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.

Portrait of perinatal and infant health in Arabic speakers of Quebec

This project follows project 2018-2019 entitled: “Stillbirth among Arabic speakers: Comparison with Francophones and Anglophones in Quebec”.

This project aims to evaluate the perinatal health of Arabic speakers in Quebec compared with Francophones and Anglophones. Specific objectives include: year 1: To investigate preterm birth in Arabic speakers; year 2: To study infant mortality in Arabic speakers. Instability in several Arab countries in recent years has led to massive migration of Arabic speakers to Quebec. In 2016, nearly 6,000 Syrian migrants settled in the province. This minority may have special needs in regards to perinatal health. In a recent study funded by HCALM, we demonstrated that Arabic speakers from Arab countries had a high risk of stillbirth compared with Francophones and Anglophones in Quebec (under review). Inequality in other perinatal health indicators has however not been studied.

This knowledge gap is particularly concerning for preterm birth and infant mortality. Preterm birth and infant mortality are the two most important indicators of perinatal health in populations and are routinely used for surveillance. European studies have shown that preterm birth and infant mortality are more prevalent in migrants from North Africa and in refugees. Despite these concerning trends, rates of preterm birth and infant mortality in Arabic speakers, the largest foreign language group in Quebec, remain unknown. In the context of increasing diversity, we propose to study inequality in preterm birth and infant mortality between Arabic speakers and Francophones / Anglophones in Quebec. We hypothesize that Arabic speakers have a higher risk of adverse infant outcomes due to limited healthcare access, communication barriers, cultural and socioeconomic differences, or behavioral factors.

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Outputs:

1. Bolster-Foucault, C., Bilodeau-Bertrand, M., Djeha, A., & Auger, N. (2021). Infant mortality among Arabic-speakers in Quebec, Canada, 1989-2017. Journal of immigrant and minority health, 23(2), 215–221. https://doi.org/10.1007/s10903-020-01115-1

2. Bernier, J., Bilodeau-Bertrand, M., Djeha, A., & Auger, N. (2021). Ramadan exposure during early pregnancy and risk of stillbirth in Arab women living in Canada. Paediatric and perinatal epidemiology, 35(6), 689–693. https://doi.org/10.1111/ppe.12761

3. Tith, R. M., Bilodeau-Bertrand, M., Lee, G. E., Healy-Profitós, J., & Auger, N. (2019). Fasting during Ramadan Increases Risk of Very Preterm Birth among Arabic-Speaking Women. The Journal of Nutrition, 149(10), 1826–1832. https://doi.org/10.1093/jn/nxz126

Still birth among Arabic speakers: Comparison with Francophones and Anglophones in Quebec

Language status is slowly emerging as a source of inequality in perinatal health for minorities in Quebec. Minority groups in Quebec are primarily defined by language, where Arabic, the most important immigrant language, accounts for 18% of foreign languages. In Quebec, language reflects ethnicity and social status, and is associated with cultural norms and access to health care. Previous research demonstrated that compared with Francophones, the Anglophone minority has a higher risk of numerous adverse birth outcomes, including stillbirth, preterm birth, fetal growth restriction, and infant mortality. Inequality in perinatal health for other minority groups, including Arabic speakers, has however not been studied. In the context of increasing immigration, the research will study inequality in stillbirth between Arabic speakers and Francophones and Anglophones in Quebec. The researcher hypothesize that Arabic speakers have a higher risk of stillbirth compared with Francophones, due to limited health care access, communication barriers, cultural or socioeconomic differences, or behavioral factors.

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Outputs:

1. Auger, N., Racape, J., Raynault, M. F., Bilodeau-Bertrand, M., Lee, G. E., & Janevic, T. (2020). Stillbirth among Arab women in Canada, 1981-2015. Public health reports, 135(2), 245–252. https://doi.org/10.1177/0033354919900894