Pregnancy outcomes of Anglophones compared with Francophones in Québec

A growing number of studies suggest that Anglophones may be at risk of preterm birth and stillbirth in Québec. However, pregnancy outcomes such as gestational diabetes and preeclampsia have not been studied. These two pregnancy complications are major causes of morbidity in pregnant women and have potential to explain why some Anglophones have a greater risk of preterm birth and stillbirth. Gestational diabetes is a type of hyperglycemia that develops specifically during pregnancy, and can lead to complications in infants and mothers. Preeclampsia is a life-threatening pregnancy complication that can lead to severe hypertension, seizures, and maternal death. The objective of this research proposal is to investigate if Anglophones have a higher risk of gestational diabetes and preeclampsia, compared with Francophones. We will perform population-based studies using linked data that include birth characteristics and medico-administrative information in Québec from 2008 to 2020. The main exposure will be English or French maternal mother tongue. The main outcomes will be gestational diabetes and preeclampsia. We will measure the association between maternal mother tongue and the risk of gestational diabetes and preeclampsia using regression models. We will also determine if maternal characteristics such as age, country of origin, education, and socioeconomic status influence the relationships of interest. Our findings will help assess the extent to which Anglophones have high risk pregnancies that may benefit from enhanced obstetric care to prevent adverse outcomes.

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Outcomes:

• Auger N, Bilodeau-Bertrand M, Ayoub A, Lafleur N, Wei SQ. (2024; submitted). Increasing risk of gestational diabetes in the Anglophone minority of Quebec. Canadian Journal of Diabetes.

• Auger, N., Bilodeau-Bertrand, M., Lafleur, N., & Lewin, A. (2024). Underlying Causes of Ethnocultural Inequality in Pregnancy Outcomes: Role of Hospital Proximity. Journal of immigrant and minority health, 26(1), 54–62. https://doi.org/10.1007/s10903-023-01545-7

• Auger N, Bilodeau-Bertrand M, Lafleur N. (2023). Access to perinatal healthcare: Risk of adverse birth outcomes among minority Anglophones in Montreal, Canada [Poster presentation]. Colloquium 2023 on the Health of OLMCs, Health Canada, Ottawa, Ontario, Canada.

• Auger N, Bilodeau-Bertrand M, Lafleur N, Lewin, A. (2023). Ethnocultural inequality in pregnancy outcomes: Comparison of Francophones and Anglophones in Montreal [Poster presentation]. Colloquium 2023 on the Health of OLMCs, Health Canada, Ottawa, Ontario, Canada.

• Auger N. Pregnancy outcomes of Quebec Anglophones: recent research results. (unknown). QUESCREN Concordia Lunch and Learn. Montreal, Québec, Canada.

Portrait of birth care in Anglophones of Quebec

There is mounting evidence of inequality in newborn health between Francophones and Anglophones of Quebec, but differences in access to birth care have not been studied. The objectives of this project are to 1) assess the location and residential distance of hospitals where Anglophone infants are born, and 2) determine if Anglophones in metropolitan Montreal prefer to give birth in English hospitals or the hospital closest to their residence. Our hypothesis is that Anglophones are more likely to travel further to receive care in English. We will perform a population-based study using birth registration certificates in Quebec from 1981-2019. The main exposure will be English vs. French mother tongue. Outcomes will include the distance between residential postal code and postal code of the place of birth, and the official language of the birth hospital (English vs. French). We will measure the association between language and hospital distance using multivariable linear regression, and will investigate whether characteristics such as maternal age, region, education, country of birth, material deprivation, and time period influence the associations. We will use multivariable logistic regression to examine associations with the language of hospitals. We will explore whether Anglophones who are born in hospitals that are further from home have a greater risk of preterm birth, low birth weight, or stillbirth. The results will clarify whether access to birth care is a determinant of health among pregnant Anglophone women. This project falls under the “health or social inequalities” HCALM research theme and involves working with communities and governmental officials to reduce social inequalities among minority language groups.

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Outputs:

• Auger, N., Bilodeau-Bertrand, M., & Lafleur, N. (2023). Access to perinatal healthcare in minority Anglophones: Hospital type and birth outcomes. PloS one, 18(4), e0284586. https://doi.org/10.1371/journal.pone.0284586

• Auger, N., Bilodeau-Bertrand, M., Lafleur, N., & Lewin, A. (2024). Underlying Causes of Ethnocultural Inequality in Pregnancy Outcomes: Role of Hospital Proximity. Journal of immigrant and minority health, 26(1), 54–62. https://doi.org/10.1007/s10903-023-01545-7

• Abstract accepted to present the findings of work funded by Dialogue McGill (Ethnocultural inequality in pregnancy outcomes: Comparison of Francophones and Anglophones in Montreal) at the 2023 Colloquium on the Health of Official Language Minority Community by Health Canada, virtual poster session.

• Abstract accepted to present the findings of work funded by Dialogue McGill (Access to perinatal healthcare: Risk of adverse birth outcomes among minority Anglophones in Montreal, Canada) at the 2023 Colloquium on the Health of Official Language Minority Community by Health Canada, virtual poster session.