Reproductive wastage in carrier couples of hemoglobinopathies: Experiences from a retrospective study in Madhya Pradesh, India (pp. 235-242)
Authors: Ranbir S Balgir
Abstract: The ƒÒ-thalassemia syndrome and sickle cell disorders are the major genetic and public health challenges in Central India. In view of credit for the 2nd highest infant mortality rate (IMR) in Madhya Pradesh (70 per thousand live-births in 2011), it was presumed that carriers of hemoglobinopathies might be one of the contributing factors for the high IMR. Couples including their offspring with at least one affected/suspected case of hemoglobinopathies, referred to us from NSCB Medical College and Hospital, Jabalpur were consecutively studied as matched case controls. A total of 333 couples were referred during the period from March 2010 to March 2012. Out of 333 couples, 138 were found normal and 195 couples had different hemoglobin disorders. It was observed that the number of conceptions (2.456 vs 1.522), live-births (2.246 vs 1.319), surviving offspring (2.005 vs 1.406), stillbirths (0.082 vs 0.051), and deaths under 10 year (0.236 vs 0.145) were higher and neonatal deaths (0.103 vs 0.116), and deaths under one year (0.118 vs 0.123) per couple at the time of investigations were lower in couples with hemoglobinopathies in comparison to normal controls. It was observed that the frequency of couples with combinations: HbAS x HbAS, HbAS x HbSS, and ƒÒ-Thalassemia Trait x ƒÒ-Thalassemia Trait, was considerably higher in the under-privileged communities such as scheduled castes (SC) and scheduled tribes (ST), and in Other Backward Castes (OBC) of the state of Madhya Pradesh. Affected families were imparted genetic/marriage counseling. This study indicated that afflicted couples with these hereditary disorders were increasing the affected/carrier offspring. This increased production of defective offspring leads to increased morbidity and mortality and may be contributing towards increased neonatal/infant mortality or fetal wastage in the state of Madhya Pradesh, India.