Nancy McHugh - Academia.edu (original) (raw)

Papers by Nancy McHugh

Research paper thumbnail of Diabetes in pregnancy in associations with perinatal and postneonatal mortality in First Nations and non-Indigenous populations in Quebec, Canada: population-based linked birth cohort study

BMJ Open, Apr 1, 2019

et al. Diabetes in pregnancy in associations with perinatal and postneonatal mortality in First N... more et al. Diabetes in pregnancy in associations with perinatal and postneonatal mortality in First Nations and non-Indigenous populations in Quebec, Canada: population-based linked birth cohort study. BMJ Open 2019;9:e025084.

Research paper thumbnail of Macrosomia, Perinatal and Infant Mortality in Cree Communities in Quebec, 1996-2010

PLOS ONE, Aug 12, 2016

Background Cree births in Quebec are characterized by the highest reported prevalence of macrosom... more Background Cree births in Quebec are characterized by the highest reported prevalence of macrosomia (~35%) in the world. It is unclear whether Cree births are at greater elevated risk of perinatal and infant mortality than other First Nations relative to non-Aboriginal births in Quebec, and if macrosomia may be related. Methods This was a population-based retrospective birth cohort study using the linked birth-infant death database for singleton births to mothers from Cree (n = 5,340), other First Nations (n = 10,810) and non-Aboriginal (n = 229,960) communities in Quebec, 1996-2010. Community type was ascertained by residential postal code and municipality name. The primary outcomes were perinatal and infant mortality. Results Macrosomia (birth weight for gestational age >90 th percentile) was substantially more frequent in Cree (38.0%) and other First Nations (21.9%) vs non-Aboriginal (9.4%) communities. Comparing Cree and other First Nations vs non-Aboriginal communities, perinatal mortality rates were 1.52 (95% confidence intervals 1.17, 1.98) and 1.34 (1.10, 1.64) times higher, and infant mortality rates 2.27 (1.71, 3.02) and 1.49 (1.16, 1.91) times higher, respectively. The risk elevations in perinatal and infant death in Cree communities attenuated after adjusting for maternal characteristics (age, education, marital status, parity), but became greater after further adjustment for birth weight (small, appropriate, or large for gestational age).

Research paper thumbnail of Perfluoroalkyl acid and bisphenol-A exposure via food sources in four First Nation communities in Quebec, Canada

Public Health Nutrition, 2022

Objective:To document perfluoroalkyl acids (PFAA) and bisphenol-A (BPA) exposure in four First Na... more Objective:To document perfluoroalkyl acids (PFAA) and bisphenol-A (BPA) exposure in four First Nation communities in northern Quebec compared with the Canadian Health Measures Survey (CHMS Cycle 5 2016–2017) and examine the associations between dietary consumption and chemical exposure.Design:We used cross-sectional data from the JES-YEH! project conducted in collaboration with four First Nation communities in 2015. A FFQ collected information on diet, and PFAA and BPA were measured in biological samples. We used generalised linear models to test the associations between food intake and chemical biomarkers.Setting:Northern Quebec.Participants:Youth aged 3–19 years (n 198).Results:Mean perfluorononanoic acid (PFNA) levels were significantly higher in JES-YEH! than CHMS, and BPA levels were higher among those aged 12–19 years compared with CHMS. Dairy products were associated with PFNA among Anishinabe and Innu participants (geometric mean ratio 95 % CI: 1·53 (95 % CI 1·03, 2·29) and ...

Research paper thumbnail of Anemia, iron status, and associated protective and risk factors among children and adolescents aged 3 to 19 years old from four First Nations communities in Quebec

Canadian Journal of Public Health, 2020

Objectives Anemia and iron deficiency (ID) are frequent among Indigenous children of Canada, but ... more Objectives Anemia and iron deficiency (ID) are frequent among Indigenous children of Canada, but few data are available in Quebec. The present study aimed to characterize anemia and ID prevalence and associated protective and risk factors among First Nations youth in Quebec. Methods The 2015 First Nations (JES!-YEH!) pilot study was conducted among children and adolescents (3 to 19 years; n = 198) from four First Nations communities in Quebec. Blood and urine samples and anthropometric measurements were collected. Hemoglobin (Hb), serum ferritin (SF), plasma hs-CRP, and urinary cotinine levels were measured. Factors associated with anemia and ID (including traditional and market food consumption) were assessed using an interview-administered food frequency questionnaire, based on which nutritional intakes were calculated. Structural equation models were used to test associations. Results The prevalence of anemia and ID was elevated (16.8% and 20.5% respectively). Traditional meat, f...

Research paper thumbnail of Disparities in infant hospitalizations in Indigenous and non-Indigenous populations in Quebec, Canada

CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne, Jan 29, 2017

Infant mortality is higher in Indigenous than non-Indigenous populations, but comparable data on ... more Infant mortality is higher in Indigenous than non-Indigenous populations, but comparable data on infant morbidity are lacking in Canada. We evaluated disparities in infant morbidities experienced by Indigenous populations in Canada. We used linked population-based birth and health administrative data from Quebec, Canada, to compare hospitalization rates, an indicator of severe morbidity, in First Nations, Inuit and non-Indigenous singleton infants (< 1 year) born between 1996 and 2010. Our cohort included 19 770 First Nations, 3930 Inuit and 225 380 non-Indigenous infants. Compared with non-Indigenous infants, all-cause hospitalization rates were higher in First Nations infants (unadjusted risk ratio [RR] 2.05, 95% confidence interval [CI] 1.99-2.11; fully adjusted RR 1.43, 95% CI 1.37-1.50) and in Inuit infants (unadjusted RR 1.96, 95% CI 1.87-2.05; fully adjusted RR 1.37, 95% CI 1.24-1.52). Higher risks of hospitalization (accounting for multiple comparisons) were observed for ...

Research paper thumbnail of Disparities and Trends in Birth Outcomes, Perinatal and Infant Mortality in Aboriginal vs. Non-Aboriginal Populations: A Population-Based Study in Quebec, Canada 1996-2010

PloS one, 2015

Aboriginal populations are at substantially higher risks of adverse birth outcomes, perinatal and... more Aboriginal populations are at substantially higher risks of adverse birth outcomes, perinatal and infant mortality than their non-Aboriginal counterparts even in developed countries including Australia, U.S. and Canada. There is a lack of data on recent trends in Canada. We conducted a population-based retrospective cohort study (n = 254,410) using the linked vital events registry databases for singleton births in Quebec 1996-2010. Aboriginal (First Nations, Inuit) births were identified by mother tongue, place of residence and Indian Registration System membership. Outcomes included preterm birth, small-for-gestational-age, large-for-gestational-age, low birth weight, high birth weight, stillbirth, neonatal death, postneonatal death, perinatal death and infant death. Perinatal and infant mortality rates were 1.47 and 1.80 times higher in First Nations (10.1 and 7.3 per 1000, respectively), and 2.37 and 4.46 times higher in Inuit (16.3 and 18.1 per 1000, respectively) relative to no...

Research paper thumbnail of Birth outcomes and infant mortality among First Nations Inuit, and non-Indigenous women by northern versus southern residence, Quebec

Journal of Epidemiology and Community Health, 2010

Background-In circumpolar countries such as Canada, northern regions represent a unique geographi... more Background-In circumpolar countries such as Canada, northern regions represent a unique geographical entity climatically, socioeconomically and environmentally. There is a lack of comparative data on birth outcomes among Indigenous and non-Indigenous subpopulations within northern regions and compared with southern regions.

Research paper thumbnail of Rates of stillbirth by gestational age and cause in Inuit and First Nations populations in Quebec

Canadian Medical Association Journal, 2013

A ttention has recently been drawn to the paucity of data on rates and causes of stillbirth, a pr... more A ttention has recently been drawn to the paucity of data on rates and causes of stillbirth, a pregnancy outcome that is largely ignored compared with later deaths. 1 Aboriginal populations in Canada rank at the top of the list of disadvantaged groups with the highest rates of stillbirth in the Western world. 1 First Nations and Inuit, 2 distinct Aboriginal populations in Canada, have stillbirth rates that are 2-3 times that among non-Aboriginal Canadians. 1,2 Although these trends are alarming, little data exist to guide prevention efforts among Aboriginal Canadians. Not much is known about how stillbirth rates in Aboriginal populations vary by gestational age or cause of death, despite evidence that prevention requires knowledge on the timing and cause of stillbirth. 3 Opportunities for preventing stillbirth are typically greater after 28 weeks of gestation, 4 particularly at term, but the absence of gestational age-and cause-specific comparisons between Aboriginal and non-Aboriginal Canadians is a major impediment to reducing stillbirth rates. To gain a better understanding of the timing and causes of stillbirth in Inuit and First Nations populations, we estimated gestational age-and cause-specific fetal death rates in the Aboriginal and non-Aboriginal populations in the province of Quebec, where Inuit and First Nations people can be identified by parental information on birth registration forms. Methods Data and variables Data included singleton stillbirths (n = 9983) and live births (n = 2 397 971) in Quebec from 1981 to 2009. We excluded 464 voluntary pregnancy terminations (International Classification of Disease [ICD]-9 code 779.6 and ICD-10 code P96.4). To maximize comparability with the prevailing literature, 5 and because recording was Background: Inuit and First Nations populations have higher rates of stillbirth than non-Aboriginal populations in Canada do, but little is known about the timing and cause of stillbirth in Aboriginal populations. We compared gestational age-and cause-specific stillbirth rates in Inuit and First Nations populations with the rates in the non-Aboriginal population in Quebec. Methods: Data included singleton stillbirths and live births at 24 or more gestational weeks among Quebec residents from 1981 to 2009. We calculated odds ratios (ORs), rate differences and 95% confidence intervals (CIs) for the retrospective cohort of Inuit and First Nations births relative to non-Aboriginal births using fetuses at risk (i.e., ongoing pregnancies) as denominators and adjusting for maternal characteristics. The main outcomes were stillbirth by gestational age (24-27, 28-36, ≥ 37 wk) and cause of death. Results: Rates of stillbirth per 1000 births were greater among Inuit (6.8) and First Nations (5.7) than among non-Aboriginal (3.6) residents. Relative to the non-Aboriginal population, the risk of stillbirth was greater at term (≥ 37 wk) than before term for both Inuit (OR 3.1, 95% CI 1.9 to 4.8) and First Nations (OR 2.6, 95% CI 2.1 to 3.3) populations. Causes most strongly associated with stillbirth were poor fetal growth, placental disorders and congenital anomalies among the Inuit, and hypertension and diabetes among the First Nations residents. Interpretation: Stillbirth rates in Aboriginal populations were particularly high at term gestation. Poor fetal growth, placental disorders and congenital anomalies were important causes of stillbirth among the Inuit, and diabetic and hypertensive complications were important causes in the First Nations population. Prevention may require improvements in pregnancy and obstetric care.

Research paper thumbnail of Rates of stillbirth by gestational age and cause in Inuit and First Nations populations in Quebec

Canadian Medical Association Journal, 2013

A ttention has recently been drawn to the paucity of data on rates and causes of stillbirth, a pr... more A ttention has recently been drawn to the paucity of data on rates and causes of stillbirth, a pregnancy outcome that is largely ignored compared with later deaths. 1 Aboriginal populations in Canada rank at the top of the list of disadvantaged groups with the highest rates of stillbirth in the Western world. 1 First Nations and Inuit, 2 distinct Aboriginal populations in Canada, have stillbirth rates that are 2-3 times that among non-Aboriginal Canadians. 1,2 Although these trends are alarming, little data exist to guide prevention efforts among Aboriginal Canadians. Not much is known about how stillbirth rates in Aboriginal populations vary by gestational age or cause of death, despite evidence that prevention requires knowledge on the timing and cause of stillbirth. 3 Opportunities for preventing stillbirth are typically greater after 28 weeks of gestation, 4 particularly at term, but the absence of gestational age-and cause-specific comparisons between Aboriginal and non-Aboriginal Canadians is a major impediment to reducing stillbirth rates. To gain a better understanding of the timing and causes of stillbirth in Inuit and First Nations populations, we estimated gestational age-and cause-specific fetal death rates in the Aboriginal and non-Aboriginal populations in the province of Quebec, where Inuit and First Nations people can be identified by parental information on birth registration forms. Methods Data and variables Data included singleton stillbirths (n = 9983) and live births (n = 2 397 971) in Quebec from 1981 to 2009. We excluded 464 voluntary pregnancy terminations (International Classification of Disease [ICD]-9 code 779.6 and ICD-10 code P96.4). To maximize comparability with the prevailing literature, 5 and because recording was Background: Inuit and First Nations populations have higher rates of stillbirth than non-Aboriginal populations in Canada do, but little is known about the timing and cause of stillbirth in Aboriginal populations. We compared gestational age-and cause-specific stillbirth rates in Inuit and First Nations populations with the rates in the non-Aboriginal population in Quebec. Methods: Data included singleton stillbirths and live births at 24 or more gestational weeks among Quebec residents from 1981 to 2009. We calculated odds ratios (ORs), rate differences and 95% confidence intervals (CIs) for the retrospective cohort of Inuit and First Nations births relative to non-Aboriginal births using fetuses at risk (i.e., ongoing pregnancies) as denominators and adjusting for maternal characteristics. The main outcomes were stillbirth by gestational age (24-27, 28-36, ≥ 37 wk) and cause of death. Results: Rates of stillbirth per 1000 births were greater among Inuit (6.8) and First Nations (5.7) than among non-Aboriginal (3.6) residents. Relative to the non-Aboriginal population, the risk of stillbirth was greater at term (≥ 37 wk) than before term for both Inuit (OR 3.1, 95% CI 1.9 to 4.8) and First Nations (OR 2.6, 95% CI 2.1 to 3.3) populations. Causes most strongly associated with stillbirth were poor fetal growth, placental disorders and congenital anomalies among the Inuit, and hypertension and diabetes among the First Nations residents. Interpretation: Stillbirth rates in Aboriginal populations were particularly high at term gestation. Poor fetal growth, placental disorders and congenital anomalies were important causes of stillbirth among the Inuit, and diabetic and hypertensive complications were important causes in the First Nations population. Prevention may require improvements in pregnancy and obstetric care.

Research paper thumbnail of Association of macrosomia with perinatal and postneonatal mortality among First Nations people in Quebec

Canadian Medical Association Journal, 2011

A trend toward higher birthweights has emerged in recent decades. 1-3 Reflected in this trend is ... more A trend toward higher birthweights has emerged in recent decades. 1-3 Reflected in this trend is a rise in the prevalence of infant macrosomia, commonly defined as either a birthweight greater than 4000 g or a birthweight for gestational age greater than the 90th percentile relative to a fetal growth standard. 4-8 Maternal obesity, impaired glucose tolerance and gestational diabetes mellitus are important risk factors for infant macrosomia 9,10 and are known to afflict a much higher proportion of people in Aboriginal populations than in the general population. 11-14 This is true especially for Aboriginal populations in which a traditional lifestyle has changed to a less physically active, modern lifestyle in recent decades. A high prevalence of infant macrosomia (up to 36%, which, to the best of our knowledge, is the highest in the world) has been reported in some First Nations communities of Quebec and eastern Ontario in Canada. 15-17 However, little is known about the implications of this high prevalence for perinatal and infant health of First Nations people in these regions. We examined whether infant macrosomia was associated with increased risk for perinatal and postneonatal death among First Nations infants in Quebec. Methods Data source and inclusion criteria We conducted an analysis of perinatal and infant mortality by birthweight for gestational age in a cohort of births to women with a First Nations mother tongue (n = 5193) and a majority reference group of women whose mother tongue is French (n = 653 424) in the province of Quebec from 1991 to 2000. We used linked data from Statistics Canada on birth and infant deaths. We restricted our analysis to births that occurred at a gestational age of 20

Research paper thumbnail of Exposure to perfluoroalkyl substances (PFAS) and associations with thyroid parameters in First Nation children and youth from Quebec

Environment International, 2019

Background: Perfluoroalkyl substances (PFASs) are found in several consumer goods. Exposure to PF... more Background: Perfluoroalkyl substances (PFASs) are found in several consumer goods. Exposure to PFASs in children has been associated with alteration in thyroid hormones, which have critical roles in brain function. Objective: In 2015, 198 children and youth (3-19 y) were recruited as part of the pilot project Jeunes, Environnement et Santé/Youth, Environment and Health (JES!-YEH!), realized in collaboration with four First Nation communities in Quebec. We aimed to evaluate serum concentrations of PFASs in relation to concentrations of thyroid-stimulating hormone (TSH), free thyroxine (T4) and thyroglobulin while adjusting for relevant confounders. Methods: PFASs (PFOS, PFOA, PFHxS, PFNA), 2,2′,4,4′-Tetrabromodiphenyl ether (PBDE-47) thyroid parameters (TSH, free T4, and thyroglobulin) were measured in serum samples of 186 participants. Iodine, creatinine, and cotinine were measured in urine samples. Serum levels of PFASs were compared to those measured in the general Canadian population and elsewhere. Multivariate regression analyses were performed to determine associations between PFASs and TSH, free T4 and thyroglobulin. Results: PFOS, PFOA and PFHxS serum concentrations were low. However, PFNA concentrations among participants aged 12 to 19 years old from Anishinabe communities were three times higher than those measured in the Canadian Health Measures Survey (2009-2011) for the same age group (Geometric Means: 3.01 μg/L and 0.71 μg/L, respectively) and were particularly higher in the Anishinabe participants aged 6 to 11 years old (GM: 9.44 μg/L). Few participants had levels of TSH, free T4, and thyroglobulin outside age-specific paediatric ranges. When adjusted for relevant covariates and other contaminants, PFNA serum concentrations were positively associated with free T4 levels (Adjusted β = 0.36; p = 0.0014), but not with TSH and thyroglobulin levels. No association was observed between the other PFAS and thyroid hormones parameters. Conclusion: This pilot project reveals among the highest exposure to PFNA in children reported until today, and suggests effects of PFNA as an endocrine disruptor, highlighting the importance of investigating the sources and effects of disproportionate exposure to emerging contaminants in some indigenous communities and ban all PFAS at the international scale.

Research paper thumbnail of Aligner la recherche scientifique aux besoins et aux intérêts des premières nations : meilleures pratiques et initiatives prometteuses

Research paper thumbnail of Macrosomia, Perinatal and Infant Mortality in Cree Communities in Quebec, 1996-2010

PloS one, 2016

Cree births in Quebec are characterized by the highest reported prevalence of macrosomia (~35%) i... more Cree births in Quebec are characterized by the highest reported prevalence of macrosomia (~35%) in the world. It is unclear whether Cree births are at greater elevated risk of perinatal and infant mortality than other First Nations relative to non-Aboriginal births in Quebec, and if macrosomia may be related. This was a population-based retrospective birth cohort study using the linked birth-infant death database for singleton births to mothers from Cree (n = 5,340), other First Nations (n = 10,810) and non-Aboriginal (n = 229,960) communities in Quebec, 1996-2010. Community type was ascertained by residential postal code and municipality name. The primary outcomes were perinatal and infant mortality. Macrosomia (birth weight for gestational age >90th percentile) was substantially more frequent in Cree (38.0%) and other First Nations (21.9%) vs non-Aboriginal (9.4%) communities. Comparing Cree and other First Nations vs non-Aboriginal communities, perinatal mortality rates were 1...

Research paper thumbnail of Individual- and Community-Level Disparities in Birth Outcomes and Infant Mortality among First Nations, Inuit and Other Populations in Quebec~!2009-12-01~!2010-04-12~!2010-07-06~!

The Open Women' s Health Journal, 2010

Objective: We assessed individual-and community-level disparities and trends in birth outcomes an... more Objective: We assessed individual-and community-level disparities and trends in birth outcomes and infant mortality among First Nations (North American Indians) and Inuit versus other populations in Quebec, Canada.

Research paper thumbnail of Community Remoteness, Perinatal Outcomes and Infant Mortality among First Nations in Quebec~!2009-12-02~!2010-04-12~!2010-07-06~!

The Open Women' s Health Journal, 2010

Objective: Little is known about community remoteness in relation to birth outcomes among Indigen... more Objective: Little is known about community remoteness in relation to birth outcomes among Indigenous populations. We assessed whether community remoteness matters for perinatal outcomes and infant mortality in Quebec First Nations communities.

Research paper thumbnail of Urban Living is Not Associated with Better Birth and Infant Outcomes among Inuit and First Nations in Quebec~!2009-11-30~!2010-04-12~!2010-07-06~!

The Open Women' s Health Journal, 2010

Objective: There is limited and inconsistent evidence concerning rural versus urban differences i... more Objective: There is limited and inconsistent evidence concerning rural versus urban differences in birth and infant outcomes for Indigenous peoples. We assessed birth and infant outcomes among Inuit, First Nations and French mother tongue groups by rural versus urban residence in Quebec, Canada.

Research paper thumbnail of Disparities and Trends in Birth Outcomes, Perinatal and Infant Mortality in Aboriginal vs. Non-Aboriginal Populations: A Population-Based Study in Quebec, Canada 1996-2010

PloS one, 2015

Aboriginal populations are at substantially higher risks of adverse birth outcomes, perinatal and... more Aboriginal populations are at substantially higher risks of adverse birth outcomes, perinatal and infant mortality than their non-Aboriginal counterparts even in developed countries including Australia, U.S. and Canada. There is a lack of data on recent trends in Canada. We conducted a population-based retrospective cohort study (n = 254,410) using the linked vital events registry databases for singleton births in Quebec 1996-2010. Aboriginal (First Nations, Inuit) births were identified by mother tongue, place of residence and Indian Registration System membership. Outcomes included preterm birth, small-for-gestational-age, large-for-gestational-age, low birth weight, high birth weight, stillbirth, neonatal death, postneonatal death, perinatal death and infant death. Perinatal and infant mortality rates were 1.47 and 1.80 times higher in First Nations (10.1 and 7.3 per 1000, respectively), and 2.37 and 4.46 times higher in Inuit (16.3 and 18.1 per 1000, respectively) relative to no...

Research paper thumbnail of Diabetes in pregnancy in associations with perinatal and postneonatal mortality in First Nations and non-Indigenous populations in Quebec, Canada: population-based linked birth cohort study

BMJ Open, Apr 1, 2019

et al. Diabetes in pregnancy in associations with perinatal and postneonatal mortality in First N... more et al. Diabetes in pregnancy in associations with perinatal and postneonatal mortality in First Nations and non-Indigenous populations in Quebec, Canada: population-based linked birth cohort study. BMJ Open 2019;9:e025084.

Research paper thumbnail of Macrosomia, Perinatal and Infant Mortality in Cree Communities in Quebec, 1996-2010

PLOS ONE, Aug 12, 2016

Background Cree births in Quebec are characterized by the highest reported prevalence of macrosom... more Background Cree births in Quebec are characterized by the highest reported prevalence of macrosomia (~35%) in the world. It is unclear whether Cree births are at greater elevated risk of perinatal and infant mortality than other First Nations relative to non-Aboriginal births in Quebec, and if macrosomia may be related. Methods This was a population-based retrospective birth cohort study using the linked birth-infant death database for singleton births to mothers from Cree (n = 5,340), other First Nations (n = 10,810) and non-Aboriginal (n = 229,960) communities in Quebec, 1996-2010. Community type was ascertained by residential postal code and municipality name. The primary outcomes were perinatal and infant mortality. Results Macrosomia (birth weight for gestational age >90 th percentile) was substantially more frequent in Cree (38.0%) and other First Nations (21.9%) vs non-Aboriginal (9.4%) communities. Comparing Cree and other First Nations vs non-Aboriginal communities, perinatal mortality rates were 1.52 (95% confidence intervals 1.17, 1.98) and 1.34 (1.10, 1.64) times higher, and infant mortality rates 2.27 (1.71, 3.02) and 1.49 (1.16, 1.91) times higher, respectively. The risk elevations in perinatal and infant death in Cree communities attenuated after adjusting for maternal characteristics (age, education, marital status, parity), but became greater after further adjustment for birth weight (small, appropriate, or large for gestational age).

Research paper thumbnail of Perfluoroalkyl acid and bisphenol-A exposure via food sources in four First Nation communities in Quebec, Canada

Public Health Nutrition, 2022

Objective:To document perfluoroalkyl acids (PFAA) and bisphenol-A (BPA) exposure in four First Na... more Objective:To document perfluoroalkyl acids (PFAA) and bisphenol-A (BPA) exposure in four First Nation communities in northern Quebec compared with the Canadian Health Measures Survey (CHMS Cycle 5 2016–2017) and examine the associations between dietary consumption and chemical exposure.Design:We used cross-sectional data from the JES-YEH! project conducted in collaboration with four First Nation communities in 2015. A FFQ collected information on diet, and PFAA and BPA were measured in biological samples. We used generalised linear models to test the associations between food intake and chemical biomarkers.Setting:Northern Quebec.Participants:Youth aged 3–19 years (n 198).Results:Mean perfluorononanoic acid (PFNA) levels were significantly higher in JES-YEH! than CHMS, and BPA levels were higher among those aged 12–19 years compared with CHMS. Dairy products were associated with PFNA among Anishinabe and Innu participants (geometric mean ratio 95 % CI: 1·53 (95 % CI 1·03, 2·29) and ...

Research paper thumbnail of Anemia, iron status, and associated protective and risk factors among children and adolescents aged 3 to 19 years old from four First Nations communities in Quebec

Canadian Journal of Public Health, 2020

Objectives Anemia and iron deficiency (ID) are frequent among Indigenous children of Canada, but ... more Objectives Anemia and iron deficiency (ID) are frequent among Indigenous children of Canada, but few data are available in Quebec. The present study aimed to characterize anemia and ID prevalence and associated protective and risk factors among First Nations youth in Quebec. Methods The 2015 First Nations (JES!-YEH!) pilot study was conducted among children and adolescents (3 to 19 years; n = 198) from four First Nations communities in Quebec. Blood and urine samples and anthropometric measurements were collected. Hemoglobin (Hb), serum ferritin (SF), plasma hs-CRP, and urinary cotinine levels were measured. Factors associated with anemia and ID (including traditional and market food consumption) were assessed using an interview-administered food frequency questionnaire, based on which nutritional intakes were calculated. Structural equation models were used to test associations. Results The prevalence of anemia and ID was elevated (16.8% and 20.5% respectively). Traditional meat, f...

Research paper thumbnail of Disparities in infant hospitalizations in Indigenous and non-Indigenous populations in Quebec, Canada

CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne, Jan 29, 2017

Infant mortality is higher in Indigenous than non-Indigenous populations, but comparable data on ... more Infant mortality is higher in Indigenous than non-Indigenous populations, but comparable data on infant morbidity are lacking in Canada. We evaluated disparities in infant morbidities experienced by Indigenous populations in Canada. We used linked population-based birth and health administrative data from Quebec, Canada, to compare hospitalization rates, an indicator of severe morbidity, in First Nations, Inuit and non-Indigenous singleton infants (< 1 year) born between 1996 and 2010. Our cohort included 19 770 First Nations, 3930 Inuit and 225 380 non-Indigenous infants. Compared with non-Indigenous infants, all-cause hospitalization rates were higher in First Nations infants (unadjusted risk ratio [RR] 2.05, 95% confidence interval [CI] 1.99-2.11; fully adjusted RR 1.43, 95% CI 1.37-1.50) and in Inuit infants (unadjusted RR 1.96, 95% CI 1.87-2.05; fully adjusted RR 1.37, 95% CI 1.24-1.52). Higher risks of hospitalization (accounting for multiple comparisons) were observed for ...

Research paper thumbnail of Disparities and Trends in Birth Outcomes, Perinatal and Infant Mortality in Aboriginal vs. Non-Aboriginal Populations: A Population-Based Study in Quebec, Canada 1996-2010

PloS one, 2015

Aboriginal populations are at substantially higher risks of adverse birth outcomes, perinatal and... more Aboriginal populations are at substantially higher risks of adverse birth outcomes, perinatal and infant mortality than their non-Aboriginal counterparts even in developed countries including Australia, U.S. and Canada. There is a lack of data on recent trends in Canada. We conducted a population-based retrospective cohort study (n = 254,410) using the linked vital events registry databases for singleton births in Quebec 1996-2010. Aboriginal (First Nations, Inuit) births were identified by mother tongue, place of residence and Indian Registration System membership. Outcomes included preterm birth, small-for-gestational-age, large-for-gestational-age, low birth weight, high birth weight, stillbirth, neonatal death, postneonatal death, perinatal death and infant death. Perinatal and infant mortality rates were 1.47 and 1.80 times higher in First Nations (10.1 and 7.3 per 1000, respectively), and 2.37 and 4.46 times higher in Inuit (16.3 and 18.1 per 1000, respectively) relative to no...

Research paper thumbnail of Birth outcomes and infant mortality among First Nations Inuit, and non-Indigenous women by northern versus southern residence, Quebec

Journal of Epidemiology and Community Health, 2010

Background-In circumpolar countries such as Canada, northern regions represent a unique geographi... more Background-In circumpolar countries such as Canada, northern regions represent a unique geographical entity climatically, socioeconomically and environmentally. There is a lack of comparative data on birth outcomes among Indigenous and non-Indigenous subpopulations within northern regions and compared with southern regions.

Research paper thumbnail of Rates of stillbirth by gestational age and cause in Inuit and First Nations populations in Quebec

Canadian Medical Association Journal, 2013

A ttention has recently been drawn to the paucity of data on rates and causes of stillbirth, a pr... more A ttention has recently been drawn to the paucity of data on rates and causes of stillbirth, a pregnancy outcome that is largely ignored compared with later deaths. 1 Aboriginal populations in Canada rank at the top of the list of disadvantaged groups with the highest rates of stillbirth in the Western world. 1 First Nations and Inuit, 2 distinct Aboriginal populations in Canada, have stillbirth rates that are 2-3 times that among non-Aboriginal Canadians. 1,2 Although these trends are alarming, little data exist to guide prevention efforts among Aboriginal Canadians. Not much is known about how stillbirth rates in Aboriginal populations vary by gestational age or cause of death, despite evidence that prevention requires knowledge on the timing and cause of stillbirth. 3 Opportunities for preventing stillbirth are typically greater after 28 weeks of gestation, 4 particularly at term, but the absence of gestational age-and cause-specific comparisons between Aboriginal and non-Aboriginal Canadians is a major impediment to reducing stillbirth rates. To gain a better understanding of the timing and causes of stillbirth in Inuit and First Nations populations, we estimated gestational age-and cause-specific fetal death rates in the Aboriginal and non-Aboriginal populations in the province of Quebec, where Inuit and First Nations people can be identified by parental information on birth registration forms. Methods Data and variables Data included singleton stillbirths (n = 9983) and live births (n = 2 397 971) in Quebec from 1981 to 2009. We excluded 464 voluntary pregnancy terminations (International Classification of Disease [ICD]-9 code 779.6 and ICD-10 code P96.4). To maximize comparability with the prevailing literature, 5 and because recording was Background: Inuit and First Nations populations have higher rates of stillbirth than non-Aboriginal populations in Canada do, but little is known about the timing and cause of stillbirth in Aboriginal populations. We compared gestational age-and cause-specific stillbirth rates in Inuit and First Nations populations with the rates in the non-Aboriginal population in Quebec. Methods: Data included singleton stillbirths and live births at 24 or more gestational weeks among Quebec residents from 1981 to 2009. We calculated odds ratios (ORs), rate differences and 95% confidence intervals (CIs) for the retrospective cohort of Inuit and First Nations births relative to non-Aboriginal births using fetuses at risk (i.e., ongoing pregnancies) as denominators and adjusting for maternal characteristics. The main outcomes were stillbirth by gestational age (24-27, 28-36, ≥ 37 wk) and cause of death. Results: Rates of stillbirth per 1000 births were greater among Inuit (6.8) and First Nations (5.7) than among non-Aboriginal (3.6) residents. Relative to the non-Aboriginal population, the risk of stillbirth was greater at term (≥ 37 wk) than before term for both Inuit (OR 3.1, 95% CI 1.9 to 4.8) and First Nations (OR 2.6, 95% CI 2.1 to 3.3) populations. Causes most strongly associated with stillbirth were poor fetal growth, placental disorders and congenital anomalies among the Inuit, and hypertension and diabetes among the First Nations residents. Interpretation: Stillbirth rates in Aboriginal populations were particularly high at term gestation. Poor fetal growth, placental disorders and congenital anomalies were important causes of stillbirth among the Inuit, and diabetic and hypertensive complications were important causes in the First Nations population. Prevention may require improvements in pregnancy and obstetric care.

Research paper thumbnail of Rates of stillbirth by gestational age and cause in Inuit and First Nations populations in Quebec

Canadian Medical Association Journal, 2013

A ttention has recently been drawn to the paucity of data on rates and causes of stillbirth, a pr... more A ttention has recently been drawn to the paucity of data on rates and causes of stillbirth, a pregnancy outcome that is largely ignored compared with later deaths. 1 Aboriginal populations in Canada rank at the top of the list of disadvantaged groups with the highest rates of stillbirth in the Western world. 1 First Nations and Inuit, 2 distinct Aboriginal populations in Canada, have stillbirth rates that are 2-3 times that among non-Aboriginal Canadians. 1,2 Although these trends are alarming, little data exist to guide prevention efforts among Aboriginal Canadians. Not much is known about how stillbirth rates in Aboriginal populations vary by gestational age or cause of death, despite evidence that prevention requires knowledge on the timing and cause of stillbirth. 3 Opportunities for preventing stillbirth are typically greater after 28 weeks of gestation, 4 particularly at term, but the absence of gestational age-and cause-specific comparisons between Aboriginal and non-Aboriginal Canadians is a major impediment to reducing stillbirth rates. To gain a better understanding of the timing and causes of stillbirth in Inuit and First Nations populations, we estimated gestational age-and cause-specific fetal death rates in the Aboriginal and non-Aboriginal populations in the province of Quebec, where Inuit and First Nations people can be identified by parental information on birth registration forms. Methods Data and variables Data included singleton stillbirths (n = 9983) and live births (n = 2 397 971) in Quebec from 1981 to 2009. We excluded 464 voluntary pregnancy terminations (International Classification of Disease [ICD]-9 code 779.6 and ICD-10 code P96.4). To maximize comparability with the prevailing literature, 5 and because recording was Background: Inuit and First Nations populations have higher rates of stillbirth than non-Aboriginal populations in Canada do, but little is known about the timing and cause of stillbirth in Aboriginal populations. We compared gestational age-and cause-specific stillbirth rates in Inuit and First Nations populations with the rates in the non-Aboriginal population in Quebec. Methods: Data included singleton stillbirths and live births at 24 or more gestational weeks among Quebec residents from 1981 to 2009. We calculated odds ratios (ORs), rate differences and 95% confidence intervals (CIs) for the retrospective cohort of Inuit and First Nations births relative to non-Aboriginal births using fetuses at risk (i.e., ongoing pregnancies) as denominators and adjusting for maternal characteristics. The main outcomes were stillbirth by gestational age (24-27, 28-36, ≥ 37 wk) and cause of death. Results: Rates of stillbirth per 1000 births were greater among Inuit (6.8) and First Nations (5.7) than among non-Aboriginal (3.6) residents. Relative to the non-Aboriginal population, the risk of stillbirth was greater at term (≥ 37 wk) than before term for both Inuit (OR 3.1, 95% CI 1.9 to 4.8) and First Nations (OR 2.6, 95% CI 2.1 to 3.3) populations. Causes most strongly associated with stillbirth were poor fetal growth, placental disorders and congenital anomalies among the Inuit, and hypertension and diabetes among the First Nations residents. Interpretation: Stillbirth rates in Aboriginal populations were particularly high at term gestation. Poor fetal growth, placental disorders and congenital anomalies were important causes of stillbirth among the Inuit, and diabetic and hypertensive complications were important causes in the First Nations population. Prevention may require improvements in pregnancy and obstetric care.

Research paper thumbnail of Association of macrosomia with perinatal and postneonatal mortality among First Nations people in Quebec

Canadian Medical Association Journal, 2011

A trend toward higher birthweights has emerged in recent decades. 1-3 Reflected in this trend is ... more A trend toward higher birthweights has emerged in recent decades. 1-3 Reflected in this trend is a rise in the prevalence of infant macrosomia, commonly defined as either a birthweight greater than 4000 g or a birthweight for gestational age greater than the 90th percentile relative to a fetal growth standard. 4-8 Maternal obesity, impaired glucose tolerance and gestational diabetes mellitus are important risk factors for infant macrosomia 9,10 and are known to afflict a much higher proportion of people in Aboriginal populations than in the general population. 11-14 This is true especially for Aboriginal populations in which a traditional lifestyle has changed to a less physically active, modern lifestyle in recent decades. A high prevalence of infant macrosomia (up to 36%, which, to the best of our knowledge, is the highest in the world) has been reported in some First Nations communities of Quebec and eastern Ontario in Canada. 15-17 However, little is known about the implications of this high prevalence for perinatal and infant health of First Nations people in these regions. We examined whether infant macrosomia was associated with increased risk for perinatal and postneonatal death among First Nations infants in Quebec. Methods Data source and inclusion criteria We conducted an analysis of perinatal and infant mortality by birthweight for gestational age in a cohort of births to women with a First Nations mother tongue (n = 5193) and a majority reference group of women whose mother tongue is French (n = 653 424) in the province of Quebec from 1991 to 2000. We used linked data from Statistics Canada on birth and infant deaths. We restricted our analysis to births that occurred at a gestational age of 20

Research paper thumbnail of Exposure to perfluoroalkyl substances (PFAS) and associations with thyroid parameters in First Nation children and youth from Quebec

Environment International, 2019

Background: Perfluoroalkyl substances (PFASs) are found in several consumer goods. Exposure to PF... more Background: Perfluoroalkyl substances (PFASs) are found in several consumer goods. Exposure to PFASs in children has been associated with alteration in thyroid hormones, which have critical roles in brain function. Objective: In 2015, 198 children and youth (3-19 y) were recruited as part of the pilot project Jeunes, Environnement et Santé/Youth, Environment and Health (JES!-YEH!), realized in collaboration with four First Nation communities in Quebec. We aimed to evaluate serum concentrations of PFASs in relation to concentrations of thyroid-stimulating hormone (TSH), free thyroxine (T4) and thyroglobulin while adjusting for relevant confounders. Methods: PFASs (PFOS, PFOA, PFHxS, PFNA), 2,2′,4,4′-Tetrabromodiphenyl ether (PBDE-47) thyroid parameters (TSH, free T4, and thyroglobulin) were measured in serum samples of 186 participants. Iodine, creatinine, and cotinine were measured in urine samples. Serum levels of PFASs were compared to those measured in the general Canadian population and elsewhere. Multivariate regression analyses were performed to determine associations between PFASs and TSH, free T4 and thyroglobulin. Results: PFOS, PFOA and PFHxS serum concentrations were low. However, PFNA concentrations among participants aged 12 to 19 years old from Anishinabe communities were three times higher than those measured in the Canadian Health Measures Survey (2009-2011) for the same age group (Geometric Means: 3.01 μg/L and 0.71 μg/L, respectively) and were particularly higher in the Anishinabe participants aged 6 to 11 years old (GM: 9.44 μg/L). Few participants had levels of TSH, free T4, and thyroglobulin outside age-specific paediatric ranges. When adjusted for relevant covariates and other contaminants, PFNA serum concentrations were positively associated with free T4 levels (Adjusted β = 0.36; p = 0.0014), but not with TSH and thyroglobulin levels. No association was observed between the other PFAS and thyroid hormones parameters. Conclusion: This pilot project reveals among the highest exposure to PFNA in children reported until today, and suggests effects of PFNA as an endocrine disruptor, highlighting the importance of investigating the sources and effects of disproportionate exposure to emerging contaminants in some indigenous communities and ban all PFAS at the international scale.

Research paper thumbnail of Aligner la recherche scientifique aux besoins et aux intérêts des premières nations : meilleures pratiques et initiatives prometteuses

Research paper thumbnail of Macrosomia, Perinatal and Infant Mortality in Cree Communities in Quebec, 1996-2010

PloS one, 2016

Cree births in Quebec are characterized by the highest reported prevalence of macrosomia (~35%) i... more Cree births in Quebec are characterized by the highest reported prevalence of macrosomia (~35%) in the world. It is unclear whether Cree births are at greater elevated risk of perinatal and infant mortality than other First Nations relative to non-Aboriginal births in Quebec, and if macrosomia may be related. This was a population-based retrospective birth cohort study using the linked birth-infant death database for singleton births to mothers from Cree (n = 5,340), other First Nations (n = 10,810) and non-Aboriginal (n = 229,960) communities in Quebec, 1996-2010. Community type was ascertained by residential postal code and municipality name. The primary outcomes were perinatal and infant mortality. Macrosomia (birth weight for gestational age >90th percentile) was substantially more frequent in Cree (38.0%) and other First Nations (21.9%) vs non-Aboriginal (9.4%) communities. Comparing Cree and other First Nations vs non-Aboriginal communities, perinatal mortality rates were 1...

Research paper thumbnail of Individual- and Community-Level Disparities in Birth Outcomes and Infant Mortality among First Nations, Inuit and Other Populations in Quebec~!2009-12-01~!2010-04-12~!2010-07-06~!

The Open Women' s Health Journal, 2010

Objective: We assessed individual-and community-level disparities and trends in birth outcomes an... more Objective: We assessed individual-and community-level disparities and trends in birth outcomes and infant mortality among First Nations (North American Indians) and Inuit versus other populations in Quebec, Canada.

Research paper thumbnail of Community Remoteness, Perinatal Outcomes and Infant Mortality among First Nations in Quebec~!2009-12-02~!2010-04-12~!2010-07-06~!

The Open Women' s Health Journal, 2010

Objective: Little is known about community remoteness in relation to birth outcomes among Indigen... more Objective: Little is known about community remoteness in relation to birth outcomes among Indigenous populations. We assessed whether community remoteness matters for perinatal outcomes and infant mortality in Quebec First Nations communities.

Research paper thumbnail of Urban Living is Not Associated with Better Birth and Infant Outcomes among Inuit and First Nations in Quebec~!2009-11-30~!2010-04-12~!2010-07-06~!

The Open Women' s Health Journal, 2010

Objective: There is limited and inconsistent evidence concerning rural versus urban differences i... more Objective: There is limited and inconsistent evidence concerning rural versus urban differences in birth and infant outcomes for Indigenous peoples. We assessed birth and infant outcomes among Inuit, First Nations and French mother tongue groups by rural versus urban residence in Quebec, Canada.

Research paper thumbnail of Disparities and Trends in Birth Outcomes, Perinatal and Infant Mortality in Aboriginal vs. Non-Aboriginal Populations: A Population-Based Study in Quebec, Canada 1996-2010

PloS one, 2015

Aboriginal populations are at substantially higher risks of adverse birth outcomes, perinatal and... more Aboriginal populations are at substantially higher risks of adverse birth outcomes, perinatal and infant mortality than their non-Aboriginal counterparts even in developed countries including Australia, U.S. and Canada. There is a lack of data on recent trends in Canada. We conducted a population-based retrospective cohort study (n = 254,410) using the linked vital events registry databases for singleton births in Quebec 1996-2010. Aboriginal (First Nations, Inuit) births were identified by mother tongue, place of residence and Indian Registration System membership. Outcomes included preterm birth, small-for-gestational-age, large-for-gestational-age, low birth weight, high birth weight, stillbirth, neonatal death, postneonatal death, perinatal death and infant death. Perinatal and infant mortality rates were 1.47 and 1.80 times higher in First Nations (10.1 and 7.3 per 1000, respectively), and 2.37 and 4.46 times higher in Inuit (16.3 and 18.1 per 1000, respectively) relative to no...