Consanguineous marriage

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CONSAGUINITY AND APNEA OF PREMATURITY
Hala Tamim, PhD1 Khalid Yunis, MD2
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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.
  

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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.

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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.

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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.

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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.

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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.
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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).
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Results
Table 1 Association between Neonatal
characteristics and Apnea of Prematurity
Variables Odds ratio 95 Confidence interval
First-degree consanguinity 2.16 1.06-4.42
Gestational age (weeks)
? 30 9.26 4.31-19.89
31-33 4.86 2.53-9.31
34-36 1
Complication 1.68 1.01-2.82
Multiple gestation 1.70 1.01-2.84
5-minute Apgar score lt7 2.29 1.04-5.04

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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).
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Results
Table 2 Logistic regression analysis of the main
predictors of Apnea of Prematurity
Variables Odds ratio 95 Confidence interval
First-degree consanguinity 2.89 1.30-6.43
Gestational age (weeks)
? 30 6.33 2.62-15.31
31-33 4.53 2.26-9.08
34-36 1
Complication during pregnancy 1.37 0.75-2.49
Multiple gestation 1.41 0.78-2.55
5-minute Apgar score lt7 0.49 0.21-1.18
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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.
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References
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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
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CURRENT INVESTIGATORS AT NCPNN MEMBER
INSTITUTIONS (by alphabetical order)
Hospital Investigator
Ain Wa Zain Hospital Margo Ali, MD
American University Hospital Khalid Yunis, MD
Hotel Dieu de France Hospital Imad Melki, MD
Jbeily Hospital Niazi Jbeily,MD
Makassed General Hospital Hassan Fakhoury, MD
Najjar Hospital Mohammad Itani, MD
Notre Dame de la Paix (Akkar) Ghayth Makhoul, MD
Rassoul al Aazam Hospital Alia Aaraj, MD
Rayak Hospital Amir Al Zahr, MD
Rizk Hospital Gerard Wakim, MD
Rahhal Hospital (Akkar) Joseph Rashkidi, MD
Sahel General Hospital Mona Alameh, MD
St. Georges Hospital Yolla Nassif, MD