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

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.

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.

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