequalities could be hypothesized. Hence, neighbourhood is a complex mixture of factors which cannot be simply defined by a delineation on a map, making common definitions of neighbourhood (e.g. administrative borders) problematic. We present a new concept for the evaluation of contextual health inequalities in an urban setting. Methods: An ego-centred approach to neighbourhood effects on health allows to establish to what degree the health outcomes of a person are on average correlated to the health outcomes of his/her neighbours. This approach does not necessitate the definition of what a neighbourhood is, or of its boundaries. Using data from the BaBi birth cohort following up 958 mother-child pairs in Bielefeld/Germany we illustrate how the method provides information about the spatial structure of a possible association between unmeasured neighbourhood factors and birthweight. Spatially correlated birthweight indicates a neighbourhood effect on maternal health. Results: A parametric model of the correlation structure gives two indicators: a distance after which health outcomes are no longer correlated (practical range), and the strength of correlation (RSV). We modelled birthweight directly and residuals after controlling for (spatially correlated) covariates. After adjusting for the mother’s demographics and neighbourhood characteristics, birthweights remained spatially correlated with RSV of 11% and a practical range of 128 m. Conclusions: Modelling the spatial correlation of a health outcome provides a measure of the degree of health correlation, thus offering new evidence on the production of health inequalities while incorporating current modelling approaches. Moreover, it measures heterogeneity in a city. This could be used as an indicator for policy makers or town planners to identify areas in need of socioeconomic investment. KW - health inequalities KW - urban KW - birth weight KW - child KW - demography KW - ego KW - Germany KW - socioeconomic factors KW - health disparity KW - towns KW - maternal health Y1 - 2019 U6 - https://doi.org/10.1093/eurpub/ckz186.243 SN - 1101-1262 SN - 1464-360X VL - 29 IS - 4 ER - TY - GEN A1 - Ludwig, Angelique A1 - Doyle, Ina-Merle A1 - Löffler, Antje A1 - Breckenkamp, Jürgen A1 - Spallek, Jacob A1 - Razum, Oliver A1 - Miani, Celine T1 - The impact of psychosocial factors on breastfeeding duration in the BaBi-Study. Analysis of a birth cohort study in Germany T2 - Midwifery N2 - Breastfeeding is beneficial for both mother and child. A breastfed child can benefit from improved mental developments, protection against infectious diseases and infectious disease mortality, and a decreased risk of overweight and obesity (Whalen and Cramton 2010)(Regional Office for Europe (World Health Organisation) 2019). Furthermore, there is evidence on protection against type 1 and 2 diabetes, allergic rhinitis, asthma or wheezing, atopic dermatitis, childhood leukemia, hypercholesterolemia later in life, sudden infant death syndrome (Whalen and Cramton 2010) and malocclusion (Victora et al. 2016). Breastfeeding women have a lower risk of breast and ovarian cancer, postpartum depression, and type 2 diabetes. They can, furthermore, benefit from prolonged lactational amenorrhea (Victora et al. 2016), improved postpartum sleep (Whalen and Cramton 2010) and postpartum weight loss (Kramer and Kakuma 2012). KW - psychosocial factors KW - breastfeeding duration KW - birth KW - cohort study Y1 - 2020 U6 - https://doi.org/10.1016/j.midw.2020.102688 SN - 1532-3099 SN - 0266-6138 VL - 86 ER - TY - GEN A1 - Wandschneider, Lisa A1 - Sauzet, Odile A1 - Breckenkamp, Jürgen A1 - Spallek, Jacob A1 - Razum, Oliver T1 - Small-Area Factors and Their Impact on Low Birth Weight—Results of a Birth Cohort Study in Bielefeld, Germany T2 - Frontiers in Public Health N2 - Introduction: The location of residence is a factor possibly contributing to social inequalities and emerging evidence indicates that it already affects perinatal development. The underlying pathways remain unknown; theory-based and hypothesis-driven analyses are lacking. To address these challenges, we aim to establish to what extent small-area characteristics contribute to low birth weight (LBW), independently of individual characteristics. First, we select small-area characteristics based on a conceptual model and measure them. Then, we empirically analyse the impact of these characteristics on LBW. Material and methods: Individual data were provided by the birth cohort study “Health of infants and children in Bielefeld/Germany.” The sample consists of 892 eligible women and their infants distributed over 80 statistical districts in Bielefeld. Small-area data were obtained from local noise maps, emission inventory, Google Street View and civil registries. A linear multilevel analysis with a two-level structure (individuals nested within statistical districts) was conducted. Results: The effects of the selected small-area characteristics on LBW are small to non-existent, no significant effects are detected. The differences in proportion of LBW based on marginal effects are small, ranging from zero to 1.1%. Newborns from less aesthetic and subjectively perceived unsafe neighbourhoods tend to have higher proportions of LBW. Discussion: We could not find evidence for negative effects of small-area factors on LBW, but our study confirms that obtaining adequate sample size, reliable measure of exposure and using available data for operationalisation of the small-area context represent the core challenges in this field of research. KW - low birth weight KW - small-area analysis KW - multilevel analysis KW - virtual audit KW - noise pollution KW - fine particulate matter KW - socioeconomic deprivation KW - cohort study Y1 - 2020 U6 - https://doi.org/10.3389/fpubh.2020.00136 SN - 2296-2565 VL - 8 ER - TY - GEN A1 - Ludwig, Angelique A1 - Miani, Céline A1 - Breckenkamp, Jürgen A1 - Sauzet, Odile A1 - Borde, Theda A1 - Doyle, Ina-Merle A1 - Brenne, Silke A1 - Höller-Holtrichter, Chantal A1 - David, Matthias A1 - Spallek, Jacob A1 - Razum, Oliver T1 - Are Social Status and Migration Background Associated with Utilization of Non-medical Antenatal Care? Analyses from Two German Studies T2 - Maternal and Child Health Journal N2 - 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.ResultsIn 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. KW - Non-medical antenatal care KW - Migration background KW - Education KW - Socioeconomic status KW - Pregnancy Y1 - 2020 U6 - https://doi.org/10.1007/s10995-020-02937-z SN - 1573-6628 SN - 1092-7875 VL - 24 IS - 7 SP - 943 EP - 952 ER -