CONSAGUINITY AND APNEA OF

PREMATURITY

Hala Tamim, PhD1

Khalid Yunis, MD2

BackgroundDefinition 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.

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.

BackgroundPrevalence 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.

BackgroundSocio-demographic Characteristics of Consanguinity

Parental consanguinity increases the

autosomal recessive conditions

through the expression of recessive

deleterious alleles, especially in the

offspring of first degree cousins.

BackgroundHealth Impacts of Consanguinity

BackgroundHealth 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.

Cont’d

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.

BackgroundApnea of Prematurity

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.

Objective

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

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.

National Collaborative Perinatal Neonatal Network NCPNN

Between September 1, 1998, and

March 31, 2001, a total of 21,723

consecutive newborn infants were

delivered and admitted to the

NCPNN.

MethodsSubjects

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.

MethodsSubjects

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.

MethodsSubjects

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.

MethodsStatistical analysis

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).

VariablesOdds 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 <7 2.29 1.04-5.04

Table 1: Association between Neonatal characteristics and Apnea of Prematurity

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

Results

VariablesOdd

s 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 <7 0.49 0.21-1.18

Table 2: Logistic regression analysis of the main predictors of Apnea of Prematurity

ConclusionThere 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)

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:

Pascale Nakad, B.Sc (1999-present) Network coordinator:

GhinaMumtaz, M.Sc (2002-present)Ban Al Sahab, M.Sc (2003-2004)Hind Beydoun, MPH (1999-2003)Choghik Boulghourjian, M.Sc (1998-2001)

Network statistician:(Epidemiology and Population Health)

Hala Tamim, PhDEpidemiology & Population Health

Mustafa Khogali, MDFamily Medicine

Co-investigators:

Khalid A. Yunis, MDPediatrics & Neonatology

Project director:

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