{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,12]],"date-time":"2026-09-12T16:58:18Z","timestamp":1789232298610,"version":"build-2803163510"},"reference-count":43,"publisher":"MDPI AG","issue":"9","license":[{"start":{"date-parts":[[2018,9,5]],"date-time":"2018-09-05T00:00:00Z","timestamp":1536105600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100009139","name":"Deutsches Zentrum f\u00fcr Infektionsforschung","doi-asserted-by":"publisher","award":["Infrastructure"],"award-info":[{"award-number":["Infrastructure"]}],"id":[{"id":"10.13039\/100009139","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100005624","name":"Medizinischen Hochschule Hannover","doi-asserted-by":"publisher","award":["Clinician Scientist"],"award-info":[{"award-number":["Clinician Scientist"]}],"id":[{"id":"10.13039\/501100005624","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["IJERPH"],"abstract":"<jats:p>Background: Immigration into Europe has reached an all-time high. Provision of coordinated healthcare, especially to refugee women that are at increased risk for adverse pregnancy outcomes, is a challenge for receiving health care systems. Methods: We assessed pregnancy rates and associated primary healthcare needs in three refugee cohorts in Northern Germany during the current crisis. Results: Out of n = 2911 refugees, 18.0% were women of reproductive age, and 9.1% of these were pregnant. Pregnancy was associated with a significant, 3.7-fold increase in primary health care utilization. Language barrier and cultural customs impeded healthcare to some refugee pregnant women. The most common complaints were demand for pregnancy checkup without specific symptoms (48.6%), followed by abdominal pain or urinary tract infections (in 11.4% of cases each). In 4.2% of pregnancies, severe complications such as syphilis or suicide attempts occurred. Discussion: We present data on pregnancy rates and pregnancy associated medical need in three current refugee cohorts upon arrival in Germany. Healthcare providers should be particularly aware of the requirements of pregnant migrants and should adapt primary caretaking strategies accordingly.<\/jats:p>","DOI":"10.3390\/ijerph15091934","type":"journal-article","created":{"date-parts":[[2018,9,6]],"date-time":"2018-09-06T02:55:07Z","timestamp":1536202507000},"page":"1934","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":29,"title":["Pregnancy Related Health Care Needs in Refugees\u2014A Current Three Center Experience in Europe"],"prefix":"10.3390","volume":"15","author":[{"given":"Christian","family":"Dopfer","sequence":"first","affiliation":[{"name":"Department of Pediatric Pneumology, Allergology, and Neonatology, Hannover Medical School, 30625 Hannover, Germany"},{"name":"German Center for Lung Research, Biomedical Research in End Stage and Obstructive Lung Disease\/BREATH Hannover, 30625 Hannover, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Annabelle","family":"Vakilzadeh","sequence":"additional","affiliation":[{"name":"Hannover Medical School, 30625 Hannover, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christine","family":"Happle","sequence":"additional","affiliation":[{"name":"Department of Pediatric Pneumology, Allergology, and Neonatology, Hannover Medical School, 30625 Hannover, Germany"},{"name":"German Center for Lung Research, Biomedical Research in End Stage and Obstructive Lung Disease\/BREATH Hannover, 30625 Hannover, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8951-9874","authenticated-orcid":false,"given":"Evelyn","family":"Kleinert","sequence":"additional","affiliation":[{"name":"Department of General Practice, University Medical Center G\u00f6ttingen, 37073 G\u00f6ttingen, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9496-9423","authenticated-orcid":false,"given":"Frank","family":"M\u00fcller","sequence":"additional","affiliation":[{"name":"Department of General Practice, University Medical Center G\u00f6ttingen, 37073 G\u00f6ttingen, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Diana","family":"Ernst","sequence":"additional","affiliation":[{"name":"Department of Clinical Immunology and Rheumatology, Hannover Medical School, 30625 Hannover, Germany"},{"name":"German Center for Infection Research (DZIF), Partner Site Hannover-Braunschweig, 38124 Braunschweig, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Reinhold E.","family":"Schmidt","sequence":"additional","affiliation":[{"name":"Department of Clinical Immunology and Rheumatology, Hannover Medical School, 30625 Hannover, Germany"},{"name":"German Center for Infection Research (DZIF), Partner Site Hannover-Braunschweig, 38124 Braunschweig, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Georg M. N.","family":"Behrens","sequence":"additional","affiliation":[{"name":"Department of Clinical Immunology and Rheumatology, Hannover Medical School, 30625 Hannover, Germany"},{"name":"German Center for Infection Research (DZIF), Partner Site Hannover-Braunschweig, 38124 Braunschweig, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sonja","family":"Merkesdal","sequence":"additional","affiliation":[{"name":"Department of Clinical Immunology and Rheumatology, Hannover Medical School, 30625 Hannover, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Martin","family":"Wetzke","sequence":"additional","affiliation":[{"name":"Department of Pediatric Pneumology, Allergology, and Neonatology, Hannover Medical School, 30625 Hannover, Germany"},{"name":"German Center for Infection Research (DZIF), Partner Site Hannover-Braunschweig, 38124 Braunschweig, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7129-100X","authenticated-orcid":false,"given":"Alexandra","family":"Jablonka","sequence":"additional","affiliation":[{"name":"Department of Clinical Immunology and Rheumatology, Hannover Medical School, 30625 Hannover, Germany"},{"name":"German Center for Infection Research (DZIF), Partner Site Hannover-Braunschweig, 38124 Braunschweig, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2018,9,5]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","unstructured":"Puchner, K., Karamagioli, E., Pikouli, A., Tsiamis, C., Kalogeropoulos, A., Kakalou, E., Pavlidou, E., and Pikoulis, E. (2018). Time to Rethink Refugee and Migrant Health in Europe: Moving from Emergency Response to Integrated and Individualized Health Care Provision for Migrants and Refugees. Int. J. Environ. Res. Public Health, 15.","DOI":"10.3390\/ijerph15061100"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"283","DOI":"10.1016\/j.cmi.2017.03.012","article-title":"Migration and infectious diseases","volume":"23","author":"Castelli","year":"2017","journal-title":"Clin. Microbiol. Infect."},{"key":"ref_3","doi-asserted-by":"crossref","unstructured":"Heslehurst, N., Brown, H., Pemu, A., Coleman, H., and Rankin, J. (2018). Perinatal health outcomes and care among asylum seekers and refugees: A systematic review of systematic reviews. BMC Med., 16.","DOI":"10.1186\/s12916-018-1064-0"},{"key":"ref_4","doi-asserted-by":"crossref","unstructured":"Gibson-Helm, M., Teede, H., Block, A., Knight, M., East, C., Wallace, E.M., and Boyle, J. (2014). Maternal health and pregnancy outcomes among women of refugee background from African countries: A retrospective, observational study in Australia. BMC Pregnancy Childbirth, 14.","DOI":"10.1186\/s12884-014-0392-0"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"134","DOI":"10.1080\/00016340802603805","article-title":"Stillbirths and infant deaths among migrants in industrialized countries","volume":"88","author":"Gissler","year":"2009","journal-title":"Acta Obstet. Gynecol. Scand."},{"key":"ref_6","first-page":"79","article-title":"Obstetric profiles and pregnancy outcomes of immigrant women with refugee status","volume":"94","author":"Flynn","year":"2001","journal-title":"Ir. Med. J."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"737","DOI":"10.1080\/00016340009169187","article-title":"Increased perinatal mortality among sub-Saharan immigrants in a city-population in Sweden","volume":"79","author":"Essen","year":"2000","journal-title":"Acta Obstet. Gynecol. Scand."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"1630","DOI":"10.1111\/j.1471-0528.2008.01942.x","article-title":"Somali women and their pregnancy outcomes postmigration: Data from six receiving countries","volume":"115","author":"Small","year":"2008","journal-title":"BJOG"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"934","DOI":"10.1016\/j.socscimed.2009.06.027","article-title":"Migration to western industrialised countries and perinatal health: A systematic review","volume":"69","author":"Gagnon","year":"2009","journal-title":"Soc. Sci. Med."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"157","DOI":"10.1159\/000328318","article-title":"Pregnancy outcome of migrant women delivering in a public institution in northern Italy","volume":"72","author":"Zanconato","year":"2011","journal-title":"Gynecol. Obstet. Investig."},{"key":"ref_11","unstructured":"World Health Organization (2018, June 28). WHO Recommendations on Antenatal Care for a Positive Pregnancy Experience. Available online: http:\/\/apps.who.int\/iris\/bitstream\/handle\/10665\/250796\/9789241549912-eng.pdf."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"116","DOI":"10.1111\/birt.12159","article-title":"Maternal health and pregnancy outcomes comparing migrant women born in humanitarian and nonhumanitarian source countries: A retrospective, observational study","volume":"42","author":"Teede","year":"2015","journal-title":"Birth"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"2494","DOI":"10.1007\/s10995-016-2072-3","article-title":"Use of maternal health services: Comparing refugee, immigrant and US-born populations","volume":"20","author":"Kentoffio","year":"2016","journal-title":"Matern. Child Health J."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"578","DOI":"10.1007\/s00103-016-2333-8","article-title":"Current seroprevalence, vaccination and predictive value of liver enzymes for hepatitis B among refugees in Germany","volume":"59","author":"Hampel","year":"2016","journal-title":"Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"375","DOI":"10.1007\/s15010-018-1134-4","article-title":"Notifiable infectious diseases in refugees and asylum seekers: Experience from a major reception center in Munich, Germany","volume":"46","author":"Alberer","year":"2018","journal-title":"Infection"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"487","DOI":"10.1007\/s40121-017-0169-7","article-title":"Measles, Rubella and Varicella IgG Seroprevalence in a Large Refugee Cohort in Germany in 2015: A Cross-Sectional Study","volume":"6","author":"Jablonka","year":"2017","journal-title":"Infect. Dis. Ther."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"781","DOI":"10.1007\/s15010-016-0926-7","article-title":"Measles, mumps, rubella, and varicella seroprevalence in refugees in Germany in 2015","volume":"44","author":"Jablonka","year":"2016","journal-title":"Infection"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"997","DOI":"10.1055\/s-0043-109701","article-title":"Norovirus outbreaks in German refugee camps in 2015","volume":"55","author":"Grote","year":"2017","journal-title":"Z. Gastroenterol."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"939","DOI":"10.1097\/MEG.0000000000000889","article-title":"Seroprevalence of antibodies and antigens against hepatitis A-E viruses in refugees and asylum seekers in Germany in 2015","volume":"29","author":"Jablonka","year":"2017","journal-title":"Eur. J. Gastroenterol. Hepatol."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"1679","DOI":"10.1007\/s00103-013-1858-3","article-title":"Prenatal care in Germany","volume":"56","author":"Vetter","year":"2013","journal-title":"Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz"},{"key":"ref_21","unstructured":"(2018, June 28). Federal Statistical Office of Germany. Available online: https:\/\/www.destatis.de\/DE\/ZahlenFakten\/GesellschaftStaat\/Bevoelkerung\/Geburten\/Glossar\/GebaerfaehigesAlter.html."},{"key":"ref_22","unstructured":"(2018, June 28). Womens Refugee Commission. Available online: https:\/\/www.womensrefugeecommission.org\/empower\/resources\/practitioners-forum\/facts-and-figures."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"307","DOI":"10.5116\/ijme.5985.c959","article-title":"Why be a refugee camp doctor: The challenges, rewards and medical education aspects","volume":"8","author":"Watfa","year":"2017","journal-title":"Int. J. Med. Educ."},{"key":"ref_24","doi-asserted-by":"crossref","unstructured":"Efird, J.T., and Bith-Melander, P. (2018). Refugee Health: An Ongoing Commitment and Challenge. Int. J. Environ. Res. Public Health, 15.","DOI":"10.3390\/ijerph15010131"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"91","DOI":"10.1186\/s12939-018-0801-5","article-title":"Caring for pregnant refugee women in a turbulent policy landscape: Perspectives of health care professionals in Calgary, Alberta","volume":"17","author":"Winn","year":"2018","journal-title":"Int. J. Equity Health"},{"key":"ref_26","first-page":"1","article-title":"A community-based survey on Syrian refugee women\u2019s health and its predictors in Sanliurfa, Turkey","volume":"21","author":"Simsek","year":"2017","journal-title":"Women Health"},{"key":"ref_27","doi-asserted-by":"crossref","unstructured":"Buber-Ennser, I., Kohlenberger, J., Rengs, B., Al Zalak, Z., Goujon, A., Striessnig, E., Potan\u010dokov\u00e1, M., Gisser, R., Testa, M.R., and Lutz, W. (2016). Human Capital, Values, and Attitudes of Persons Seeking Refuge in Austria in 2015. PLoS ONE, 11.","DOI":"10.1371\/journal.pone.0163481"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"157","DOI":"10.1007\/s15010-016-0934-7","article-title":"Tetanus and diphtheria immunity in refugees in Europe in 2015","volume":"45","author":"Jablonka","year":"2017","journal-title":"Infection"},{"key":"ref_29","doi-asserted-by":"crossref","unstructured":"Jablonka, A., Dopfer, C., Happle, C., Sogkas, G., Ernst, D., Atschekzei, F., Hirsch, S., Sch\u00e4ll, A., Jirmo, A., and Solbach, P. (2018). Tuberculosis Specific Interferon-Gamma Production in a Current Refugee Cohort in Western Europe. Int. J. Environ. Res. Public Health, 15.","DOI":"10.3390\/ijerph15061263"},{"key":"ref_30","first-page":"24","article-title":"Safe motherhood in refugee settings","volume":"19","author":"Sachs","year":"1997","journal-title":"Afr. Health."},{"key":"ref_31","doi-asserted-by":"crossref","unstructured":"Pavli, A., and Maltezou, H. (2017). Health problems of newly arrived migrants and refugees in Europe. J. Travel Med., 24.","DOI":"10.1093\/jtm\/tax016"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"22","DOI":"10.1186\/s40985-017-0065-4","article-title":"Review of infectious diseases in refugees and asylum seekers-current status and going forward","volume":"38","author":"Eiset","year":"2017","journal-title":"Public Health Rev."},{"key":"ref_33","doi-asserted-by":"crossref","unstructured":"Bukasa, A., Campbell, H., Brown, K., Bedford, H., Ramsay, M., Amirthalingam, G., and Tookey, P. (2018). Rubella infection in pregnancy and congenital rubella in United Kingdom, 2003 to 2016. Euro Surveill., 23.","DOI":"10.2807\/1560-7917.ES.2018.23.19.17-00381"},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"409","DOI":"10.1016\/S1701-2163(16)34171-8","article-title":"Rates of rubella immunity among immigrant and non-immigrant pregnant women","volume":"31","author":"McElroy","year":"2009","journal-title":"J. Obstet. Gynaecol. Can."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"349","DOI":"10.1177\/0009922806293915","article-title":"Congenital rubella syndrome in a child born to Liberian refugees: Clinical and public health perspectives","volume":"46","author":"Plotinsky","year":"2007","journal-title":"Clin. Pediatr."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"27","DOI":"10.1186\/1475-9276-9-27","article-title":"Immigration as pathogenic: A systematic review of the health of immigrants to Canada","volume":"9","year":"2010","journal-title":"Int. J. Equity Health"},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"449","DOI":"10.1007\/s00737-017-0723-z","article-title":"Prevalence and risk of mental disorders in the perinatal period among migrant women: A systematic review and meta-analysis","volume":"20","author":"Anderson","year":"2017","journal-title":"Arch. Womens Ment. Health"},{"key":"ref_38","unstructured":"Gogol, K.N., Gotsiridze, E.G., Guruli, Z.V., Kintraia, N.P., and Tsaava, F.D. (2006). The expectancy-stress factor in pregnant refugee women. Georgian Med. News, 13\u201316."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"243","DOI":"10.1136\/jech.2008.083535","article-title":"International migration and adverse birth outcomes: Role of ethnicity, region of origin and destination","volume":"64","author":"Urquia","year":"2010","journal-title":"J. Epidemiol. Community Health"},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"584","DOI":"10.1111\/inr.12382","article-title":"Pregnancy outcomes among Syrian refugee and Jordanian women: A comparative study","volume":"64","author":"Alnuaimi","year":"2017","journal-title":"Int. Nurs. Rev."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"23","DOI":"10.4274\/tjod.64022","article-title":"Do Syrian refugees have increased risk for worser pregnancy outcomes? Results of a tertiary center in Istanbul","volume":"15","author":"Gungor","year":"2018","journal-title":"Turk J. Obstet. Gynecol."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"45","DOI":"10.1007\/s00404-016-4188-5","article-title":"Clinical characteristics and pregnancy outcomes of Syrian refugees: A case-control study in a tertiary care hospital in Istanbul, Turkey","volume":"295","author":"Erenel","year":"2017","journal-title":"Arch. Gynecol. Obstet."},{"key":"ref_43","first-page":"h415","article-title":"Healthcare for Syrian refugees","volume":"351","author":"Gornall","year":"2015","journal-title":"BMJ"}],"container-title":["International Journal of Environmental Research and Public Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1660-4601\/15\/9\/1934\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T15:18:58Z","timestamp":1760195938000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1660-4601\/15\/9\/1934"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2018,9,5]]},"references-count":43,"journal-issue":{"issue":"9","published-online":{"date-parts":[[2018,9]]}},"alternative-id":["ijerph15091934"],"URL":"https:\/\/doi.org\/10.3390\/ijerph15091934","relation":{},"ISSN":["1660-4601"],"issn-type":[{"value":"1660-4601","type":"electronic"}],"subject":[],"published":{"date-parts":[[2018,9,5]]}}}