Diagnostic and perinatal outcomes in consanguineous couples with a structural fetal anomaly: a cohort study

Fionnuala Mone, Samantha Doyle, Asfa Ahmad, Hala Abu Subieh, Susan Hamilton, Stephanie Allen, Tamas Marton, Denise Williams, Mark Kilby

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Abstract

Introduction
Consanguineous unions occur when a couple are related outside marriage and is associated with adverse genetic and perinatal outcomes for affected offspring. The objectives of this study were to evaluate: (i) background characteristics, (ii) uptake of prenatal and postnatal investigation and (iii) diagnostic outcomes of UK consanguineous couples presenting with a fetal structural anomaly.

Material and methods
This was a retrospective and partly prospective cohort study comparing consanguineous (n = 62) and non‐consanguineous (n = 218) pregnancies with current or previous fetal structural anomalies reviewed in a UK prenatal genetic clinic from 2008 to 2019. Outcomes were compared using odds ratios (OR).

Results
Most consanguineous couples were of Pakistani ethnicity (odds ratio [OR] 29, 95% confidence interval [95% CI] 13‐62) and required use of an interpreter [OR 9, 95% CI 4‐20). In the consanguineous group, the uptake of prenatal invasive testing was lower (OR 0.4, 95% CI 0.2‐0.7) and the number declining follow up was greater (OR 10, 95% CI 3‐34) than in the non‐consanguineous group. This likely explained the lower proportion of consanguineous couples where a final definitive unifying diagnosis to explain the fetal structural anomalies was reached (OR 0.3, 95% CI 0.2‐0.6). When a diagnosis was obtained in this group, it was always postnatal and most often using genomic sequencing technologies (OR 6, 95% CI 1‐27). The risk of perinatal death was greater (OR 3, 95% CI 1‐6) in the consanguineous group, as was the risk of fetal structural anomaly recurrence in a subsequent pregnancy (OR 4, 95% CI 1‐13). There was no difference in the uptake of perinatal autopsy or termination of pregnancy between groups.

Conclusions
Consanguineous couples are a vulnerable group in the prenatal setting. Although adverse perinatal outcomes in this group are more common secondary to congenital anomalies, despite the evolution of genomic sequencing technologies, due to a lower uptake of prenatal testing it is less likely that a unifying diagnosis is obtained and recurrence can occur. There is a need for proactive genetic counseling and education from the multidisciplinary team, addressing language barriers as well as religious and cultural beliefs in an attempt to optimize reproductive options.
Original languageEnglish
JournalActa obstetricia et gynecologica Scandinavica
Early online date31 Oct 2020
DOIs
Publication statusE-pub ahead of print - 31 Oct 2020

Keywords

  • autopsy
  • autosomal recessive
  • congenital anomaly
  • consanguineous
  • fetus
  • genomic testing
  • termination of pregnancy

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