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Consanguineous marriage

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Title: Consanguineous marriage


1
CONSAGUINITY AND APNEA OF PREMATURITY
Hala Tamim, PhD1 Khalid Yunis, MD2
2
Background
Definition of consanguinity
Consanguineous marriage is the union of
individuals having a common ancestor. It is
categorized as 1st, 2nd and 3rd degree. The 1st
being the closest kinship. It is believed that
consanguineous marriages would preserve Family
dynamics structure and provide Cultural,
Social and economic benefits.
3
Background
Prevalence of Consanguinity
  • High estimates of consanguineous marriages have
    been reported in various Arab countries
  • 54 in Kuwait1
  • 29-50 in Egypt2
  • 52 in Saudi Arabia3
  • 51 in the United Arab Emirates4
  • 50 in Jordan5
  • 15 in Lebanon6
  • 40 in Yemen7.

4
Background
Socio-demographic Characteristics of Consanguinity
  • Consanguineous marriages are more prevalent in
    rural than urban areas8, such marriages have been
    positively associated with Low age at marriage8,
    Low educational level of the mother9, Low
    occupational status of husband5.

5
Background
Health Impacts of Consanguinity
  • Parental consanguinity increases the autosomal
    recessive conditions through the expression of
    recessive deleterious alleles, especially in the
    offspring of first degree cousins.

6
Background
Contd
Health Impacts of Consanguinity
  • Parental consanguinity has been associated with
    increased risk of pediatric disorders including
  • Stillbirths and perinatal mortality10, Congenital
    birth defects, Malformations, and mental
    retardation11, Blood diseases (hemophilia,
    â-thalassemia)12, cystic fibrosis13, Chronic
    renal failure14 and Neonatal diabetes mellitus15.

7
Background
Apnea of Prematurity
  • Apnea of prematurity is a common problem in the
    neonatal intensive care setting that affects
    premature infants (those born before 37 weeks of
    gestation). It is defined as either the cessation
    of breathing for longer than 20 seconds or that
    of any duration if accompanied by cyanosis and
    sinus bradycardia.

8
Objective
  • The aim of this study was to examine the
    association between consanguinity and apnea of
    prematurity among infants born in Greater Beirut,
    Lebanon, a country with a relatively high
    prevalence of consanguineous marriages.

9
National Collaborative Perinatal Neonatal Network
NCPNN
  • Initiated in September 1998, the National
    Collaborative Perinatal Neonatal Network (NCPNN)
    is a non-profit voluntary collaboration of health
    professionals.
  • NCPNN contains major hospitals in the city of
    Beirut as well as hospitals in the South, East,
    North and the mountains. The network is now in
    the process of expanding to other areas in
    Lebanon (Annex 1,2).

10
National Collaborative Perinatal Neonatal Network
NCPNN
  • Data is collected prospectively at the network
    hospitals.
  • Information on maternal and neonatal
    characteristics is obtained from obstetric and
    nursery records and through direct interviews
    with the mothers before hospital discharge.

11
Methods
Subjects
Between September 1, 1998, and March 31, 2001, a
total of 21,723 consecutive newborn infants were
delivered and admitted to the NCPNN.
12
Methods
Subjects
Inclusion criteria were Infants less than 37
weeks of gestation, admitted to the intensive
care unit of one of the NCPNN centers, and having
no congenital malformations, sepsis, neurologic
disorders, or metabolic and electrolytic
disturbances such as hypoglycemia, hypocalcemia,
or hypomagnesemia.
13
Methods
Subjects
  • The inclusion criteria were satisfied for 857
    infants of the total of 21,723 infants, of whom
    78 had apnea of prematurity. Analysis was based
    on 597 infants with complete information on
    consanguinity, 66 of whom had apnea of
    prematurity.

14
Methods
Statistical analysis
To assess the relation between neonatal
characteristics and Apnea of Prematurity, odds
ratios and 95 percent confidence intervals were
calculated. Variables significantly associated
with Apnea of Prematurity at the bivariate level
were included in a logistic regression model to
determine the independent effect of consanguinity
on apnea of prematurity.
15
Results
Bivariate analysis revealed that the variables
significantly associated with Apnea of
Prematurity were First-degree consanguinity,
Gestational age, Presence of complications during
pregnancy, Multiple gestation, 5-minute Apgar
score (Table 1).
16
Results
Table 1 Association between Neonatal
characteristics and Apnea of Prematurity
17
Results
Adjusting for Gestational age, Presence of
complications during pregnancy, Multiple
gestation and 5-minute Apgar score, the effect of
first-degree consanguinity on Apnea of
Prematurity was OR 2.89 CI 1.3-6.43 (Table 2).
18
Results
Table 2 Logistic regression analysis of the main
predictors of Apnea of Prematurity
19
Conclusion
There is an urgent need to inform the public
properly about the anticipated deleterious
effects of inbreeding in societies where
intermarriage is widely practiced. Further
etiologic studies that look into the association
of consanguinity and apnea of prematurity are
needed to support this finding and clarify the
significance of such an association.
20
References
21
NETWORK COORDINATING CENTER (AUBMC)
Annex 1
Khalid A. Yunis, MD Pediatrics Neonatology
Project director
Mustafa Khogali, MD Family Medicine
Co-investigators
Hala Tamim, PhD Epidemiology Population Health
Network statistician (Epidemiology and
Population Health)
GhinaMumtaz, M.Sc (2002-present) Ban Al Sahab,
M.Sc (2003-2004) Hind Beydoun, MPH
(1999-2003) Choghik Boulghourjian, M.Sc
(1998-2001)
Network coordinator
Pascale Nakad, B.Sc (1999-present)
Dania Abi Haydar, B.Sc (1999-present) Hiba Al
Assaad, B.Sc (2001-2003) May Al Kassar, B.Sc
(2001-present) Bassima Dergham, B.Sc
(2002-present) Mary Ghanem, MPH (2003-2004) Diana
Jamal,B.Sc (2004-present) May Sanyoura. B.Sc.
(2004-present)
Research Assistants
22
CURRENT INVESTIGATORS AT NCPNN MEMBER
INSTITUTIONS (by alphabetical order)
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