Transcript Consanguineous marriage

CONSAGUINITY AND
APNEA OF PREMATURITY
Hala Tamim, PhD1
Khalid Yunis, MD2
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.
Background
Prevalence of Consanguinity
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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.
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.
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.
Background
Cont’d
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, âthalassemia)12, cystic fibrosis13, Chronic renal
failure14 and Neonatal diabetes mellitus15.
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.
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.
National Collaborative Perinatal
Neonatal Network NCPNN
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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).
National Collaborative Perinatal
Neonatal Network NCPNN
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Data is collected prospectively at the
network hospitals.
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Information on maternal and neonatal
characteristics is obtained from
obstetric and nursery records and
through direct interviews with the
mothers before hospital discharge.
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.
Subjects
Methods
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.
Subjects
Methods
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.
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.
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, 5minute Apgar score (Table 1).
Results
Table 1: Association between Neonatal
characteristics and Apnea of Prematurity
Variables
First-degree consanguinity
Gestational age (weeks)
 30
31-33
34-36
Complication
Multiple gestation
5-minute Apgar score <7
Odds
ratio
95% Confidence
interval
2.16
1.06-4.42
9.26
4.86
1
1.68
1.70
2.29
4.31-19.89
2.53-9.31
1.01-2.82
1.01-2.84
1.04-5.04
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).
Results
Table 2: Logistic regression analysis of the main
predictors of Apnea of Prematurity
95%
Odds
Variables
Confidence
ratio
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 <7
0.49
0.21-1.18
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.
References
NETWORK COORDINATING CENTER (AUBMC)
Project director:
Co-investigators:
Khalid A. Yunis, MD
Pediatrics & Neonatology
Mustafa Khogali, MD
Family Medicine
Hala Tamim, PhD
Epidemiology & Population Health
Network statistician:
GhinaMumtaz, M.Sc (2002-present)
(Epidemiology and Population Ban Al Sahab, M.Sc (2003-2004)
Health)
Hind Beydoun, MPH (1999-2003)
Choghik Boulghourjian, M.Sc (1998-2001)
Network coordinator:
Research Assistants:
Pascale Nakad, B.Sc (1999present)
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)
CURRENT INVESTIGATORS AT NCPNN MEMBER
INSTITUTIONS (by alphabetical order)
Hospital
Ain Wa Zain Hospital
American University Hospital
Investigator
Margo Ali, MD
Khalid Yunis, MD
Hotel Dieu de France Hospital
Jbeily Hospital
Makassed General Hospital
Imad Melki, MD
Niazi Jbeily,MD
Hassan Fakhoury, MD
Najjar Hospital
Notre Dame de la Paix (Akkar)
Rassoul al Aazam Hospital
Mohammad Itani, MD
Ghayth Makhoul, MD
Alia Aaraj, MD
Rayak Hospital
Rizk Hospital
Rahhal Hospital (Akkar)
Sahel General Hospital
Amir Al Zahr, MD
Gerard Wakim, MD
Joseph Rashkidi, MD
Mona Alameh, MD