Pregnancy outcomes of Anglophones compared with Francophones in Québec

Research suggests that English-speaking women in Québec may face a higher risk of adverse pregnancy outcomes, including preterm birth and stillbirth. However, less is known about whether they are also at greater risk of pregnancy complications such as gestational diabetes and preeclampsia, both of which can seriously affect the health of mothers and babies.

This project will examine whether English-speaking women in Québec are more likely than French-speaking women to experience gestational diabetes or preeclampsia during pregnancy. Researchers will analyze population-based health and birth data collected in Québec between 2008 and 2020 and will also examine how factors such as age, education, country of origin, and socioeconomic status may influence these risks.

The findings will help improve understanding of pregnancy health risks among English-speaking communities in Québec and may support the development of targeted obstetric care to improve maternal and infant health outcomes.

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Outputs:

• Auger N, Ayoub A, Bilodeau-Bertrand M, Lafleur N, Wei SQ. Ethnocultural status and risk of preeclampsia in a Canadian setting. Pregnancy Hypertension: An International Journal of Women’s Cardiovascular Health. 2025;7;39:101202. doi:10.1016/j.preghy.2025.101202 . PMID: 39922025.

• Auger N, Bilodeau-Bertrand M, Ayoub A, Lafleur N, Wei SQ. Increasing risk of gestational diabetes in an ethnocultural minority of Canada. Journal of Immigrant and Minority Health. 2025;27(2):191-199. doi:10.1007/s10903-024-01667-6, PMID: 39824967.

• Presentation of the findings of work funded by Dialogue McGill (Auger N, Bilodeau-Bertrand M, Ayoub A, Lafleur N, Wei SQ. Risk of gestational diabetes in Anglophones and Francophones of Quebec) at the 91st Annual Acfas Congress (May 14th 2024).

• QUESCREN researcher portrait, highlighting our team’s research projects on the English-speaking community, published at: https://www.concordia.ca/artsci/ scpa/quescren/researchers/portr aits/Nathalie-Auger.html

Socio-regional inequities in breast cancer screening in Quebec: Best practices for equitable participation in the Quebec breast cancer screening program (PQDCS)

Breast cancer is a major cause of cancer-related deaths in Quebec, which accounts for nearly a quarter of Canada’s cases. Although early detection through the Quebec Breast Cancer Screening Program (PQDCS) saves lives, participation remains below the 70% target, with significant regional and linguistic disparities.

English-speaking women—especially those with limited French proficiency or living in vulnerable conditions—face added barriers such as language challenges, lower health literacy, socioeconomic constraints, and limited trust in the health system. Montreal, home to many English-speaking and diverse communities, has the lowest screening rates in the province, showing that bilingual materials alone are not enough.

This project brings together researchers, community organizations, and institutional partners to better understand these inequities and co-create solutions. Using an intersectional and equity-focused approach, the study will explore how language and social determinants affect access to screening, identify barriers, and assess the potential of community-based health navigation.

Outputs:

Coming soon…

Gestational diabetes and preeclampsia in Anglophones of Québec: dissemination of results through open access

Previous research suggests that Anglophones in Québec may face an increasing risk of adverse birth outcomes. Earlier analyses have shown that, compared with Francophones, Anglophones have a higher risk of stillbirth and preterm birth. To better understand the factors underlying these disparities, funding was awarded by Dialogue McGill in 2023 to support two complementary studies examining the risk of gestational diabetes and preeclampsia among Anglophones versus Francophones. These conditions are significant pregnancy-related morbidities with important implications for maternal and infant health. The researchers plan to publish the findings from both studies in peer-reviewed open-access journals to ensure broad dissemination. In parallel, they are collaborating with knowledge user Marianne Bilodeau-Bertrand to translate the results into surveillance-related activities aimed at informing the Québec Ministry of Health and Social Services.

Outputs:

Two manuscripts were published in peer reviewed journals:

1) Auger, N., Ayoub, A., Bilodeau-Bertrand, M., Lafleur, N., & Wei, S. Q. (2025). Ethnocultural status and risk of preeclampsia in a Canadian setting. Pregnancy Hypertension, 39, 101202. https://doi.org/10.1016/j.preghy.2025.101202

2) Auger, N., Bilodeau-Bertrand, M., Ayoub, A., Lafleur, N., & Wei, S. Q. (2025). Increasing risk of gestational diabetes in an ethnocultural minority of Canada. Journal of Immigrant and Minority Health, 27(2), 191–199. https://doi.org/10.1007/s10903-024-01667-6.

Output recipients include members of the academic community as well as data and knowledge users at the Institut national de santé publique du Québec and Ministry of Health and Social Services of Quebec.

Utilization of Psychosocial Oncology Services by Oral Cancer Patients According to their Minority Language Profile in Montreal area.

Several patients with oral cancer experience psychosocial distress during their care trajectory, and even afterwards. In recent years, psychosocial oncology services (SOP) have been implemented in many hospital centers to support cancer patients with emotional, psychological, or social support needs. The use of SOP by patients with oral cancer has not yet been documented, which hinders monitoring and continuous improvement of care. In Quebec, shortages of healthcare personnel, persistent barriers to distress screening, and stigma surrounding the use of mental health services may influence the use of SOP in oral oncology, especially among the anglophone minority where difficulties accessing healthcare and mental health services have been reported. Our objective is to generate surveillance data on the use of SOP by patients and survivors of oral cancer, according to their official linguistic status in Quebec. Therefore, we are conducting a retrospective study based on data from real patients with oral cancer who are followed in one of the major hospital centers in Montreal. In addition to sociodemographic and clinical data, francophone and anglophone patients will be compared on the rate of referral to the psychosocial oncology department, the delay and response rate to these requests, and the type of SOP received. Analyses will be conducted to explore factors related to potential differences in SOP utilization between francophone and anglophone patients. Communicating our data to healthcare providers and policymakers will help them review their policies and strategies to promote comprehensive care for patients in oral oncology while ensuring equitable access to services between linguistic minorities and majorities.

Outputs:

• March 26, 2024 – Research protocol published (Utilization of Psychosocial Oncology Services by Oral Cancer Patients: a Study Protocol), open access: http://dx.doi.org/https://doi.org/10.21203/rs.3.rs4151906/v1

• April 24, 2024 – Poster presentation at Research Day (Faculty of Dental Medicine and Oral Health Sciences); ~200 attendees: https://www.mcgill.ca/dentistry/researchand-graduate-students/events/research-day

• March 13, 2025 – Presentation at international conference (2025 AADOCR/CADR Annual Meeting & Exhibition, New York, USA): https://www.aadocr.org/2025aaam

• April–August 2025 – Results manuscript in preparation (to be published open access).

Health outcomes of Anglophones after pregnancy: differences in access compared with Francophones in Québec

In Québec, Anglophones are more likely to have pregnancy complications than Francophones. Our research has shown that Anglophones are at risk of outcomes such as preterm birth, stillbirth, preeclampsia, and gestational diabetes. These pregnancy complications have been associated with the onset of medical problems later in life, including mental illness and type 2 diabetes. This proposal aims to examine if Anglophone women are more likely to require care for mental illness and type 2 diabetes than Francophones in the long-term period after pregnancy.

During the previous funding cycle, we built a longitudinal cohort that allows us to study the long-term health of Anglophones after pregnancy. The cohort contains demographic and health information for all Anglophones and Francophones who were pregnant in Québec between 2006 and 2022. In the present study, we will examine two outcomes that led to hospitalization anytime after pregnancy: mental illness and type 2 diabetes. We will assess the association between maternal language and the risk of having a mental illness or diabetes admission up to 17 years after pregnancy, comparing Anglophones with Francophones. We will also study whether characteristics such as socioeconomic deprivation and education modify the long-term risk of each outcome. Our results will provide much needed information on the health of Anglophones in the years after pregnancy, and help identify groups that could benefit from better access to mental health and medical services.

Outcomes:

• Presentation of findings at the “Building Together 2026” conference organized by CHSSN.

• Presentation of the findings at the “Dialogue McGill 2026: Growing Capacity and Retaining Talent in Health Care and Social Services” conference.

The Law 2 on Palliative and End-of-life Care in Quebec: Getting a Grip on the Challenges associated with Providing Quality of Care to English-speaking Population

Even after the adoption of Bill 2 in Quebec and Bill C-14 in Canada, only very limited efforts were made to adequately educate civil society on these matters. Furthermore, unlike the cannabis law where there was widespread media attention to the multiple issues at stake, the media coverage of Bill 2 has largely focused on medical assistance in dying. This has overshadowed the importance of palliative care. In fact, Bill 2 has led to misrepresentations about the continuum of palliative care services and its access. While Bill 2 in Quebec and Bill C-14 in Canada are available in both official languages and despite selected associated activities to inform civil society in both languages over the past three years, investigator’s field experience and that of expert colleagues reveal that English-speaking health care professionals, caregivers, volunteers, patients, and the population in general do not have ready access to the information.

The present research proposes: 1) Integrative scoping review of best practices related to knowledge translation, literacy and capacity building of frontline health care providers, as well as to reach out to members in reference to chronic and palliative care (year 1); 2) Four focus groups with health care professionals involved in Chronic and Palliative Care and End-of-Life Care at the CIUSSS Centre Sud de l’Île de Montréal and CIUSSS Centre Ouest de l’Île de Montréal. 3a) Five individual interviews with heath care providers involved in Chronic and Palliative Care and End- of-Life Care. Also researchers will develop and pilot-test throughout the focus groups and individual interviews, an easy readily available and accessible training program in English for palliative health care providers, namely physicians, nurses, advanced practice nurses (infirmières de pratique spécialisée (IPS), social workers, field-based nurses and physicians (non-governmental organisations) with adapted support documents in English. 3b) Five individual interviews with experts involved in Chronic and Palliative Care and End-of-Life Care are planned (year 2). Also researchers will develop and validate an interview guide with supporting documents that promote a better understanding of the four components of Bill 2, palliative care resources in English and how to access them; participatory approaches, knowledge exchange and knowledge transfer workshops will be proposed for this purpose.

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Outputs:

1. Vissandjée, B., Fernandez, I., Durivage, P., Freitas, Z., Savignac, P., & Van Pevenage, I. (2021). COVID-19, promotion and provision of palliative care: reaching out, accounting for linguistic diversity. Global health promotion, 28(2), 87–90. https://doi.org/10.1177/1757975921989995

2. Lapierre J, Croteau S, Gagnon M-P, et al. Télésanté en contexte de pandémie et de déconfinement : pratiques infirmières innovantes et partenariats pour des communautés équitables, sécuritaires et durables. Global Health Promotion. 2021;28(1):89-97. doi:10.1177/1757975920980720

3. Unknown. (2020, 6 Februrary). Maîtriser la loi 2 sur les soins palliatifs et de fin de vie au Québec : les défis des proches aidants anglophones avec une littératie de santé faible. 6th International REIACTIS Conference ‘‘Inclusive Society and Aging’’, Metz, France.

4. Fernandez, I. Des soins palliatifs équitables et de qualité : intervenir selon une sensibilité aux diversités linguistiques et aux trajectoires d’immigration. En ligne [Zoom]. Colloque étudiant et jeunes chercheur.es SHERPA/CREDEF. 4 juin 2021.

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