TY - GEN A1 - Scholaske, Laura A1 - Brose, Annette A1 - Spallek, Jacob A1 - Entringer, Sonja T1 - Perceived discrimination and risk of preterm birth among Turkish immigrant women in Germany T2 - Social Science & Medicine N2 - Background: Health disparities, including adverse birth outcomes, exist between Turkish immigrants and the autochthonous population in Germany. The state of research on the risk of preterm birth (PTB, defined as <37 weeks of gestation), the leading cause of infant mortality and morbidity, among Turkish immigrant women is mixed. Perceived discrimination is discussed in the context of health disparities related to migration. We examined whether PTB risk is also increased in Turkish immigrant women in Germany and whether perceived discrimination due to origin contributes to this risk. Methods: We selected a sample from the German Socio-Economic Panel (SOEP) study of German autochthonous and Turkish immigrant women who recently gave birth (between 2002 and 2016) (N = 2,525, incl. n = 217 Turkish immigrant women of which n = 111 completed an item on perceived discrimination). The included variables of central interest were immigrant status, perceived discrimination, gestational age, and socioeconomic situation. Results: Logistic regression models indicated that PTB risk was significantly higher for Turkish immigrant women than autochthonous women (OR: 2.75, 95% CI [1.79–4.16]), even when adjusting for socioeconomic status. Within the subsample of Turkish immigrant women, perceived discrimination was related to a significantly higher PTB risk (OR: 4.91, 95% CI [1.76–15.06]). Conclusions: Our study provides evidence for a higher PTB risk in Turkish immigrant women compared to autochthonous women in Germany. Perceived discrimination may contribute to this higher risk. The findings represent an important first step towards developing targeted interventions to improve pregnancy and birth outcomes in minority groups. KW - Perceived discrimination KW - Preterm birth KW - Turkish immigrants KW - Health disparities Y1 - 2019 U6 - https://doi.org/10.1016/j.socscimed.2019.112427 SN - 0277-9536 SN - 1873-5347 SN - 0037-7856 VL - 236 ER - TY - GEN A1 - Spallek, Jacob A1 - Scholaske, Laura A1 - Kurt, Medlin A1 - Lindner-Matthes, Denise A1 - Entringer, Sonja T1 - Intergenerational transmission of health disparities among Turkish-origin immigrants in Germany: study protocol of a multi-centric cohort study (BaBi-stress and BaBeK study) T2 - BMC pregnancy and childbirth N2 - 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. KW - Transmission of health inequalities KW - Stress biology KW - Turkish immigrants KW - Pregnancy KW - Birth Y1 - 2020 U6 - https://doi.org/10.1186/s12884-020-2853-y VL - 20 IS - 1 SP - 158 ER - TY - GEN A1 - Spallek, Jacob A1 - Scholaske, Laura A1 - Duman, Elif Aysimi A1 - Razum, Oliver A1 - Entringer, Sonja T1 - Association of maternal migrant background with inflammation during pregnancy – results of a birth cohort study in Germany T2 - Brain, Behavior, and Immunity N2 - Background Health disparities in children of immigrants are prevalent from birth and are hypothesized to – in part – emerge as a biological consequence of migration’s unfavorable social and psychological sequelae. The aim of this study was to examine whether maternal migrant background is associated with inflammation during pregnancy - a key pathway by which maternal states and conditions during pregnancy may influence fetal development and subsequent pregnancy, birth, and child developmental and health outcomes. Material and Methods Data was available from 126 pregnant women who participated in a population based multi-site prospective birth cohort study in Bielefeld and Berlin, Germany. The study included two study visits in mid- and late pregnancy. At each visit, a composite maternal pro-inflammatory score was derived from circulating levels of plasma inflammatory markers (IL-6, CRP). Migrant background was defined by country of origin of participants and their parents’ (Turkey or other) and generation status (1st or 2nd generation). We applied hierarchical linear models (HLM) in order to quantify the relationship between different migrant background variables and inflammation during pregnancy after adjustment for potential confounders (including socioeconomic status). Results Migrant background was significantly associated with inflammation during pregnancy. When compared to women without migrant background, levels of inflammation were increased in 1) pregnant women with migrant background in general (B = 0.35, SE = 0.12, p < .01); 2) 1st (B = 0.28, SE = 0.15, p < .10) and 2nd generation (B = 0.40, SE = 0.15, p < .01); 3) women with a Turkish migrant background (B = 0.28, SE = 0.14, p < .10) and women with another migrant background (B = 0.42, SE = 0.15, p <.01); and 4) 2nd generation Turkish origin women (B = 0.38, SE = 0.20, p <.10), 1st generation women with other migrant background (B = 0.44, SE = 0.26, p <.10), and 2nd generation women with other migrant background (B=0.43, SE = 0.17, p <.05). Discussion Our findings support a role for maternal inflammation as a pathway of intergenerational transmission of migration-related health inequalities, suggest that the effect seems to persist in 2nd generation immigrants, and highlight the need for future research and targeted interventions in this context. KW - Transmission of Health Inequalities KW - Stress biology KW - Immigrants KW - Inflammation Y1 - 2021 U6 - https://doi.org/10.1016/j.bbi.2021.06.010 SN - 1090-2139 VL - Vol. 96 SP - 271 EP - 278 ER - TY - GEN A1 - Scholaske, Laura A1 - Spallek, Jacob A1 - Entringer, Sonja T1 - Perceived stress and depressive symptoms during pregnancy and postpartum in Turkish-origin women living in German T2 - Journal of Psychosomatic Research N2 - Objective: People of Turkish origin (also referred to as “with a Turkish migrant background”) are one of the largest migrant groups in Germany and show disparities across different stress-related health outcomes. Specifically, women of Turkish origin in Germany have a greater risk for some mental health issues and adverse pregnancy and birth outcomes compared to women without migrant background. We tested differences between women of Turkish origin and women without migrant background in self-reported pregnancy and postpartum stress experiences and depressive symptoms. Methods: 32 women of Turkish origin (mean age 29.7 years) and 77 women without migrant background (mean age 32 years) participated in a multi-site prospective cohort study with two study visits during pregnancy and one month postpartum. Women provided sociodemographic data and completed the Perceived Stress Scale (PSS) and the Center for Epidemiology – Depression (CESD) scale at each study visit. Results: Using hierarchical linear models, we found that women of Turkish origin (both first and second gen- eration) reported more perceived stress (b = 0.57, CI: 0.29–0.84, p < 0.001) and depressive symptoms (b = 0.32, CI = 0.14–0.49, p < 0.001) compared to women without migrant background across gestation. A linear regression analysis showed that there was also a significant difference in depressive symptoms at one month postpartum (b = 0.35, CI = 0.03–0.66, p < 0.05). Conclusion: Tailored psychosocial interventions are needed to address mental health needs of pregnant Turkish origin women and to intervene on the possible transmission of stress-related health disadvantages to their offspring. KW - Depression Turkish origin women KW - Perceived stress KW - Pregnancy KW - Turkish origin women Y1 - 2024 U6 - https://doi.org/10.1016/j.jpsychores.2023.111570 SN - 0022-3999 IS - 177 ER - TY - GEN A1 - Scholaske, Laura A1 - Spallek, Jacob A1 - Duman, Elif Aysimi A1 - Adam, Emma K. A1 - Razum, Oliver A1 - Entringer, Sonja T1 - Increased Levels of Psychological Stress and Alterations in Stress Biology during Pregnancy among Women of Turkish-Origin in Germany T2 - Psychoneuroendocrinology N2 - Background People of Turkish origin constitute one of the biggest migrant groups in Germany. They have an increased risk to develop stress-related health disadvantages, and this risk is also prevalent in the offspring generation from early ages on. We have conducted a multi-site prospective cohort study to examine the role of stress and stress biology in this intergenerational perpetuation of health disparities. Methods 140 pregnant women (33 of Turkish origin) participated in a prospective cohort study with two study visits during pregnancy and one after birth (T1: 20-25 weeks of gestation, T2: 30-35 weeks of gestation, T3: four weeks after birth). At T1 and T2, women completed the Perceived Stress Scale and Center for Epidemiologic Studies Depression Scale and collected saliva samples after awakening, 30 minutes after awakening, and in the evening, and venous blood samples were collected for analysis of CRP and IL-6 concentrations. Results Multilevel models showed that Turkish-origin women exhibited higher levels of perceived stress and depressive symptoms, had increased inflammatory levels (Spallek et al., 2021), a blunted cortisol awakening response and flatter diurnal cortisol slope during pregnancy compared to non-migrant women after adjustment for socioeconomic factors.Some of the effects were mainly driven by 2nd generation migrants. Conclusions Increased levels of psychosocial stress and stress-related biological alterations among Turkish-origin pregnant women may contribute to the intergenerational transmission of health disadvantages in this group. Y1 - 2023 UR - https://www.sciencedirect.com/science/article/pii/S0306453023002470?via%3Dihub U6 - https://doi.org/10.1016/j.psyneuen.2023.106269 SN - 0306-4530 VL - 153 PB - ScienceDirect ER - TY - GEN A1 - Scholaske, Laura A1 - Spallek, Jacob A1 - Entringer, Sonja T1 - Women of Turkish origin exhibit higher stress levels during pregnancy: Results from a prospective cohort study T2 - Bewegte Zeiten: Lebenswelten im Wandel - Gemeinsamer Kongress der Deutschen Gesellschaft für Medizinische Psychologie e.V. & der Deutschen Gesellschaft für Medizinische Soziologie e.V. N2 - Health inequalities exist between people with and without a migration background in many societies. These inequalities seem to be perpetuated to the offspring generation born in the host country. This phenomenon is also observed among people of Turkish origin in Germany. Stress psychological and stress biological processes during pregnancy may play an important role in how maternal conditions may be transmitted to the child. We present here findings on the role of Turkish migration background for psychological stress experiences and stress biology during pregnancy. 140 pregnant women (81 non migrant German, 33 of Turkish origin, 26 of other origin) participated in a prospective cohort study that was carried out in Bielefeld and Berlin and that encompassed two study visits during pregnancy at first and second trimester pregnancy (Spallek et al., 2020). At both study visits, we derived concentrations of maternal inflammatory markers (CRP, IL-6) and diurnal cortisol profiles, and participants completed the Perceived Stress Scale (PSS) and Center for Epidemiologic Studies Depression Scale (CESD). Multilevel models showed that Turkish-origin women had increased inflammatory levels (Spallek et al., 2021), a blunted cortisol awakening response and flatter diurnal cortisol slope (Entringer et al., 2022), and they exhibited higher levels of perceived stress and depressive symptoms during pregnancy compared to non-migrant women after adjustment for socioeconomic factors. Women of Turkish origin show increased stress levels on the psychological and biological level during pregnancy. The potential role of this elevated stress for the offspring’s health is subject to future analyses. Y1 - 2023 UR - https://www.uni-giessen.de/de/fbz/fb11/institute/med_psych/bewegtezeiten/programm/programm-und-abstract-band_dgmp-dgms2023.pdf/view SP - 173 ER - TY - GEN A1 - Scholaske, Laura A1 - Spallek, Jacob A1 - Entringer, Sonja T1 - Fetale Programmierung von Gesundheitsdisparitäten bei Kindern mit Migrationshintergrund T2 - Public Health Forum N2 - Kinder von Migrant*innen zeigen bereits in frühen Lebensjahren häufig Gesundheitsdisparitäten, die mit mütterlicher Gesundheit und migrationsbezogenen Faktoren eng zusammenhängen. Zur Erklärung dieses Phänomens der intergenerationalen Transmission von Gesundheitsdisparitäten schlagen wir ein Modell vor, das eine Lebensverlaufsperspektive mit dem Konzept der fetalen Programmierung von Gesundheit und Krankheitsvulnerabilität zusammenbringt. KW - Fetale Programmierung KW - Gesundheitliche Ungleichheiten KW - Intergenerationale Übertragung KW - Migrant*innen Y1 - 2021 UR - https://www.degruyter.com/document/doi/10.1515/pubhef-2021-0015/html U6 - https://doi.org/10.1515/pubhef-2021-0015 SN - 1876-4851 VL - 29 IS - 2 SP - 131 EP - 134 ER - TY - CHAP A1 - Scholaske, Laura A1 - Spallek, Jacob A1 - Entringer, Sonja ED - Spallek, Jacob ED - Zeeb, Hajo T1 - Intergenerationale Übertragung von Migrationserfahrungen und fetale Programmierung von Krankheit und Gesundheit T2 - Handbuch Migration und Gesundheit : Grundlagen, Perspektiven und Strategien N2 - Gesundheitsdisparitäten manifestieren sich in der Nachkommengeneration von Migrant*innen teilweise schon in frühen Lebensjahren. Viele dieser Gesundheits-disparitäten werden durch sozioökonomische Benachteiligung und Akkulturation vermittelt. Anhand des Konzeptes der fetalen Pro-grammierung kann erklärt werden, dass das mütterliche Stresserleben – vermittelt über endokrine und immunologische Prozesse – die spätere Gesundheit und Krank-heitsvulnerabilität der Nachkommen bereits in der Schwangerschaft beeinflusst. Es gibt aus der internationalen Forschung zahlreiche Belege dafür, dass endokrine und immunologische Prozesse den Zusam-menhang zwischen mütterlichen migrationsbezogenen Stressoren und Schwangerschafts-, Geburts- und späteren Gesundheitsoutcomes des Kindes vermitteln. Bei Migrant*innen in Deutschland sind diese Zusammenhänge weitestgehend unterforscht. KW - Intergenerationale Übertragung KW - Migrationserfahrungen Y1 - 2021 SN - 978-3-456-85995-8 SP - 351 EP - 368 PB - Hogrefe AG CY - Bern ET - 1 ER - TY - GEN A1 - Scholaske, Laura A1 - Entringer, Sonja A1 - Razum, Oliver A1 - Spallek, Jacob T1 - Elevated stress during pregnancy in women of Turkish origin: Results from a prospective cohort study T2 - European Journal of Public Health N2 - Background Ethnic health disparities exist in the context of pregnancy and childbirth, suggesting that women of Turkish origin (i.e., they or their parents born in Turkey) in Germany have higher risks for some adverse maternal health and child developmental outcomes. Stress is believed to be a relevant pathway by which migration may be associated with these risks. In this study, we tested associations of Turkish origin with stress biology and psychological stress experiences during pregnancy. Methods 140 pregnant women (33 of Turkish/26 of other origin) participated in a prospective cohort study that was carried out in Bielefeld and Berlin (Spallek et al., 2020). Inflammatory markers CRP and IL-6 from venous blood samples and diurnal cortisol profiles from salivary cortisol samples were derived and participants completed the Perceived Stress Scale (PSS) and Center for Epidemiologic Studies Depression Scale (CESD) at two study visits during pregnancy (T1: 20-25 weeks of gestation, T2: 30-35 weeks of gestation). Multilevel models were conducted to account for the nested data structure due to repeated measurements. Results Compared to non-migrant women, women of Turkish origin had significantly higher inflammatory levels (b = 0.28, SE = 0.14, p=.052) (Spallek et al., 2021), a blunted cortisol awakening response (b=-0.21, CI=-0.38–0.03, p<.05), a flatter diurnal cortisol slope (b = 0.02, CI = 0.00-0.04, p<.05), and higher PSS (b = 0.46, SE = 0.13, p< .001) and CESD scores (b = 0.29, SE = 0.08, p<.001) during pregnancy after adjusting for socioeconomic factors. Conclusions The results of our study suggest higher stress at the biological and psychological level in pregnant women of Turkish origin. Stress is a risk factor for pregnancy complications and poor birth and child developmental outcomes. To reduce such unequally distributed risks, interventions for stress reduction are needed that are tailored to women of Turkish origin. KW - stress KW - pregnancy KW - Turkish origin KW - prospective cohort study Y1 - 2022 UR - https://academic.oup.com/eurpub/article/32/Supplement_3/ckac129.608/6765682?searchresult=1 U6 - https://doi.org/10.1093/eurpub/ckac129.608 SN - 1101-1262 SN - 1464-360X VL - 32 IS - Supplement_3 ER - TY - GEN A1 - Entringer, Sonja A1 - Scholaske, Laura A1 - Kurt, Medlin A1 - Duman, Elif Aysimi A1 - Adam, Emma K. A1 - Razum, Oliver A1 - Spallek, Jacob T1 - Diurnal cortisol variation during pregnancy in Turkish origin and non-migrant women in a German birth cohort study T2 - Journal of Psychosomatic Research N2 - Background Immigrants from Turkey experience health disadvantages relative to non-immigrant populations in Germany that are manifest from the earliest stages of the lifespan onwards and are perpetuated across generations. Chronic stress and perturbations of stress-responsive physiological systems, including the hypothalamus-pituitary-adrenal (HPA)-axis, are believed to in part mediate this relationship. Cortisol plays an important role in the association between maternal stress during pregnancy and many pregnancy-, birth- and offspring-related outcomes. We therefore examined whether maternal migrant background is associated with diurnal cortisol variation during pregnancy. Methods 109 pregnant women (incl. n = 32 Turkish origin women) that participated in a multi-site prospective cohort study in Germany collected saliva samples across the day on two consecutive days around 24 and 32 weeks gestation. Hierarchical linear models were applied to quantify associations between migrant background and diurnal cortisol variation across pregnancy. Results Women of Turkish origin exhibited a significantly lower cortisol awakening response (CAR) and a flatter diurnal cortisol slope (DCS) compared to non-migrant women after adjusting for household income. These relationships between migrant status and diurnal cortisol variation were mainly driven by 2nd generation migrants. Discussion A potential HPA axis dysregulation of Turkish-origin pregnant women may contribute to the intergenerational transmission of health disadvantages in this group. KW - cortisol variation KW - pregnancy KW - Turkish origin KW - birth cohort study KW - Germany Y1 - 2022 UR - https://www.sciencedirect.com/science/article/abs/pii/S0022399922003051 U6 - https://doi.org/10.1016/j.jpsychores.2022.111020 SN - 0022-3999 VL - 162 SP - 1 EP - 10 ER -