Prenatal, Neonatal and Pediatric Health Care and Reproductive Medicine in Relation to Hemoglobinopathies in Three Stratified Communities of Central India

Background: Hemoglobinopathies cause a high degree of maternal morbidity and maternal and fetal mortality, and reproductive wastage in vulnerable communities/populations of India. Both prospective and retrospective studies in this context are lacking in central India.
Objectives: Prospective and retrospective studies of referral index cases of hemoglobin disorders may provide most valuable data for analysis with respect to introspection and prospective re-evaluation in vulnerable communities.

Methods: In a cross-sectional prospective study of suspected cases of hemoglobin disorders routinely referred to us from NSCB Medical College and Hospital, Jabalpur for electrophoresis and other hematological investigations, a total of 213 couples with their offspring were studied from March 2010 to June 2011. Couples were stratified according to their caste/tribe and also depending upon the detection of β-thalassemia or other hemoglobin disorders in either of the family members. Reproductive history, i.e. number of abortions, still births, neonatal death, death under 1 year, death below 10 years of age, etc. of each couple was recorded retrospectively for each category of couples. Of the couples with hemoglobinopathies, 27 belonged to scheduled tribes (ST), 48 scheduled castes (SC) and 32 were Other Backward Castes (OBC). Of the 213 couples studied, 106 (mixed group belonging to above OBC, SC and ST) found free of hemoglobinopathies (β-thalassemia or hemoglobin disorders) were labelled as normal-controls and others (107) had different hemoglobinopathies.

Results and Discussion: The number of conceptions including the affected surviving offspring per couple with hemoglobinopathies was higher in both OBC (2.750) and SC (2.521). Broadly, it was observed that the number of stillbirths was higher in couples with hemoglobinopathies in ST (186) as compared to other caste categories, whereas, the number of abortions was similarly higher in couples with hemoglobinopathies in SC (141) per 1000 live-births. The number of deaths of offspring below 10 years age per 1000 live-births was also higher in couples with hemoglobinopathies in SC (111) and OBC (98).

Conclusion: Carrier and affected offspring of hemoglobin disorders further increases, maternal morbidity and fetal mortality, which is a major health burden on the vulnerable communities. Roles of preventive genetic counselling, prenatal, neonatal and pediatric health care are over emphasized in the affected communities.

Keywords: Prenatal, Neonatal and Pediatric health, Reproductive medicine, Hemoglobinopathies, Maternal morbidity, Fetal wastage, Prospective genetic counseling.