IntroductionThe heterogeneity among the German population is increasing. Sociodemographic differentials (eg, in education and migrant status) have been associated with health disparities. Life course studies show that a considerable part of these disparities is determined by exposures during pregnancy and early childhood. The BaBi study was established in 2012 to investigate the production of health disparities from foetal life to childhood in the city of Bielefeld, Germany.Methods and analysisBetween 2013 and 2016, detailed information on socioeconomic characteristics, migration background, lifestyle factors, environmental factors, healthcare use, and health status of 995 newborns, including 24 twins, and their families was collected using standardised instruments. Data collection started during pregnancy or shortly after birth with a computer-assisted personal interview of the pregnant woman/mother. Follow-up data will be collected until 2018 by computer-assisted telephone interviews around the first, second and after the third birthday of the child and by linking routine healthcare data. Blood samples are collected from a small subsample of 50 mothers for a substudy about stress during pregnancy (BaBi-Stress study).Ethics and disseminationThe study was approved by the ethical committee of the Medical Faculty of Muenster University and the Data Protection Board of Bielefeld University. Results will be published in scientific journals. Data sets and questionnaires will be made accessible for researchers based on access proposals and data usage contracts.

Objective Non-medical antenatal care (ANC) refers to a range of non-medical services available to women during pregnancy aiming at supporting women and prepare them for the birth and the postpartum period. In Germany, they include antenatal classes, breastfeeding classes and pregnancy-specific yoga or gymnastics courses. Studies suggest that various types of nonmedical ANC carry benefits for both the women and their babies. Little is known about the uptake of non-medical ANC among different socioeconomic population subgroups, but one may expect lower utilization among socio-economically disadvantaged women. We analyzed factors contributing to the utilization of non-medical ANC in general and antenatal classes in particular. Methods Baseline data of the Bielefeld BaBi birth cohort (2013-2016) and the Berlin perinatal study (2011)(2012) were analyzed. Comparing the two cohorts allowed to increase the socio-economic and migration background variance of the study population and to capture the effect of the local context on uptake of services. Multivariate logistic regression analyses were performed to study associations between the uptake of non-medical ANC and socio-economic and migration status. Results In Berlin and Bielefeld, being a first generation migrant and having lower levels of education were associated with lower non-medical ANC uptake. In Berlin, being a 2nd generation woman or having a low income was also associated with lower uptake. Conclusions for PracticeOur study suggests that non-medical ANC remains in some part the prerogative of non-migrant, well-educated and economically privileged women. Since differences in non-medical ANC have the potential to create inequalities in terms of birth outcomes and maternal health during pregnancy and post-partum, more efforts are needed to promote the use of non-medical ANC by all population groups. SignificanceWhat is already known on this subject? Non-medical antenatal care (ANC) contributes to an enhanced pregnancy experience and improved birth outcomes. A recent study showed a lower uptake of non-medical antenatal care among migrants than among women without migration background using unadjusted data. Socioeconomic status has been hypothesized to impact the utilization of non-medical ANC.What this study adds? This study highlights the existence of social inequalities in non-medical ANC use. Our results suggest that there is a strong relationship between the use of non-medical ANC and migration background and educational attainment, with 1st generation migrants and women with low and medium levels of education having a lower uptake of services.

For recruitment of women with a migration background, it is crucial to use both careful preparation in the form of qualitative measures (focus groups, structured interviews) and a pilot study. Extra resources should be planned from the beginning for diverse recruitment strategies and a higher personnel demand (e. g., for translations and back translations). Efforts for the inclusions of migrants in social epidemiological studies in Germany should be a routine process.

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