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  • Title: The impact of consanguinity and inbreeding on perinatal mortality in Karachi, Pakistan.
    Author: Hussain R.
    Journal: Paediatr Perinat Epidemiol; 1998 Oct; 12(4):370-82. PubMed ID: 9805711.
    Abstract:
    Close consanguineous unions continue to be extremely common in much of West Asia, including Pakistan. However, the impact of inbreeding on offspring mortality, particularly perinatal mortality, remains poorly documented. This paper attempts to measure the mortality risks associated with consanguinity and inbreeding while controlling for the effects of other potential confounders. The study sample comprises a multi-ethnic population residing in selected squatter settlements of Karachi. The adjusted odds ratio for perinatal mortality in the offspring of women married to their first cousins was 2.0 [95% CI 1.5, 2.6]. When parental inbreeding was also taken into account, the adjusted odds ratio for perinatal mortality increased further. Analysis of a subsample of data limited to pregnancies to women aged 35 years or above (at the time of the survey) showed that, despite adjustment for important biological and socio-demographic factors, both consanguinity and inbreeding remained important predictors of perinatal mortality in the offspring. Implications of the present study for further research are highlighted. This study examined the nature and extent of perinatal mortality among consanguineous couples living in squatter settlements in Karachi, Pakistan. Data were obtained from a sample of 1021 ever-married women living in 4 squatter settlements in Karachi in 1995. The sampling frame was based on an earlier study of primary health care. Findings indicate that 59% of marriages were consanguineous unions. 83.6% of consanguineous unions were between first cousins. Almost 50% of first-cousin couples had parents who had close consanguineous marriages. Consanguinity occurred among Muslims, Christians, and Hindus. Logit analysis was confined to first-cousin and non-first-cousin marriages. There were 4767 singleton full-term pregnancies, of which 368 were perinatal deaths: 195 (4.1%) were stillbirths and 173 (3.6%) were early neonatal deaths. The overall perinatal mortality rate during 1968-95 was 83.6/1000 live births. Perinatal mortality was 68.2/1000 during 1990-95 and 106.0/1000 during 1980-85. The odds ratios of perinatal mortality were twice as high among first couple unions or unions with consanguineous parent unions. Low birth weight did not vary by consanguinity status. Other predictors of perinatal mortality were a history of perinatal loss in the previous pregnancy, high parity (7), non-use of contraception, religious affiliation, year of birth, and sex of fetus. The adjusted odds ratio for perinatal mortality among women aged over 35 years was 3.7. Odds ratios were not elevated if there was a break in inbreeding among families. Male fetuses were especially vulnerable.
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