Birth outcomes among children of forced migrants, voluntary migrants, and the native-born in Germany

Abstract Background Differences in birth outcomes among children born to forced migrants, voluntary migrants, and native-born parents remain understudied. Methods We used data from the German Socio-Economic Panel (2003-2021; N = 6,013). Birth weight, length, and head circumference were standardized by gestational age and sex using national population-based references. Logistic regressions were used to assess group differences in the risk of preterm birth and extreme birth outcomes-defined as falling in the highest or lowest 10% of the national distribution. Among children with birth measurements in the normal range, linear regressions were used to examine mean differences in weight, length, and head circumference. All models were adjusted for maternal age, education, and parity. Sensitivity analyses were conducted on subgroups restricted to term births to assess the robustness of findings. Results Children of forced migrants had significantly higher odds of preterm birth (OR = 3.31; 95% CI: 2.51-4.37), large for gestational age (OR = 1.75; 95% CI: 1.33-2.31), long birth length (OR = 2.07; 95% CI: 1.57-2.73), and large head circumference (OR = 1.52; 95% CI: 1.15-2.00) compared to children of native-born parents. Among those in the normal range, birth weight was slightly lower in children of forced migrants (β = -55.87 g; 95% CI: -102.54 to -9.21), though not clinically meaningful. No consistent differences were found for children of voluntary migrants. In sensitivity analyses restricted to term births, group differences disappeared, suggesting gestational age misclassification may underlie the observed disparities. Conclusions Children of forced migrants had higher odds of being classified as preterm and large at birth compared to children of native-born parents. No consistent differences were observed for children of voluntary migrants. Group differences in birth size disappeared in term births, suggesting that disparities may stem from misclassified gestational age. Key messages • Children of forced migrants are more likely to be born large and classified as preterm than those of native-born or voluntary migrant parents. • Group differences may partly reflect misclassification of gestational age due to delayed or inadequate access to prenatal care among forced migrant families.