title: The association of pre-pregnancy overweight and obesity with delivery outcomes: a comparison of immigrant and non-immigrant women in Berlin, Germany.
abstract: OBJECTIVE
  To analyse the influence of maternal overweight/obesity on delivery outcomes among first- and second-generation immigrant women and non-immigrant women.
  
  
  METHODS
  We used perinatal data from Berlin/Germany (n = 1987 first generation, n = 687 second generation, n = 2185 non-immigrants; gestational age: 24+ weeks; maternal age: 18+ years). Poisson models were fitted to estimate the effect of pre-pregnancy overweight/obesity (categorised according to WHO) on mode of delivery (vaginal vs. emergency caesarean section (ECS)) and labour onset (spontaneous vs. induced).
  
  
  RESULTS
  First generation, second generation and non-immigrant women were more likely to have their labour induced when obese [first generation: RR = 1.41 (95 % CI: 1.15-1.72); second generation: RR = 1.51 (95 % CI: 1.14-2.00); non-immigrants: RR = 1.53 (95 % CI: 1.28-1.81)] compared to normal weight. There were also indications of obese women being more likely to deliver by ECS than women of normal weight, irrespective of migrant status.
  
  
  CONCLUSIONS
  An elevated RR for obese and in parts for overweight women of labour induction and ECS pertains irrespective of migrant status. This warrants further research looking into pathophysiological in addition to health-system factors. Weight control interventions addressed at overweight/obese women planning pregnancies are urgently needed.
authors.affiliation: Department of Epidemiology and International Public Health, Bielefeld School of Public Health (BiSPH), Bielefeld University, Bielefeld, Germany.
authors.forename: Katharina
authors.initials: K
authors.lastname: Reiss
authors.affiliation: Department of Epidemiology and International Public Health, Bielefeld School of Public Health (BiSPH), Bielefeld University, Bielefeld, Germany. juergen.breckenkamp@uni-bielefeld.de.
authors.forename: Jürgen
authors.initials: J
authors.lastname: Breckenkamp
authors.affiliation: Alice Salomon Hochschule Berlin, University of Applied Sciences, Berlin, Germany.
authors.forename: Theda
authors.initials: T
authors.lastname: Borde
authors.affiliation: Department of Gynecology, Campus Virchow-Klinikum, Charité Universitätsmedizin Berlin, Berlin, Germany.
authors.forename: Silke
authors.initials: S
authors.lastname: Brenne
authors.affiliation: Department of Gynecology, Campus Virchow-Klinikum, Charité Universitätsmedizin Berlin, Berlin, Germany.
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Henrich
authors.affiliation: Department of Gynecology, Campus Virchow-Klinikum, Charité Universitätsmedizin Berlin, Berlin, Germany.
authors.forename: Matthias
authors.initials: M
authors.lastname: David
authors.affiliation: Department of Epidemiology and International Public Health, Bielefeld School of Public Health (BiSPH), Bielefeld University, Bielefeld, Germany.
authors.forename: Oliver
authors.initials: O
authors.lastname: Razum
mesh_terms: D000293:Adolescent; D000328:Adult; D001604:Berlin; D015992:Body Mass Index; D036861:Delivery, Obstetric / Q000379:methods*; D054242:Emigrants and Immigrants / Q000706:statistics & numerical data*; D005260:Female; D015438:Health Behavior / Q000208:ethnology; D006801:Humans; D007751:Labor, Induced; D009765:Obesity / Q000208:ethnology; D050177:Overweight / Q000208:ethnology*; D011247:Pregnancy; D011248:Pregnancy Complications / Q000208:ethnology; D011256:Pregnancy Outcome / Q000208:ethnology*; D012307:Risk Factors; D012959:Socioeconomic Factors; D055815:Young Adult
keywords: Emergency caesarean section; Immigrants; Induction of labour; Overweight/obesity; Pre-pregnancy BMI