Perinatales Outcome bei Frauen mit Gestationsdiabetes unter besonderer Berücksichtigung eines Migrationshintergrundes – Ergebnisse einer prospektiven Studie in Berlin

Zusammenfassung

Hintergrund Etwa 25 % der Bevölkerung Deutschlands haben einen Migrationshintergrund (MH), der mit einem schlechteren perinatalen Outcome einhergehen kann. Der Gestationsdiabetes (GDM) gehört zu den häufigsten Schwangerschaftserkrankungen; von ihm sind Frauen mit MH in höherem Maße betroffen. Bisher liegen keine systematisch erhobenen Daten zur Betreuung von Migrantinnen mit GDM vor.

Fragestellung Ziel der Studie war es, Auswirkungen eines MH auf Schwangerschaften von Frauen mit GDM zu evaluieren: Haben Immigrantinnen und ihre Nachkommen ein schlechteres perinatales Outcome als Frauen ohne MH in den Parametern Geburtseinleitung, Sectio, Makrosomie, Apgar, Nabelschnur-pH-Wert, Verlegung auf eine neonatologische Intensivstation, Frühgeburt und prä-/postpartale Hb-Differenz? Beeinflusst ein MH außerdem den Zeitpunkt der ersten Schwangerenvorsorge sowie die Zahl der Vorsorgeuntersuchungen?

Methoden Datenerhebung an drei Berliner Geburtskliniken 2011/2012 unmittelbar in der Kreißsaalaufnahme über 12 Monate anhand standardisierter Interviews (Fragebogenset) in deutscher, türkischer und anderen Sprachen. Fragen zu soziodemografischen Aspekten, Schwangerenvorsorge sowie ggf. Migration und Akkulturation. Verknüpfung der Befragungsdaten mit Mutterpass- und klinischen Perinataldaten. Adjustierung für Alter, BMI, Parität und sozioökonomischen Status erfolgte in Regressionsmodellen.

Ergebnisse Die Daten von n = 2878 Frauen mit MH (GDM: 4,7 %) und n = 2785 Frauen ohne MH (GDM: 4,8 %) konnten verglichen werden. Eine multiple Regressionsanalyse zeigte keine Unterschiede in den Chancen der beiden Gruppen mit GDM hinsichtlich Sectio, Makrosomie, Apgar, Nabelschnur-pH-Werten, Verlegungen auf eine neonatologische Intensivstation sowie Zeitpunkt der ersten Schwangerenvorsorge ≥ 12 SSW und Zahl der Vorsorgeuntersuchungen < 10. Sowohl für Frauen mit GDM und MH (OR 1,57; 95 %-KI 1,08–2,27) als auch für solche mit GDM ohne MH (OR 1,47; 95 %-KI 1,01–2,14) bestand eine signifikant höhere Chance der Geburtseinleitung.

Schlussfolgerung Frauen mit GDM und MH zeigen ein ähnlich gutes Schwangerschaftsergebnis wie solche mit GDM und ohne MH, was auf eine hohe Qualität der peripartalen Betreuung und Versorgung hinweist. Im Vergleich zu Frauen ohne GDM wird bedingt durch diesen und den höheren BMI unabhängig vom MH vermehrt eingeleitet. Die Ergebnisse für Frauen mit GDM lassen unabhängig vom MH auf einen ähnlichen Standard der Inanspruchnahme von Vorsorgeuntersuchungen in der Schwangerschaft schließen.

Abstract

Background About 25 % of the population of Germany has a migrant background (MB), which can be associated with a poorer perinatal outcome. Gestational diabetes mellitus (GDM), one of the most common diseases in pregnancy, affects immigrant women to a greater extent. So far, no systematically collected data on the care of migrants with GDM are available.

Aims The aim of the study was to evaluate the effects of a MB on the outcome of pregnancies in women with GDM: Do immigrant women and their descendants have worse perinatal outcome data than non-immigrant women in the parameters induction of labor, caesarean section, macrosomia, Apgar score, umbilical cord arterial pH, transfer to a neonatal intensive care unit (NICU), and pre-/postpartum Hb difference? Does a MB also influence the time of the first prenatal check-up as well as the number of prenatal examinations?

Methods Data were obtained from three maternity clinics (tertiary centers) in Berlin, Germany, for a 12-month period in 2011/2012. The standardized interviews on admission to the delivery wards based on questionnaires which covered socio-demographic factors and information on use of antenatal care as well as immigration history and acculturation. The data was supplemented by information obtained from the official maternal record of prenatal care (‘Mutterpass’) and perinatal data routinely documented in the hospital. Regression modeling was used to adjust for age, BMI, parity and socio-economic status.

Results The data of n = 2878 immigrant women (GDM: 4.7 %) and n = 2785 non-immigrant women (GDM: 4.8 %) were included. A multiple regression analysis showed no statistically significant difference in the chances of the two groups with GDM with regard to caesarean sections, macrosomia, Apgar score, umbilical cord arterial pH, transfers to NICU, the time of the first prenatal check-up ≥ 12 gestational weeks and the number of prenatal examinations < 10. Both women with GDM and MB (OR 1.57; 95 % CI 1.08–2.27) and GDM without MB (OR 1.47; 95 % CI 1.01–2.14) had a significantly higher chance of induction of labor.

Conclusions The factor MB did not affect the perinatal outcome in pregnant women with GDM, which indicates a high quality of the peripartum care. Regardless the MB, compared to women without GDM the chance for induction of labor is increased due to the diabetes and higher BMI. The results for immigrant and non-immigrant women with GDM suggest a similar standard of prenatal care.

Schlüsselwörter

Migration - Migrationshintergrund - Gestationsdiabetes - Perinataldaten - Geburtseinleitung

Key words

migration - migrant background - gestational diabetes - perinatal data - induction of labor

Publication History

Received: 02 January 2021

Accepted: 06 April 2021

Article published online:
15 June 2021

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