Intergenerational transmission of health disparities among Turkish-origin residents in Germany: role of maternal stress and stress biology during pregnancy.
Final Report Abstract
Immigrants from low-to-high income countries face a high risk for health inequalities that are evident as early as at the time of birth suggesting intergenerational transmission of migrationrelated health disadvantages. However, relatively little is known about how these effects are transmitted across generations. Some health disparities of immigrants are believed to emerge as a biological consequence of immigration’s unfavourable social and psychological sequelae. Stress-related maternal-placental-fetal endocrine and immune/ inflammatory states during pregnancy are a key pathway by which maternal states and conditions can influence fetal development and subsequent pregnancy, birth, and child developmental and health outcomes. This is the first study on fetal programming of health disparities with a focus on migrant women in Germany. The study faced similar risks as other birth cohorts do. The study has implemented various measures, e.g., culturally sensitive recruitment, for recruitment and follow-up of as many pregnant women as possible, independent of their social or cultural background. Nevertheless, the response rate among families with lower socioeconomic status was lower. A total of N=144 pregnant women participated in the cohort study at Universität Bielefeld and Charité Universitätsmedizin Berlin. Blood and saliva samples to assess concentrations of endocrine and immune stress markers were collected at two time points during pregnancy (T1, 20-24 weeks, and T2, 30-34 weeks gestation). We found higher levels of inflammation (a composite score derived from circulating concentrations of IL-6 and CRP) in pregnant women with migrant background, overall and in the subgroup of Turkish origin, compared to women without migrant background. Furthermore, Turkish-origin women (2nd generation) had in general significantly lower cortisol concentrations compared to non-immigrant women. Turkish-origin women (1st and 2nd gen.) and other immigrant women (2nd gen.) showed a significantly flatter decrease of cortisol across the day (diurnal slope) than non-immigrant women, and this was more pronounced in 2nd gen. Turkish-origin women. Alterations in these stress-related biological immune and endocrine pathways during pregnancy could contribute to the transmission of health disadvantages over generations. Further research is needed to understand the underlying mechanisms and to repeat the findings in other migrant populations and in other groups that also face social disadvantages. Comparing concentrations of biological stress markers of pregnant migrant women to levels of pregnant women in the countries of origin, i.e. Turkey, would further help to elucidate the effect of migration on these outcomes during pregnancy. Our study findings provide a first step towards understanding the mechanism of the transmission of health inequalities, thereby supporting the development of targeted interventions to improve pregnancy and health outcomes in at-risk groups from a life course and intergenerational perspective.
Publications
- Intergenerational transmission of health disparities among Turkish-origin residents in Germany: role of maternal stress and stress biology during pregnancy. A study protocol, Eur J Pub Health 2018; 28: supplement 1.
Scholaske L, Lindner-Matthes D, Kurt M, Duman E, Sahbaz C, Spallek J, Entringer S
(See online at https://doi.org/10.1093/eurpub/cky048.044) - The role of discrimination for the risk of preterm birth among Turkish immigrant women, Eur J Pub Health 2018 28: supplement 4
Scholaske L, Brose A, Spallek J, Entringer S
- he German Version of the Multidimensional Acculturative Stress Inventory (MASI) for Turkish-Origin Immigrants. Measurement Invariance of Filter Questions and Validation. European Journal of Psychological Assessment. 2020
Scholaske L, Rodriguez N, Emel NS, Spallek J, Ziegler M, Entringer S
(See online at https://doi.org/10.1027/1015-5759/a000567) - Intergenerational transmission of health disparities among Turkish-origin immigrants in Germany: study protocol of a multi-centric cohort study (BaBi-stress and BaBeK study). BMC Pregnancy Childbirth. 2020 Mar 12;20(1):158
Spallek J, Scholaske L, Kurt M, Lindner-Matthes D, Entringer S
(See online at https://doi.org/10.1186/s12884-020-2853-y) - Association of maternal migrant background with inflammation during pregnancy - Results of a birth cohort study in Germany. Brain Behav Immun. 2021 Aug;96:271-278
Spallek J, Scholaske L, Duman EA, Razum O, Entringer S
(See online at https://doi.org/10.1016/j.bbi.2021.06.010) - Fetal programming of health disparities in children with a migrant background. Public Health Forum 2021; 29(2): 131–134
Scholaske L, Spallek J, Entringer S
(See online at https://doi.org/10.1515/pubhef-2021-0015) - Intergenerationale Übertragung von Migrationserfahrungen und fetale Programmierung von Krankheit und Gesundheit. In: Handbuch Migration und Gesundheit. Editors: Spallek J, Zeeb H. Hogrefe, 2021
Scholaske L, Spallek J, Entringer S
(See online at https://doi.org/10.1024/85995-000)
