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Why do UK-born Pakistani babies have high perinatal and neonatal mortality rates?
Insights
Pakistani babies face high perinatal mortality due to lethal congenital malformations, particularly autosomal recessive conditions in offspring of consanguineous parents. Early screening via ultrasonography can help mitigate these risks.
Area of Science:
- Perinatal Health
- Medical Genetics
- Public Health
Background:
- High perinatal mortality rates observed in Pakistani populations require investigation into underlying causes.
- Previous assumptions about termination reluctance are challenged by new data.
Purpose of the Study:
- To identify the primary causes of elevated perinatal mortality in Pakistani infants.
- To investigate the role of congenital malformations and consanguinity in this mortality.
- To explore potential preventive strategies.
Main Methods:
- Prospective study involving 4934 infants from diverse ethnic backgrounds.
- Analysis of perinatal mortality rates and causes, with a focus on Pakistani infants.
- Examination of malformation types, including autosomal recessive conditions and cardiac defects.
- Assessment of the association between consanguinity and specific malformations.
Main Results:
- Confirmed high perinatal mortality rate in Pakistani infants.
- Lethal malformations identified as the major cause, occurring in ~1% of Pakistani babies and contributing to ~50% of their perinatal mortality.
- Autosomal recessive malformations were common in offspring of consanguineous parents; excess lethal cardiac malformations were noted without consanguinity.
- Socio-economic factors likely contribute to the remaining excess mortality.
Conclusions:
- Lethal congenital malformations, influenced by consanguinity, are a key driver of high perinatal mortality in Pakistani infants.
- Excess cardiac malformations and socio-economic factors also play significant roles.
- Targeted interventions, including expert ultrasonography during pregnancy, are recommended for prevention.
Abstract:
A prospective study of 4934 babies of different ethnic groups has confirmed the high perinatal mortality rate for Pakistanis and has shown that this was not due to a reluctance to terminate a fetus who is known to be seriously malformed. The major cause of early mortality was a high rate of lethal malformations, which occurred in about 1 in 100 Pakistani babies and which accounted for about half of their perinatal mortality. Many of these were autosomal recessive and occurred only in the offspring of consanguineous parents. However, there was also an excess of lethal cardiac malformations which were not associated with parental consanguinity. The remainder of the excess perinatal mortality was probably due to socio-economic factors. These causes are partly amenable to preventive measures, such as the referral of Pakistani women for expert ultrasonography at 18 to 20 weeks of pregnancy.