الفهرس 
INTRODUCTION AND AIM OF THE STUDYOnly 14 pages are availabe for public view
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Abstract
In order to study the association between consanguinity and spontaneous preterm children attending the Nutrition outpatient’s clinic in Smouha Alexandria University Children’s Hospital, we carried out the present study and the following results were found and summarized as follows.
A
- Studding the general features and characters of the studied sample revealed the following:
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Mothers of extreme ages (less than 20 and 40 years and above) had increased risks of getting PTB (6.3 and 2.6 respectively).
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Illiterate mothers and fathers were (7.4 and 5.8 respectively) more likely to have a PT baby compared to university graduate.
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Both young and old fathers were 2 times more likely to have a PT baby compared to fathers of age group 30-44 years.
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Housewives mothers were 3.3 times more likely to deliver PT baby compared to working mother while paternal occupation was not associated with PTB.
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Female sex of preterm cases (50.7%) were slightly predominant than males (49.3%).
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The frequency of the order of Third child was 2.1 more likely to be born prematurely.
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Preterm babies were 5.9 more likely to be born SGA.
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30 % of preterm cases had congenital anomalies (19.3% with single anomaly, 6.7% with non syndromal multiple anomalies and 4% with delineated syndromes) compared to only 5.3% among full-term who had single anomaly.
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Gravidity, parity, maternal medical history, previous abdominal surgeries and mode of delivery were all found not associated with PTB.
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Mothers who had history of previous repeated abortions were 8.5 times more likely to deliver PT baby compared to those who had no history of abortions.
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Positive history of SB and/or ND was associated with 4 times increased risk of PTB while family history of CMF or genetic diseases increased the risk by 3.2 times.
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Mothers who had a history of one previous PTB were 8.6 more likely to have recurrent prematurity while those who had multiple PTBs were 15 times more likely to have PTB.
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Mothers who had irregular ANC visits were 1.9 more likely to have PTB.
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Mothers who were on anti-coagulant, TRT and anti-epileptic were more likely to have PTB (1.8, 5.5 and 2.7 respectively).
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Mothers who had received antenatal steroids were 5.3 more likely to have PTB.
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Mothers who had bleeding, oligohydramnios and vaginitis were more likely to give birth of a PT baby (1.6, 4 and 2.1 respectively).
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16.6% of preterm cases were resulted from consanguineous marriages (15.3% were FC and 1.3% were SC) compared to only 8.7% among full-term. Consanguineous parents were 2.1 more likely to have a PT baby while both paternal and maternal parents consanguinity were not associated with PTB.
Summary, C onclusion, and Recommendations
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B
- Studying of the prematurity subtypes revealed the following:
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25.3% of the studied preterm cases were extremely and very preterm, 30.7% were moderate preterm and 44% were late preterm.
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Young maternal and paternal ages were frequently recorded among moderate PT (6.5% and 43.5% respectively) while advanced parental ages were more among late PT (6.1%).
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Both illiterate mothers and fathers were reported frequently among Moderate PT (21.7% and 26.1% respectively) while university and post graduate were recorded frequently among late PT (18.2%).
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Single and multiple non syndromal congenital anomalies were found frequently among moderate PT (28.3% and 15.2% respectively) while syndromes were more common among extremely / very subtype (7.9%).
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Late PT had the highest percentages among those who had positive history of antenatal steroid intake (65.2%), while moderate PT had the highest percentages among those who had previous abortions (28.3%) and positive family history of CMF or genetic diseases (13%).
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Positive history of one previous PTB was more frequent among moderate PT (13%) than those with history of previous multiple PTBs late subtype (7.6%).
C
- Studying consanguinity among prematurity subtypes:
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Consanguinity was frequently reported among moderate PT (28.2%) followed by late PT (16.7%) compared to full-term (8.7%).
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The highest coefficient of inbreeding (F) was among moderate PT (0.0156) followed by late PT (0.01) compared to full-term (0.005).
D- Studying the possible mode of inheritance, the most common inheritance was reported among genetic uncertain mode of inheritance (52%) followed by AR (32%) and MF (16%).
E- The following variables were included in the logistic regression analysis: parental age and education, maternal occupation, parental consanguinity, history of abortion and antenatal care, family history of CMF, month of delivery and CA.
➢
Studying the predictors of PTB revealed that consanguineous parents were 5.2 times more likely to have PTB than non-consanguineous couples (AOR= 5.2, CI= 1.2-22.7, P= 0.028). History of previous abortions was found to increase the risk of PTB by almost 13 times more than negative history (AOR= 12.98, CI= 1.3-129.03, P= 0.029). Children who were born with congenital anomalies were 7.6 times more likely to be born PT (AOR= 7.6, CI= 2.01-28.82, P= 0.003).
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Studying the predictors of extremely / very PTB revealed that the odds of delivery an extremely/very preterm baby with congenital anomalies was more than seventeen folds that of full-term (AOR= 17.34, CI= 2.7-110.1, P= 0.002). History of previous abortions increased PTB by 30 times (AOR= 30.6, CI= 2.5-368.2, P= 0.007).
➢
Studying the predictors of moderate PTB revealed that consanguineous parents were 8.6 more likely to deliver a PT baby (AOR= 8.62, CI= 1.4-51.6, P= 0.018) while congenital anomalies significantly increased the risk of moderate prematurity to almost 12 times (AOR=11.99, CI= 2.1-68.4, P= 0.005).
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Lastly, studying the predictors of late PTB revealed that illiterate mothers were almost 9 times more likely to deliver a PT baby (AOR= 8.97, CI= 1.4-58.5, P= 0.022).
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Consanguineous parents were 9.2 times more likely to have a late PT baby (AOR= 9.2,
CI= 1.7-51.4, P= 0.011).
6.2 Conclusion
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In conclusion, the present study provides evidence for multiple risk factors associated with PTB together with parental consanguinity. Some of these risk factors revealed positive associations such as parental age, education, occupation, third birth order, SGA, congenital anomalies, previous history of abortions and still birth or neonatal death, previous PTB, family history of congenital malformations or genetic diseases, antenatal care and steroid intake.
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Some variables were found strongly associated with extremely / very preterm subtypes, including illiterate parents, SGA, syndromal multiple congenital anomalies, history of previous 3 or more abortions, previous PTB, antenatal steroid intake and oligohydramnios.
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Studying the subtypes of PTB revealed that moderate preterm subtype, young and illiterate parents, SGA, congenital anomalies either single or multiple non syndromal anomalies as well as family history of congenital malformation or genetic diseases were all associated risk factors. Moderate preterm was also highly associated with history of previous PTB, antenatal care visits, antenatal steroids and vaginitis.
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Late preterm subtype was associated with illiterate mothers, young fathers, third child order, SGA, single and multiple congenital anomalies, history of PTB (either once or more) and antenatal steroid intake.
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Parental consanguinity seemed to increase the risk of moderate and late prematurity.
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The highest coefficient of inbreeding (F) was recorded among moderate preterm subtype.
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Different predictors were identified by logistic regression analysis which revealed associations between PTB and parental consanguinity, previous abortions and congenital anomalies.
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History of abortions and congenital anomalies were the only predictors of extremely / very subtype, while parental consanguinity and congenital anomalies played the major role in predicting moderate subtype. Maternal education and parental consanguinity were the predictors of late preterm.
6.3 Recommendations
1
- Providing good filing system in hospitals and health care centers is mandatory for excellent data base.
2
- Improving the awareness of medical staff about the significance of the genetic role in causation of many and serious health problems.
3
- Stressing on improving and practical application of premarital and genetic counseling are very important tools for controlling many health problems including prematurity.
4
- Increasing the public awareness about the deleterious effect of consanguineous marriages and its discouragement when possible to avoid several serious health problems especially those who have mutated AR genes.
5
- Specific attention should be given to couples who have positive family history of genetic diseases in order to avoid recurrence of CMF /genetic problems.
6
- Further studies are needed to:
a.
Explore the role of consanguineous marriages in other pediatric health problems.
b.
Conducting similar studies on larger scale, other settings and different target populations to emphasize its evidence and estimate more accurate risk of consanguineous marriage.