Consanguinity, Fertility and Reproductive Outcomes: An International Review
Main Article Content
Abstract
Consanguineous marriages have been common throughout human history, and remain so even today in many parts of the world. Many Arab countries display some of the highest rates of consanguinity and, specifically, first cousin marriages which may encompass 25 to 30 percent of all marriages.
The effects of inbreeding on reproductive outcome have been extensively studied. It used to be generally believed that inbreeding contributed to increased mortality and morbidity with detrimental effects on reproductive outcome; however, some studies have shown only a moderate to slight impact. The fertility of consanguineous couples and infant and childhood morbidity and mortality in their progeny have also been extensively studied and numerous studies have concluded that consanguinity is not associated with either a significant positive or negative effect on fertility.
The majority of studies found that first cousin couples produce more children. In many cases the mean number of live births to women in consanguineous marriages has been reported as being higher than that in non-consanguineous unions, although several studies found that mean fertility rates may be lower in consanguineous couples. In general, higher total fertility rates have been reported in consanguineous marriages. Reports regarding the association of consanguinity and fetal wastage are conflicting, with some reporting that the total prenatal losses were essentially the same for consanguineous and non-consanguineous.
Congenital malformations have long been established to be higher in consanguineous couples about the background rate (4.5% vs 1%). Due to the principle of the existence of a common ancestor. Consanguinity is most commonly associated with inborn errors of metabolism, most of which are autosomal recessive. Consanguinity also increases the incidence of multi-factorial disorders such as diabetes, cardiovascular disorders, obesity and certain types of cancers, which may in turn affect reproductive outcomes. Pregnancy outcomes, such as increased pregnancy wastage and preterm labor have been reported with consanguineous marriages.
The most significant effects on reproductive outcomes are mostly due to autosomal recessive inherited conditions and inborn errors in metabolism.
In the future, with completion of the study of the whole human Genome and current advances in pre-implantation diagnosis and screening it may be possible to mitigate some of the adverse reproductive outcomes associated with consanguinity.
Article Details
How to Cite
JABER, Lutfi; NASHIF, Alaa S.; DIAMOND, Gary.
Consanguinity, Fertility and Reproductive Outcomes: An International Review.
Medical Research Archives, [S.l.], v. 11, n. 7.1, july 2023.
ISSN 2375-1924.
Available at: <https://esmed.org/MRA/mra/article/view/4051>. Date accessed: 15 may 2024.
doi: https://doi.org/10.18103/mra.v11i7.1.4051.
Section
Review Articles
The Medical Research Archives grants authors the right to publish and reproduce the unrevised contribution in whole or in part at any time and in any form for any scholarly non-commercial purpose with the condition that all publications of the contribution include a full citation to the journal as published by the Medical Research Archives.
References
1. Alwan A, Modell B. Community control of genetic and congenital disorders. EMRO Technical Publication Series 24: WHO Regional Office for the Eastern Mediterranean Region, Egypt 1997.
2. Modell B, Darr A. Science and society: Genetic counselling and customary
consanguineous marriage. Nat Rev Genet. 2002,3:225-229.
3. Tadmouri GO, Nair P, Obeid T, Al Ali MT, Al Khaja N, Hamamy HA. Consanguinity and reproductive health among Arabs. Reprod Health. 2009,6:17.
4. Bittles AH, Mason WM, Greene J, Rao NA. Reproductive behavior and health in consanguineous marriages. Science. 1991;252:789-794.
5. Editorial. Consanguinity and health. Lancet 1991;338:85-86.
6. Jaber L, Halpern GJ, Shohat T. Trends in the frequencies of consanguineous marriages in the Israeli Arab community. Clin Genet. 2000;58:106-110.
7. Hamamy H, Jamhawi L, Al-Darawsheh J, Ajlouni K. Consanguineous marriages in Jordan: Why is the rate changing with time? Clin Genet. 2005;67:511-516.
8. Schull WJ, Nagano H, Yamamoto M, Komatsu I. The effects of parental consanguinity and inbreeding in Hirado, Japan. I. Stillbirths and prereproductive mortality. Am J Hum Genet. 1970;22:239-262.
9. Freire-Maia N. Effects of consanguineous marriages on morbidity and precocious mortality: Genetic counseling. Am J Med Genet. 1984;18.401-406.
10. Imaizumi Y. A recent survey of consanguineous marriages in Japan. Clin Genet. 1986;30:230-233.
11. Khoury MJ, Cohen BH, Diamond EL, Chase GA, McCusick VA: Inbreeding and prereproductive mortality in the Old Order Amish. I. Genealogic epidemiology of inbreeding. Am J Epidemiol. 1987;125:453-461.
12. Bonne B. The Samaritans: A demographic study. Hum Biol. 1963;35:61-89.
13. Jaber L, Halpern GJ, Shohat M. The impact of consanguinity worldwide. Community Genet. 1998;1:12-17. (doi: 10.1159/000016130)
14. Bittles AH. The role and significance of consanguinity as a demographic variable. Popul Dev Rev. 1994;20:561-584.
15. Khlat M. Endogamy in Arab countries. In: Teebi A, Farag TI, Eds. Genetic disorders among Arab populations. New York: Oxford Univ. Press, 1997; pp. 63-80.
16. Bittles AH, Black ML. Consanguineous and human evolution. Annu Rev Anthropol. 2010;39:193-207.
17. Bittles AH, Black ML. Consanguinity, human evolution, and complex diseases. Proc Natl Acad Sci USA. 2009; 107Suppl 1:1779-1786.
18. World Population Prospects: The 2010 Revision Population Database. Accessed May 2011. http://esa.un.org/unpp
19. Bittles A. The global prevalence of consanguinity. Accessed June 2011. http://www.consang.net.
20. Khuri FI. Parallel cousin marriage reconsidered: A Middle Eastern practice that nullifies the effects of marriage on the intensity of family relationships. Man. 1976;5:597-618.
21. Kulkarni ML, Kurian M. Consanguinity and its effect on fetal growth and development: A south Indian study. J Med Genet. 1990;27:348-352.
22. Bittles AH, Black ML. The impact of consanguinity on neonatal and infant health. Early Hum Dev. 2010;86:737-741. Epub 2010 Sep 15.
23. Khlat M. Consanguineous marriage and reproduction in Beirut, Lebanon. Am J Hum Genet. 1988;43:188-196.
24. Al Arrayed SS. Review of the spectrum of genetic diseases in Bahrain. East Mediterr Health J. 1999 5:1114-1120.
25. Assaf S, Khawaja M. Consanguinity trends and correlates in the Palestinian Territories. J Biosoc Sci. 2009;41:107-124.
26. Bashi J. Effects of inbreeding on cognitive performance. Nature. 1977;266:440-2.
27. Freundlich E, Hino N. Consanguineous marriage among rural Arabs in Israel. Isr J Med Sci. 1984;20:1035-1038.
28. Fried K, Davies AM. Some effects on the offspring of uncle niece marriage in a Moroccan Jewish community in Jerusalem. Am Hum Genet. 1974;26:65-72.
29. Gev D, Roguin N, Freundlich E. Consanguinity and congenital heart disease in the rural Arab population in northern Israel. Hum Hered. 1986;36:213-217.
30. Jaber L, Merlob P, Bu X, Rotter JI, Shohat M. Marked parental consanguinity as a cause for increased major malformations in an Israeli Arab community. Am J Med Genet. 1992;44:1-6.
31. Jaber L, Bailey-Wilson JE, Haj-Yehia M, Hernandez J, Shohat M. Consanguineous matings in an Israeli-Arab community. Arch Pediatr Adolesc Med. 1994;148:412-415.
32. Khlat M, Khoury M. Inbreeding and diseases: demographic, genetic, and epidemiologic perspectives. Epidemiol Rev. 1991;13:28-41.
33. Magnus P, Berg K, Bjerkedal T. Association of parental consanguinity with decreased birth weight and increased rate of early death and congenital malformations. Clin Genet. 1985;28:335-342.
34. Morton NE. The inheritance of human birth weight. Ann Hum Genet. 1955;20:125-134.
35. Freire-Maia A, Stevenson C, Morton NE. Hybridity effect on mortality. Soc Biol. 1974;21:232-234.
36. Rao PS, Inbaraj SG. Inbreeding effects on human reproduction in Tamil Nadu of South India. Ann Hum Genet. 1977;41:87-98.
37. Rao PS, Inbaraj SG. Inbreeding effects on fertility and sterility in southern India. J Med Genet. 1979;16:24-31.
38. Rao PS, Inbaraj SG. Trends in human reproductive wastage in relation to long-term practice of inbreeding. Ann Hum Genet. 1979;42:401-413.
39. Roberts DF, Bonne B. Reproduction and inbreeding among the Samaritans. Soc Biol. 1973;20:64-70.
40. Reddy VR, Rao AP. Effects of parental consanguinity on fertility, mortality and morbidity among the Pattusalis of Tirupati, South India. Hum Hered. 1978;28:226-234.
41. Saha N, Hamad RE, Mohamed S. Inbreeding effects on reproductive outcome in a Sudanese population. Hum Hered. 1990;40:208-212.
42. Sanghvi LD. Inbreeding in India. Eugenics Q. 1966;13:291-301.
43. Shami SA, Schmit LH, Bittles AH. Consanguinity related prenatal and postnatal mortality of populations of seven Pakistani Punjab cities. J Med Genet. 1989;26:267-271.
44. Sibert JR, Jadhav M, Inbaraj SG. Fetal growth and parental consanguinity. Arch Dis Child. 1979;54:317-319.
45. Hamamy H, Antonarakis SE, Cavalli-Sforza LL, et al. Consanguineous marriages, pearls and perils: Geneva International Consanguinity Workshop Report, September 2011. Genetic Med. 2011;13; 841-847.
46. Darlington CD. Cousin marriage and the evaluation of inbreeding system in man. Heredity. 1973;14:297-331.
47. McCluer JW. Inbreeding and human fetal death. In: Porter I, Hook I, Eds. Human emtbryonic andfetal death. New York: Academic Press. 1980; pp. 241-261.
48. Bittles AH, Grant JC, Sullivan SG, Hussain R. Does inbreeding lead to decreased human fertility? Ann Hum Biol. 2002;29:111-130.
49. Robert A, Toupance B, Tremblay M, Heyer E. Impact of inbreeding on fertility in a pre-industrial population. Eur J Hum Genet. 2009;17:673-681. Epub 2008 Dec 17
50. Hussain R, Bittles AH. Assessment of association between consanguinity and fertility in Asian populations. J Health Popul Nutr. 2004, 22:1-12.
51. Saad FA, Jauniaux E. Recurrent early pregnancy loss and consanguinity. Reprod Biomed Online. 2002;5:167-170.
52. Cereijo AI, Prieto L, Martinez-Frias ML. Effect of consanguinity and endogamy on mortality and fertility in a Spanish population: Genet Iber. 1985;37:207-219.
53. Baccetti B, Capitani S, Collodel G, et al. Genetic sperm defects and consanguinity. Hum Reprod. 2001;16:1365-1371.
54. Edmond M, De Braekeleer M. Inbreeding effects on fertility and sterility: a case-control study in Saguenay-Lac-Saint-Jean (Québec, Canada) based on a population registry 1838-1971. Ann Hum Biol. 1993;20:545-555.
55. Khoury SA, Massad DF. Consanguinity, fertility, reproductive wastage, infant mortality and congenital malformations in Jordan. Saudi Med J. 2000;21:150-154.
56. Basu SK. Effect of consanguinity among North India Muslims. J Popul Res. 1975;2:57-68.
57. Devi AR, Rao NA, Bittles AH. Consanguinity, fecundity and post-natal mortality in Karnataka, South India. Ann Hum Biol. 1981;8:469-472.
58. Verma IC, Prema A, Puri RK. Health effects of consanguinity in Pondicherry. Indian Pediatr. 1992;29:685-692.
59. Asha Bai PV, John TJ, Subramaniam VR. Reproductive wastage and developmental disorders in relation to consanguinity in south India. Trop Geogr Med. 1981;33:275-280.
60. Reddy TP, Reddy KK, Reddy PG. Ancestral consanguinity and mortality among three endogamous populations of Chittoor District, Andhra Pradesh, India. Hum Biol. 2007;79:413-425.
61. Labouriau R, Amorim A. Comment on "An association between the kinship and fertility of human couples. Science. 2008;322:1634; Author reply 1634.
62. Bener A, Hussain R. Consanguineous unions and child health in the State of Qatar. Paediatr Perinat Epidemiol. 2006;20:372-378.
63. Kerkeni E, Monastiri K, Saket B, Guediche MN, Ben Cheikh H. Interplay of socio-economic factors, consanguinity, fertility, and offspring mortality in Monastir, Tunisia. Croat Med J. 2007;48:701-707.
64. Hussain R, Bittles AH. Consanguineous marriage and differentials in age at marriage, contraceptive use and fertility in Pakistan. J Biosoc Sci. 1999;31:121-138.
65. Postma E, Martini L, Martini P. Inbred women in a small and isolated Swiss village have fewer children. J Evol Biol 2010;23:1468-1474. Epub. 2010 May 12.
66. Labouriau R, Amorim A. Human fertility increases with marital radius. Genetics. 2008; 178:601-603.
67. Charlesworth D, Willis JH. The genetics of inbreeding depression. Nat Rev Genet. 2009; 10:783-796.
68. Inhorn MC, Kobeissi L, Nassar Z, Lakkis D, Fakih MH. Consanguinity and family clustering of male factor infertility in Lebanon. Fertil Steril 2009;91:1104-1109. Epub. 2008 Mar 25
69. Ober C, Elias S, Kostyu DD, Hauck WW. Decreased fecundability in Hutterite couples sharing HLA-DR. Am J Hum Genet. 1992;50:6-14.
70. Ober C. Studies of HLA, fertility and mate choice in a human isolate. Hum Reprod Update. 1999;5:103-107.
71. Schull WJ, Neel JV. The effects of parental consanguinity and inbreeding in Hirado, Japan. V. Summary and interpretation. Am J Hum Genet. 1972;24:425-453.
72. Tunçbilek E, Koç I. Consanguineous marriage in Turkey and its impact on fertility and mortality. Ann Hum Genet. 1994;58(Pt 4):321-329.
73. Bittles AH. Consanguinity and its relevance to clinical genetics. Clin Genet. 2001;60:89-98.
74. Fuster V. Inbreeding pattern and reproductive success in a rural community from Galicia (Spain). J Biosoc Sci. 2003;35:83-93.
75. Helgason A, Palsson S, Gudbjartsson DF, Kristjansson T, Stefansson K. An association between the kinship and fertility of human couples. Science. 2008;319:813-816.
76. Reddy PG. Effects of consanguineous marriages on fertility among three endogamous groups of Andhra Pradesh. Soc Biol. 1987;34:68-77.
77. Bhasin MK, Nag S. Consanguinity and its effects on fertility and child survival among Muslims of Ladakh in Jammu and Kashmir. Anthropologist. 2002;Special Issue No. 1:131-140.
78. Yasim Naidu JM, Mascie-Taylor CG. Consanguinity and its relationship to differential fertility and mortality in the Kotia: A tribal population of Andhra Pradesh, India. J Biosoc Sci. 1997;29:171-180.
79. Tunçbilek E. Clinical outcomes of consanguineous marriages in Turkey. Turk J Pediatr. 2001;43:277-279.
80. Sueyoshi S, Ohtsuka R. Effects of polygyny and consanguinity on high fertility in the rural Arab population in South Jordan. J Biosoc Sci. 2003;35:513-526.
81. Hammami A, Chalbi N, Ben Abdallah M, Elgazzeh M. Effects of consanguinity and social factors on mortality and fertility in Mauritania. Tunis Med. 2005;83:221-226.
82. Shami SA, Schmitt LH, Bittles AH. Consanguinity, spousal age at marriage and fertility in seven Pakistani Punjab cities. Ann Hum Biol. 1990;17:97-105.
83. Bittles AH, Grant JC, Shami SA. Consanguinity as a determinant of reproductive behaviour and mortality in Pakistan. Int J Epidemiol. 1993;22:463-467.
84. Kandari Y. Fertility and its relationship with sociocultural factors in Kuwaiti society. East Mediterr Health J. 2007;13:1364-1371.
85. al-Abdulkareem AA, Ballal SG: Consanguineous marriage in an urban area of Saudi Arabia: Rates and adverse health effects on the offspring. Saudi Arabia. J Community Health. 1998;23:75-83.
86. Hussain R, Bittles AH. The prevalence and demographic characteristics of consanguineous marriages in Pakistan. J Biosoc Sci. 1998; 30:261-275.
87. Moussouni A, Aouar A, Chabnil N, et al. The influence of consanguinity on reproductive health in a population of western Algeria (SABRA). European Congress of Epidemiology “Crises, epidemiological transitions and the role of epidemiologists”. 2018; 66:S380.
88. Oniya O, Neves K, Ahmed B, Konje JC. A review of the reproductive consequences consanguinity. Eur J Obstet Gynecol Repord Biol. 2019; 232:87-96.
89. Iqbal S, Zakar R, Fischer F, Zakar MZ. Consanguineous marriages and their association with women’s reproductive health and fertility behavior in Pakistan: secondary data analysis from Demographic and Health Surveys, 1990–2018. BMC Women's Health. 2022, 22:118.
90. Manzoor R, Imran W, Maken AM, Syed TH. Consanguineous marriages: Effects on pregnancy outcomes in Pakistan. J Develop Policy Res Practice. 2018, 2(1):78-105.
91. Nawaz A, Zaman M, Malik S. Consanguinity, inbreeding coefficient, fertility and birth-outcome in population of Okara district, Pakistan. Pak J Med Sci. 2021;37:770-775.
92. Bharathi K. Impact of consanguinity on fertility and mortality. IOSR J Humanities Social Sci. 2014;19:39-42.
93. Manglos-Weber ND, Weinreb AA. Own-choice marriage and fertility in Turkey.;J Marriage Fam. 2017;79: 372-389.
94. Al Husain M, al Bunyan M. Consanguineous marriages in a Saudi population and the effect of inbreeding on prenatal and postnatal mortality. Ann Trop Paediatr. 1997;17:155-160.
95. Abdulrazzaq YM, Bener A, al-Gazali LI, al-Khayat AI, Micallef R, Gaber T. A study of possible deleterious effects of consanguinity. Clin Genet. 1997;51:167-173.
96. Al-Awadi SA, Naguib KK, Moussa MA, Farag TI, Teebi AS, el-Khalifa MY. The effect of consanguineous marriages on reproductive wastage. Clin Genet. 1986;29:384-388.
97. Jaber L, Merlob P, Gabriel R, Shohat M. Effects of consanguineous marriage on reproductive outcome in an Arab community in Israel. J Med Genet. 1997;34:1000-1002.
98. Mokhtar MM, Abdel-Fattah MM. Consanguinity and advanced maternal age as risk factors for reproductive losses in Alexandria, Egypt. Eur J Epidemiol. 2001;17:559-565.
99. Assaf S, Khawaja M, DeJong J, Mahfoud Z, Yunis K. Consanguinity and reproductive wastage in the Palestinian Territories. Paediatr Perinat Epidemiol. 2009;23:107-115.
100. Akbayram S, Sari N, Akgün C, et al. The frequency of consanguineous marriage in eastern Turkey. Genet Couns. 2009;20:207-214.
101. Barbour B, Salameh P. Consanguinity in Lebanon: prevalence, distribution and determinants. J Biosoc Sci 2009;41:505-517. Epub. 2009 Jan 28.
102. Donbak L. Consanguinity in Kahramanmaras city, Turkey, and its medical impact. Saudi Med J. 2004;25:1991-1994.
103. Hussain R. Risk factors for neonatal mortality in low-income population subgroups in Karachi, Pakistan. Community Genet. 2002;5:249-256.
104. Basaran N, Hassa H, Basaran A, Artan S, Stevenson JD, Sayli BS: The effect of consanguinity on the reproductive wastage in the Turkish population. Clin Genet. 1989;36:168-173.
105. Bhinder MA. Consanguineous marriage: A peril for coming generation J Genet Disor. 2017;1:1-2.
106. Tanaka K. Genetic studies on inbreeding in some Japanese populations. XI. Effects of inbreeding on mortality in Shizuoka. Jap J Hum Genet. 1973;17:319-331.
107. Slatis HM, Reis RH, Hoene RE: Consanguineous marriages in the Chicago region. Am J Hum Genet. 1958;10:446-464.
108. Sakre MM, Bendigiri NAD, Sharad G, Tenglikar S, Amruta I. Swati AI. Epidemiological study of consanguineous marriage and its effects. Int J Community Med Public Health. 2016; 3: 1074–1078.
109. Abrar S, Safdar W, Hanif M, Shujaat N. Pregnancy outcomes of consanguinity among antenatal patients attending Combined Military Hospital Quetta, Pakistan. J Ayub Med Coll Abbottabad. 2018;30:423-427.
110. Kuntla S, Srinivas Goli, Arokiasamy P. Revisiting consanguineous marriages and their effect on pregnancy outcomes in India: Evidences from a Nation-wide Survey. Population Association of America, 2012 Annual Meeting Program, San Francisco May 3-5.
111. Saleem M, Shankar K, Sabeetha K. .A population-based cross-sectional study on consanguineous marriages in rural Tamil Nadu, India. Int J Med Sci Public Health. 2016; 5: 730-734.
112. Nath A, Patil C, Naik VA. Prevalence of consanguineous marriages in a rural community and its effect on pregnancy outcome. Indian J Community Med. 2004; XXIX: 41-43.
113. Hamamy H. Consanguineous marriages in the Middle East: Trends, impact on reproductive health and research priorities. Training Course in Sexual and Reproductive Health Research, Geneva 2010. Accessed August 2010. http://www.gfmer.ch/Medical_genetics_education_research/Hanan_Hamamy.htm
114. Maghsoudlou S, Cnattingius S, Aarabi M, Montgomery SM, Semnani S, Stephansson O, Wikström AK, Bahmanyar S. Consanguineous marriage, prepregnancy maternal characteristics and stillbirth risk: a population-based case-control study. Acta Obstet Gynecol Scand. 2015;94:1095-1101.
115. Kapurubandara S, Melov SJ, Shalou ER, et al. Percentage of consanguinity in Westmead stillbirth population from 2005–2010 (Figure). PLoS ONE. 2017. https://doi.org/10.1371/journal.pone.0171829.g001
116. Shawky RM, Elsayed SM, Zakib ME, Nour El-Din SM, Kamala FM. Consanguinity and its relevance to clinical genetics Egyptian J Med Human Genetic. 2013;14:157-164.
117. Kapurubandara S, Melov S, Shalou E, Alahakoon I. Consanguinity and associated perinatal outcomes, including stillbirth. Aust N Z J Obstet Gynaecol. 2016;56:599-604.
doi: 10.1111/ajo.12493. Epub 2016 Jul 11.
118. Egerbladh I, Bittles A . The influence of consanguineous marriage on reproductive behavior and early mortality in Northern Coastal Sweden, 1780–1899. Kinship and Demographic Behavior in the Past, 2018. pp 205-224. Part of the International Studies in Population book series (ISIP,volume 7)
119. Alberg C. Cousin marriage and autosomal recessive conditions – what is the best approach? PHG Foundation, University of Cambridge, UK, 15 October 2015.
120. Metgud CS, Naik VA, Mallapur MD. Consanguinity and pregnancy outcome among rural pregnant women of Belgaum District. National J Comm Med. 2012; 3 (Issue 4): 681. Open Access Article│www.njcmindia.org pISSN 0976 3325│eISSN 2229 6816.
121. Kaplan S, Pinar G, Kaplan B, et al. The prevalence of consanguineous marriages and affecting factors in Turkey: A national survey. J Biosoc Sci. 16; 48 (Issue 5):616-630.
122. Stoltenberg C, Magnus P, Skrondal A, Lie RT. Consanguinity and recurrence risk of stillbirth and infant death. Am J Public Health. 1999;89:517-523.
123. Stoltenberg C, Magnus P, Lie RT, Daltveit AK, Irgens LM. Influence of consanguinity and maternal education on risk of stillbirth and infant death in Norway, 1967-1993. Am J Epidemiol. 1998;148:452-459.
124. Al Husain M, al Bunyan M. Consanguineous marriages in a Saudi population and the effect of inbreeding on prenatal and postnatal mortality. Ann Trop Paediatr. 1997;17:155-160.
125. Cook R, Hanslip A. Mortality among offspring of consanguineous marriage in a rural area of east Jordan. J Trop Pediatr. 1966;11:95-99.
126. Rahman S, El Ansari W, Nimeri N, El Tinay S, Salameh K, Abbas T, Yousafzai MT, Bener A. Have neonatal mortality rates in the state of Qatar become static? A PEARL study analysis. East Mediterr Health J. 2012;18:1201-1208.
127. Chaman R, Taramsari MG, Khosravi A, Amiri M, et al. Consanguinity and neonatal death: a nested case-control study. J Family Reprod Health. 2014:8:189–193.
128. Bittles AH, Neel JV. The costs of human inbreeding and their implications for variations at the DNA level. Nat Genet. 1994;8:117-121.
129. Cavalli-Sforza LL, Moroni A, Zei G, consanguinity, inbreeding and genetic drift in Italy. Monographs in population biology 39. New Jersey, Princeton University Press, 2004.
130. Schulpen TW, van Wieringen JC, van Brummen PJ, et al. Infant mortality, ethnicity, and genetically determined disorders in The Netherlands. Eur J Public Health. 2006;16:291-294. Epub 2005 Oct 5.
131. Al-Hosani HA, Brebner J, Bener AB, Norman JN. Study of mortality risk factors for children under age 5 in Abu Dhabi. East Mediterr Health J. 2003;9:333-343.
132. Zlotogora J, Leventhal A, Amitai Y. The impact of congenital malformations and Mendelian diseases on infant mortality in Israel. Isr Med Assoc J. 2003;5:416-418.
133. van den Berg MM, Khader A, Hababeh M, Zeidan W, Seita A. Infant and neonatal mortality among Palestine refugees in Gaza, West Bank, Lebanon, and Jordan: an observational study. Lancet. 2017; 390 (Suppl 2); S10.
134. Koç I, Eryurt MA. The casual relationship between consanguineous marriages and infant mortality in Turkey. J Biosoc Sci. 2017; 49: 536-555.
135. Christianson A, Howson C, Modell B. Global report on birth defects. The hidden toll of dying and disabled children. White Plains, NY: March of Dimes Birth Defects Foundation, 2006.
136. Bennett R, Motulsky A, Bittles A, et al. Genetic counseling and screening of consanguineous couples and their offspring: Recommendations of the National Society of Genetic Counselors. J Genet Counsel. 2002;11:97-119.
137. Bennett RL, Hudgins L, Smith CO, Motulsky AG. Inconsistencies in genetic counseling and screening for consanguineous couples and their offspring: The need for practice guidelines. Genet Med. 1999;1:286–292.
138. Zlotogora J, Shalev SA. The consequences of consanguinity on the rates of and major medical conditions at birth and in early childhood. Am J Med Genet. A 2010;152A:2023-2028.
139. Center for Arab Genomic Studies, 2010. Available at: http://www.cags.org.ae/).ctga_search.html. Accessed December 1, 2010.
140. Teeuw ME, Henneman L, Bochdanovits Z, et al. Do consanguineous parents of a child affected by an autosomal recessive disease have more DNA identical-by-descent than similarly-related parents with healthy offspring? Design of a case-control study. BMC Med Genet. 2010;11:113.
141. Temtamy SA, Aglan MS, Valencia M, et al. Long interspersed nuclear element-1 (LINE1)-mediated deletion of EVC, EVC2, C4orf6, and STK32B in Ellis-van Creveld syndrome with borderline intelligence. Hum Mutat. 2008;29:931-938.
142. Teebi A. Genetic disorders among Arab populations, 2nd ed. New York: Springer, 2010.
143. Al-Gazali L, Ali BR. Mutations of a country: a mutation review of single gene disorders in the United Arab Emirates (UAE). Hum Mutat. 2010;31:505-520.
144. Hamamy H, Al-Hait S, Alwan A, Ajlouni K. Jordan: Communities and community genetics. Community Genet. 2007;10:52-60.
145. Megarbane A, Dorison N, Rodriguez D, Tamraz J. Multiple cranial nerve neuropathies, microcephaly, neurological degeneration, and “fork and bracket sign” in the MRI: A distinct syndrome. Am J Med Genet. A 2010;152A:2297-2300.
146. Yunis K, Mumtaz G, Bitar F, et al. Consanguineous marriage and congenital heart defects: A case-control study in the neonatal period. Am J Med Genet. A 2006;140:1524-1530.
147. Subramanyan R, Joy J, Venugopalan P, Sapru A, al Khusaiby SM. Incidence and spectrum of congenital heart disease in Oman. Ann Trop Paediatr. 2000;20:337-341.
148. Zlotogora J. Genetic disorders among Palestinian Arabs: 1. Effects of consanguinity. Am J Med Genet. 1997;68:472-475.
149. Kanaan ZM, Mahfouz R, Tamim H. The prevalence of consanguineous marriages in an underserved area in Lebanon and its association with congenital anomalies. Genet Test. 2008;12:367-372.
150. Murshid WR, Jarallah JS, Dad MI. Epidemiology of infantile hydrocephalus in Saudi Arabia: birth prevalence and associated factors. Pediatr Neurosurg. 2000;32:119-123.
151. Rajab A, Vaishnav A, Freeman NV, Patton MA. Neural tube defects and congenital hydrocephalus in the Sultanate of Oman. J Trop Pediatr. 1998;44:300-303.
152. Asindi A, Al-Shehri A. Neural tube defects in the Asir Region of Saudi Arabia. Ann Saudi Med. 2001;21:26-29.
153. Al-Gazali LI. A genetic aetiological survey of severe childhood deafness in the United Arab Emirates. J Trop Pediatr. 1998;44:157-160.
154. Rittler M, Liascovich R, López-Camelo J, Castilla EE. Parental consanguinity in specific types of congenital anomalies. Am J Med Genet. 2001;102:36-43.
155. Bundey S, Alam H. A 5-year prospective study of the health of children in different ethnic groups, with particular reference to the effect on inbreeding. Eur J Hum Genet. 1993;1:206-219.
156. Tarabeia J, Amitai Y, Green M, et al. Differences in infant mortality rates between Jews and Arabs in Israel, 1975-2000. Isr Med Assoc J. 2004;6:403-407.
157. Jaber L, Merlob P, Shohat M. High incidence of central nervous system malformations associated with marked parental consanguinity in an Israeli Arab community. Biomed Pharmacother. 1994;48:351-354.
158. McCandless SE, Brunger JW, Cassidy SB. The burden of genetic disease on inpatient care in a children's hospital. Am J Hum Genet. 2004;74:121-127.
159. Shami SA, Qaisar R, Bittles AH. Consanguinity and adult morbidity in Pakistan (letter). Lancet. 1991;338:954-945.
160. Roberts DF. Consanguinity and multiple sclerosis in Orkney. Genet Epidemiol. 1991;8:147-151.
161. Afzal M. Consequences of consanguinity on cognitive behavior. Behav Genet. 1988;18:583-594.
162. Morton NE. Effect of inbreeding on IQ and mental retardation. Proc Natl Acad Sci. 1978;75:3906-3908.
163. Rudan I, Smolej-Narancic L, Campbell H, Carothers A, Wright AF, Rudan P. Inbreeding and the genetic complexity of human hypertension. Genetics. 2003;163:1011-1021.
164. Rudan I, Rudan D, Campbell H, et al. Inbreeding and risk of late onset complex disease. J Med Genet. 2003;40:925-932.
165. Wright AF, Charlesworth B, Rudan I, Carothers A, Campbell H. Polygenic nature of late onset disease. Trends Genet. 2003;19:97-106.
2. Modell B, Darr A. Science and society: Genetic counselling and customary
consanguineous marriage. Nat Rev Genet. 2002,3:225-229.
3. Tadmouri GO, Nair P, Obeid T, Al Ali MT, Al Khaja N, Hamamy HA. Consanguinity and reproductive health among Arabs. Reprod Health. 2009,6:17.
4. Bittles AH, Mason WM, Greene J, Rao NA. Reproductive behavior and health in consanguineous marriages. Science. 1991;252:789-794.
5. Editorial. Consanguinity and health. Lancet 1991;338:85-86.
6. Jaber L, Halpern GJ, Shohat T. Trends in the frequencies of consanguineous marriages in the Israeli Arab community. Clin Genet. 2000;58:106-110.
7. Hamamy H, Jamhawi L, Al-Darawsheh J, Ajlouni K. Consanguineous marriages in Jordan: Why is the rate changing with time? Clin Genet. 2005;67:511-516.
8. Schull WJ, Nagano H, Yamamoto M, Komatsu I. The effects of parental consanguinity and inbreeding in Hirado, Japan. I. Stillbirths and prereproductive mortality. Am J Hum Genet. 1970;22:239-262.
9. Freire-Maia N. Effects of consanguineous marriages on morbidity and precocious mortality: Genetic counseling. Am J Med Genet. 1984;18.401-406.
10. Imaizumi Y. A recent survey of consanguineous marriages in Japan. Clin Genet. 1986;30:230-233.
11. Khoury MJ, Cohen BH, Diamond EL, Chase GA, McCusick VA: Inbreeding and prereproductive mortality in the Old Order Amish. I. Genealogic epidemiology of inbreeding. Am J Epidemiol. 1987;125:453-461.
12. Bonne B. The Samaritans: A demographic study. Hum Biol. 1963;35:61-89.
13. Jaber L, Halpern GJ, Shohat M. The impact of consanguinity worldwide. Community Genet. 1998;1:12-17. (doi: 10.1159/000016130)
14. Bittles AH. The role and significance of consanguinity as a demographic variable. Popul Dev Rev. 1994;20:561-584.
15. Khlat M. Endogamy in Arab countries. In: Teebi A, Farag TI, Eds. Genetic disorders among Arab populations. New York: Oxford Univ. Press, 1997; pp. 63-80.
16. Bittles AH, Black ML. Consanguineous and human evolution. Annu Rev Anthropol. 2010;39:193-207.
17. Bittles AH, Black ML. Consanguinity, human evolution, and complex diseases. Proc Natl Acad Sci USA. 2009; 107Suppl 1:1779-1786.
18. World Population Prospects: The 2010 Revision Population Database. Accessed May 2011. http://esa.un.org/unpp
19. Bittles A. The global prevalence of consanguinity. Accessed June 2011. http://www.consang.net.
20. Khuri FI. Parallel cousin marriage reconsidered: A Middle Eastern practice that nullifies the effects of marriage on the intensity of family relationships. Man. 1976;5:597-618.
21. Kulkarni ML, Kurian M. Consanguinity and its effect on fetal growth and development: A south Indian study. J Med Genet. 1990;27:348-352.
22. Bittles AH, Black ML. The impact of consanguinity on neonatal and infant health. Early Hum Dev. 2010;86:737-741. Epub 2010 Sep 15.
23. Khlat M. Consanguineous marriage and reproduction in Beirut, Lebanon. Am J Hum Genet. 1988;43:188-196.
24. Al Arrayed SS. Review of the spectrum of genetic diseases in Bahrain. East Mediterr Health J. 1999 5:1114-1120.
25. Assaf S, Khawaja M. Consanguinity trends and correlates in the Palestinian Territories. J Biosoc Sci. 2009;41:107-124.
26. Bashi J. Effects of inbreeding on cognitive performance. Nature. 1977;266:440-2.
27. Freundlich E, Hino N. Consanguineous marriage among rural Arabs in Israel. Isr J Med Sci. 1984;20:1035-1038.
28. Fried K, Davies AM. Some effects on the offspring of uncle niece marriage in a Moroccan Jewish community in Jerusalem. Am Hum Genet. 1974;26:65-72.
29. Gev D, Roguin N, Freundlich E. Consanguinity and congenital heart disease in the rural Arab population in northern Israel. Hum Hered. 1986;36:213-217.
30. Jaber L, Merlob P, Bu X, Rotter JI, Shohat M. Marked parental consanguinity as a cause for increased major malformations in an Israeli Arab community. Am J Med Genet. 1992;44:1-6.
31. Jaber L, Bailey-Wilson JE, Haj-Yehia M, Hernandez J, Shohat M. Consanguineous matings in an Israeli-Arab community. Arch Pediatr Adolesc Med. 1994;148:412-415.
32. Khlat M, Khoury M. Inbreeding and diseases: demographic, genetic, and epidemiologic perspectives. Epidemiol Rev. 1991;13:28-41.
33. Magnus P, Berg K, Bjerkedal T. Association of parental consanguinity with decreased birth weight and increased rate of early death and congenital malformations. Clin Genet. 1985;28:335-342.
34. Morton NE. The inheritance of human birth weight. Ann Hum Genet. 1955;20:125-134.
35. Freire-Maia A, Stevenson C, Morton NE. Hybridity effect on mortality. Soc Biol. 1974;21:232-234.
36. Rao PS, Inbaraj SG. Inbreeding effects on human reproduction in Tamil Nadu of South India. Ann Hum Genet. 1977;41:87-98.
37. Rao PS, Inbaraj SG. Inbreeding effects on fertility and sterility in southern India. J Med Genet. 1979;16:24-31.
38. Rao PS, Inbaraj SG. Trends in human reproductive wastage in relation to long-term practice of inbreeding. Ann Hum Genet. 1979;42:401-413.
39. Roberts DF, Bonne B. Reproduction and inbreeding among the Samaritans. Soc Biol. 1973;20:64-70.
40. Reddy VR, Rao AP. Effects of parental consanguinity on fertility, mortality and morbidity among the Pattusalis of Tirupati, South India. Hum Hered. 1978;28:226-234.
41. Saha N, Hamad RE, Mohamed S. Inbreeding effects on reproductive outcome in a Sudanese population. Hum Hered. 1990;40:208-212.
42. Sanghvi LD. Inbreeding in India. Eugenics Q. 1966;13:291-301.
43. Shami SA, Schmit LH, Bittles AH. Consanguinity related prenatal and postnatal mortality of populations of seven Pakistani Punjab cities. J Med Genet. 1989;26:267-271.
44. Sibert JR, Jadhav M, Inbaraj SG. Fetal growth and parental consanguinity. Arch Dis Child. 1979;54:317-319.
45. Hamamy H, Antonarakis SE, Cavalli-Sforza LL, et al. Consanguineous marriages, pearls and perils: Geneva International Consanguinity Workshop Report, September 2011. Genetic Med. 2011;13; 841-847.
46. Darlington CD. Cousin marriage and the evaluation of inbreeding system in man. Heredity. 1973;14:297-331.
47. McCluer JW. Inbreeding and human fetal death. In: Porter I, Hook I, Eds. Human emtbryonic andfetal death. New York: Academic Press. 1980; pp. 241-261.
48. Bittles AH, Grant JC, Sullivan SG, Hussain R. Does inbreeding lead to decreased human fertility? Ann Hum Biol. 2002;29:111-130.
49. Robert A, Toupance B, Tremblay M, Heyer E. Impact of inbreeding on fertility in a pre-industrial population. Eur J Hum Genet. 2009;17:673-681. Epub 2008 Dec 17
50. Hussain R, Bittles AH. Assessment of association between consanguinity and fertility in Asian populations. J Health Popul Nutr. 2004, 22:1-12.
51. Saad FA, Jauniaux E. Recurrent early pregnancy loss and consanguinity. Reprod Biomed Online. 2002;5:167-170.
52. Cereijo AI, Prieto L, Martinez-Frias ML. Effect of consanguinity and endogamy on mortality and fertility in a Spanish population: Genet Iber. 1985;37:207-219.
53. Baccetti B, Capitani S, Collodel G, et al. Genetic sperm defects and consanguinity. Hum Reprod. 2001;16:1365-1371.
54. Edmond M, De Braekeleer M. Inbreeding effects on fertility and sterility: a case-control study in Saguenay-Lac-Saint-Jean (Québec, Canada) based on a population registry 1838-1971. Ann Hum Biol. 1993;20:545-555.
55. Khoury SA, Massad DF. Consanguinity, fertility, reproductive wastage, infant mortality and congenital malformations in Jordan. Saudi Med J. 2000;21:150-154.
56. Basu SK. Effect of consanguinity among North India Muslims. J Popul Res. 1975;2:57-68.
57. Devi AR, Rao NA, Bittles AH. Consanguinity, fecundity and post-natal mortality in Karnataka, South India. Ann Hum Biol. 1981;8:469-472.
58. Verma IC, Prema A, Puri RK. Health effects of consanguinity in Pondicherry. Indian Pediatr. 1992;29:685-692.
59. Asha Bai PV, John TJ, Subramaniam VR. Reproductive wastage and developmental disorders in relation to consanguinity in south India. Trop Geogr Med. 1981;33:275-280.
60. Reddy TP, Reddy KK, Reddy PG. Ancestral consanguinity and mortality among three endogamous populations of Chittoor District, Andhra Pradesh, India. Hum Biol. 2007;79:413-425.
61. Labouriau R, Amorim A. Comment on "An association between the kinship and fertility of human couples. Science. 2008;322:1634; Author reply 1634.
62. Bener A, Hussain R. Consanguineous unions and child health in the State of Qatar. Paediatr Perinat Epidemiol. 2006;20:372-378.
63. Kerkeni E, Monastiri K, Saket B, Guediche MN, Ben Cheikh H. Interplay of socio-economic factors, consanguinity, fertility, and offspring mortality in Monastir, Tunisia. Croat Med J. 2007;48:701-707.
64. Hussain R, Bittles AH. Consanguineous marriage and differentials in age at marriage, contraceptive use and fertility in Pakistan. J Biosoc Sci. 1999;31:121-138.
65. Postma E, Martini L, Martini P. Inbred women in a small and isolated Swiss village have fewer children. J Evol Biol 2010;23:1468-1474. Epub. 2010 May 12.
66. Labouriau R, Amorim A. Human fertility increases with marital radius. Genetics. 2008; 178:601-603.
67. Charlesworth D, Willis JH. The genetics of inbreeding depression. Nat Rev Genet. 2009; 10:783-796.
68. Inhorn MC, Kobeissi L, Nassar Z, Lakkis D, Fakih MH. Consanguinity and family clustering of male factor infertility in Lebanon. Fertil Steril 2009;91:1104-1109. Epub. 2008 Mar 25
69. Ober C, Elias S, Kostyu DD, Hauck WW. Decreased fecundability in Hutterite couples sharing HLA-DR. Am J Hum Genet. 1992;50:6-14.
70. Ober C. Studies of HLA, fertility and mate choice in a human isolate. Hum Reprod Update. 1999;5:103-107.
71. Schull WJ, Neel JV. The effects of parental consanguinity and inbreeding in Hirado, Japan. V. Summary and interpretation. Am J Hum Genet. 1972;24:425-453.
72. Tunçbilek E, Koç I. Consanguineous marriage in Turkey and its impact on fertility and mortality. Ann Hum Genet. 1994;58(Pt 4):321-329.
73. Bittles AH. Consanguinity and its relevance to clinical genetics. Clin Genet. 2001;60:89-98.
74. Fuster V. Inbreeding pattern and reproductive success in a rural community from Galicia (Spain). J Biosoc Sci. 2003;35:83-93.
75. Helgason A, Palsson S, Gudbjartsson DF, Kristjansson T, Stefansson K. An association between the kinship and fertility of human couples. Science. 2008;319:813-816.
76. Reddy PG. Effects of consanguineous marriages on fertility among three endogamous groups of Andhra Pradesh. Soc Biol. 1987;34:68-77.
77. Bhasin MK, Nag S. Consanguinity and its effects on fertility and child survival among Muslims of Ladakh in Jammu and Kashmir. Anthropologist. 2002;Special Issue No. 1:131-140.
78. Yasim Naidu JM, Mascie-Taylor CG. Consanguinity and its relationship to differential fertility and mortality in the Kotia: A tribal population of Andhra Pradesh, India. J Biosoc Sci. 1997;29:171-180.
79. Tunçbilek E. Clinical outcomes of consanguineous marriages in Turkey. Turk J Pediatr. 2001;43:277-279.
80. Sueyoshi S, Ohtsuka R. Effects of polygyny and consanguinity on high fertility in the rural Arab population in South Jordan. J Biosoc Sci. 2003;35:513-526.
81. Hammami A, Chalbi N, Ben Abdallah M, Elgazzeh M. Effects of consanguinity and social factors on mortality and fertility in Mauritania. Tunis Med. 2005;83:221-226.
82. Shami SA, Schmitt LH, Bittles AH. Consanguinity, spousal age at marriage and fertility in seven Pakistani Punjab cities. Ann Hum Biol. 1990;17:97-105.
83. Bittles AH, Grant JC, Shami SA. Consanguinity as a determinant of reproductive behaviour and mortality in Pakistan. Int J Epidemiol. 1993;22:463-467.
84. Kandari Y. Fertility and its relationship with sociocultural factors in Kuwaiti society. East Mediterr Health J. 2007;13:1364-1371.
85. al-Abdulkareem AA, Ballal SG: Consanguineous marriage in an urban area of Saudi Arabia: Rates and adverse health effects on the offspring. Saudi Arabia. J Community Health. 1998;23:75-83.
86. Hussain R, Bittles AH. The prevalence and demographic characteristics of consanguineous marriages in Pakistan. J Biosoc Sci. 1998; 30:261-275.
87. Moussouni A, Aouar A, Chabnil N, et al. The influence of consanguinity on reproductive health in a population of western Algeria (SABRA). European Congress of Epidemiology “Crises, epidemiological transitions and the role of epidemiologists”. 2018; 66:S380.
88. Oniya O, Neves K, Ahmed B, Konje JC. A review of the reproductive consequences consanguinity. Eur J Obstet Gynecol Repord Biol. 2019; 232:87-96.
89. Iqbal S, Zakar R, Fischer F, Zakar MZ. Consanguineous marriages and their association with women’s reproductive health and fertility behavior in Pakistan: secondary data analysis from Demographic and Health Surveys, 1990–2018. BMC Women's Health. 2022, 22:118.
90. Manzoor R, Imran W, Maken AM, Syed TH. Consanguineous marriages: Effects on pregnancy outcomes in Pakistan. J Develop Policy Res Practice. 2018, 2(1):78-105.
91. Nawaz A, Zaman M, Malik S. Consanguinity, inbreeding coefficient, fertility and birth-outcome in population of Okara district, Pakistan. Pak J Med Sci. 2021;37:770-775.
92. Bharathi K. Impact of consanguinity on fertility and mortality. IOSR J Humanities Social Sci. 2014;19:39-42.
93. Manglos-Weber ND, Weinreb AA. Own-choice marriage and fertility in Turkey.;J Marriage Fam. 2017;79: 372-389.
94. Al Husain M, al Bunyan M. Consanguineous marriages in a Saudi population and the effect of inbreeding on prenatal and postnatal mortality. Ann Trop Paediatr. 1997;17:155-160.
95. Abdulrazzaq YM, Bener A, al-Gazali LI, al-Khayat AI, Micallef R, Gaber T. A study of possible deleterious effects of consanguinity. Clin Genet. 1997;51:167-173.
96. Al-Awadi SA, Naguib KK, Moussa MA, Farag TI, Teebi AS, el-Khalifa MY. The effect of consanguineous marriages on reproductive wastage. Clin Genet. 1986;29:384-388.
97. Jaber L, Merlob P, Gabriel R, Shohat M. Effects of consanguineous marriage on reproductive outcome in an Arab community in Israel. J Med Genet. 1997;34:1000-1002.
98. Mokhtar MM, Abdel-Fattah MM. Consanguinity and advanced maternal age as risk factors for reproductive losses in Alexandria, Egypt. Eur J Epidemiol. 2001;17:559-565.
99. Assaf S, Khawaja M, DeJong J, Mahfoud Z, Yunis K. Consanguinity and reproductive wastage in the Palestinian Territories. Paediatr Perinat Epidemiol. 2009;23:107-115.
100. Akbayram S, Sari N, Akgün C, et al. The frequency of consanguineous marriage in eastern Turkey. Genet Couns. 2009;20:207-214.
101. Barbour B, Salameh P. Consanguinity in Lebanon: prevalence, distribution and determinants. J Biosoc Sci 2009;41:505-517. Epub. 2009 Jan 28.
102. Donbak L. Consanguinity in Kahramanmaras city, Turkey, and its medical impact. Saudi Med J. 2004;25:1991-1994.
103. Hussain R. Risk factors for neonatal mortality in low-income population subgroups in Karachi, Pakistan. Community Genet. 2002;5:249-256.
104. Basaran N, Hassa H, Basaran A, Artan S, Stevenson JD, Sayli BS: The effect of consanguinity on the reproductive wastage in the Turkish population. Clin Genet. 1989;36:168-173.
105. Bhinder MA. Consanguineous marriage: A peril for coming generation J Genet Disor. 2017;1:1-2.
106. Tanaka K. Genetic studies on inbreeding in some Japanese populations. XI. Effects of inbreeding on mortality in Shizuoka. Jap J Hum Genet. 1973;17:319-331.
107. Slatis HM, Reis RH, Hoene RE: Consanguineous marriages in the Chicago region. Am J Hum Genet. 1958;10:446-464.
108. Sakre MM, Bendigiri NAD, Sharad G, Tenglikar S, Amruta I. Swati AI. Epidemiological study of consanguineous marriage and its effects. Int J Community Med Public Health. 2016; 3: 1074–1078.
109. Abrar S, Safdar W, Hanif M, Shujaat N. Pregnancy outcomes of consanguinity among antenatal patients attending Combined Military Hospital Quetta, Pakistan. J Ayub Med Coll Abbottabad. 2018;30:423-427.
110. Kuntla S, Srinivas Goli, Arokiasamy P. Revisiting consanguineous marriages and their effect on pregnancy outcomes in India: Evidences from a Nation-wide Survey. Population Association of America, 2012 Annual Meeting Program, San Francisco May 3-5.
111. Saleem M, Shankar K, Sabeetha K. .A population-based cross-sectional study on consanguineous marriages in rural Tamil Nadu, India. Int J Med Sci Public Health. 2016; 5: 730-734.
112. Nath A, Patil C, Naik VA. Prevalence of consanguineous marriages in a rural community and its effect on pregnancy outcome. Indian J Community Med. 2004; XXIX: 41-43.
113. Hamamy H. Consanguineous marriages in the Middle East: Trends, impact on reproductive health and research priorities. Training Course in Sexual and Reproductive Health Research, Geneva 2010. Accessed August 2010. http://www.gfmer.ch/Medical_genetics_education_research/Hanan_Hamamy.htm
114. Maghsoudlou S, Cnattingius S, Aarabi M, Montgomery SM, Semnani S, Stephansson O, Wikström AK, Bahmanyar S. Consanguineous marriage, prepregnancy maternal characteristics and stillbirth risk: a population-based case-control study. Acta Obstet Gynecol Scand. 2015;94:1095-1101.
115. Kapurubandara S, Melov SJ, Shalou ER, et al. Percentage of consanguinity in Westmead stillbirth population from 2005–2010 (Figure). PLoS ONE. 2017. https://doi.org/10.1371/journal.pone.0171829.g001
116. Shawky RM, Elsayed SM, Zakib ME, Nour El-Din SM, Kamala FM. Consanguinity and its relevance to clinical genetics Egyptian J Med Human Genetic. 2013;14:157-164.
117. Kapurubandara S, Melov S, Shalou E, Alahakoon I. Consanguinity and associated perinatal outcomes, including stillbirth. Aust N Z J Obstet Gynaecol. 2016;56:599-604.
doi: 10.1111/ajo.12493. Epub 2016 Jul 11.
118. Egerbladh I, Bittles A . The influence of consanguineous marriage on reproductive behavior and early mortality in Northern Coastal Sweden, 1780–1899. Kinship and Demographic Behavior in the Past, 2018. pp 205-224. Part of the International Studies in Population book series (ISIP,volume 7)
119. Alberg C. Cousin marriage and autosomal recessive conditions – what is the best approach? PHG Foundation, University of Cambridge, UK, 15 October 2015.
120. Metgud CS, Naik VA, Mallapur MD. Consanguinity and pregnancy outcome among rural pregnant women of Belgaum District. National J Comm Med. 2012; 3 (Issue 4): 681. Open Access Article│www.njcmindia.org pISSN 0976 3325│eISSN 2229 6816.
121. Kaplan S, Pinar G, Kaplan B, et al. The prevalence of consanguineous marriages and affecting factors in Turkey: A national survey. J Biosoc Sci. 16; 48 (Issue 5):616-630.
122. Stoltenberg C, Magnus P, Skrondal A, Lie RT. Consanguinity and recurrence risk of stillbirth and infant death. Am J Public Health. 1999;89:517-523.
123. Stoltenberg C, Magnus P, Lie RT, Daltveit AK, Irgens LM. Influence of consanguinity and maternal education on risk of stillbirth and infant death in Norway, 1967-1993. Am J Epidemiol. 1998;148:452-459.
124. Al Husain M, al Bunyan M. Consanguineous marriages in a Saudi population and the effect of inbreeding on prenatal and postnatal mortality. Ann Trop Paediatr. 1997;17:155-160.
125. Cook R, Hanslip A. Mortality among offspring of consanguineous marriage in a rural area of east Jordan. J Trop Pediatr. 1966;11:95-99.
126. Rahman S, El Ansari W, Nimeri N, El Tinay S, Salameh K, Abbas T, Yousafzai MT, Bener A. Have neonatal mortality rates in the state of Qatar become static? A PEARL study analysis. East Mediterr Health J. 2012;18:1201-1208.
127. Chaman R, Taramsari MG, Khosravi A, Amiri M, et al. Consanguinity and neonatal death: a nested case-control study. J Family Reprod Health. 2014:8:189–193.
128. Bittles AH, Neel JV. The costs of human inbreeding and their implications for variations at the DNA level. Nat Genet. 1994;8:117-121.
129. Cavalli-Sforza LL, Moroni A, Zei G, consanguinity, inbreeding and genetic drift in Italy. Monographs in population biology 39. New Jersey, Princeton University Press, 2004.
130. Schulpen TW, van Wieringen JC, van Brummen PJ, et al. Infant mortality, ethnicity, and genetically determined disorders in The Netherlands. Eur J Public Health. 2006;16:291-294. Epub 2005 Oct 5.
131. Al-Hosani HA, Brebner J, Bener AB, Norman JN. Study of mortality risk factors for children under age 5 in Abu Dhabi. East Mediterr Health J. 2003;9:333-343.
132. Zlotogora J, Leventhal A, Amitai Y. The impact of congenital malformations and Mendelian diseases on infant mortality in Israel. Isr Med Assoc J. 2003;5:416-418.
133. van den Berg MM, Khader A, Hababeh M, Zeidan W, Seita A. Infant and neonatal mortality among Palestine refugees in Gaza, West Bank, Lebanon, and Jordan: an observational study. Lancet. 2017; 390 (Suppl 2); S10.
134. Koç I, Eryurt MA. The casual relationship between consanguineous marriages and infant mortality in Turkey. J Biosoc Sci. 2017; 49: 536-555.
135. Christianson A, Howson C, Modell B. Global report on birth defects. The hidden toll of dying and disabled children. White Plains, NY: March of Dimes Birth Defects Foundation, 2006.
136. Bennett R, Motulsky A, Bittles A, et al. Genetic counseling and screening of consanguineous couples and their offspring: Recommendations of the National Society of Genetic Counselors. J Genet Counsel. 2002;11:97-119.
137. Bennett RL, Hudgins L, Smith CO, Motulsky AG. Inconsistencies in genetic counseling and screening for consanguineous couples and their offspring: The need for practice guidelines. Genet Med. 1999;1:286–292.
138. Zlotogora J, Shalev SA. The consequences of consanguinity on the rates of and major medical conditions at birth and in early childhood. Am J Med Genet. A 2010;152A:2023-2028.
139. Center for Arab Genomic Studies, 2010. Available at: http://www.cags.org.ae/).ctga_search.html. Accessed December 1, 2010.
140. Teeuw ME, Henneman L, Bochdanovits Z, et al. Do consanguineous parents of a child affected by an autosomal recessive disease have more DNA identical-by-descent than similarly-related parents with healthy offspring? Design of a case-control study. BMC Med Genet. 2010;11:113.
141. Temtamy SA, Aglan MS, Valencia M, et al. Long interspersed nuclear element-1 (LINE1)-mediated deletion of EVC, EVC2, C4orf6, and STK32B in Ellis-van Creveld syndrome with borderline intelligence. Hum Mutat. 2008;29:931-938.
142. Teebi A. Genetic disorders among Arab populations, 2nd ed. New York: Springer, 2010.
143. Al-Gazali L, Ali BR. Mutations of a country: a mutation review of single gene disorders in the United Arab Emirates (UAE). Hum Mutat. 2010;31:505-520.
144. Hamamy H, Al-Hait S, Alwan A, Ajlouni K. Jordan: Communities and community genetics. Community Genet. 2007;10:52-60.
145. Megarbane A, Dorison N, Rodriguez D, Tamraz J. Multiple cranial nerve neuropathies, microcephaly, neurological degeneration, and “fork and bracket sign” in the MRI: A distinct syndrome. Am J Med Genet. A 2010;152A:2297-2300.
146. Yunis K, Mumtaz G, Bitar F, et al. Consanguineous marriage and congenital heart defects: A case-control study in the neonatal period. Am J Med Genet. A 2006;140:1524-1530.
147. Subramanyan R, Joy J, Venugopalan P, Sapru A, al Khusaiby SM. Incidence and spectrum of congenital heart disease in Oman. Ann Trop Paediatr. 2000;20:337-341.
148. Zlotogora J. Genetic disorders among Palestinian Arabs: 1. Effects of consanguinity. Am J Med Genet. 1997;68:472-475.
149. Kanaan ZM, Mahfouz R, Tamim H. The prevalence of consanguineous marriages in an underserved area in Lebanon and its association with congenital anomalies. Genet Test. 2008;12:367-372.
150. Murshid WR, Jarallah JS, Dad MI. Epidemiology of infantile hydrocephalus in Saudi Arabia: birth prevalence and associated factors. Pediatr Neurosurg. 2000;32:119-123.
151. Rajab A, Vaishnav A, Freeman NV, Patton MA. Neural tube defects and congenital hydrocephalus in the Sultanate of Oman. J Trop Pediatr. 1998;44:300-303.
152. Asindi A, Al-Shehri A. Neural tube defects in the Asir Region of Saudi Arabia. Ann Saudi Med. 2001;21:26-29.
153. Al-Gazali LI. A genetic aetiological survey of severe childhood deafness in the United Arab Emirates. J Trop Pediatr. 1998;44:157-160.
154. Rittler M, Liascovich R, López-Camelo J, Castilla EE. Parental consanguinity in specific types of congenital anomalies. Am J Med Genet. 2001;102:36-43.
155. Bundey S, Alam H. A 5-year prospective study of the health of children in different ethnic groups, with particular reference to the effect on inbreeding. Eur J Hum Genet. 1993;1:206-219.
156. Tarabeia J, Amitai Y, Green M, et al. Differences in infant mortality rates between Jews and Arabs in Israel, 1975-2000. Isr Med Assoc J. 2004;6:403-407.
157. Jaber L, Merlob P, Shohat M. High incidence of central nervous system malformations associated with marked parental consanguinity in an Israeli Arab community. Biomed Pharmacother. 1994;48:351-354.
158. McCandless SE, Brunger JW, Cassidy SB. The burden of genetic disease on inpatient care in a children's hospital. Am J Hum Genet. 2004;74:121-127.
159. Shami SA, Qaisar R, Bittles AH. Consanguinity and adult morbidity in Pakistan (letter). Lancet. 1991;338:954-945.
160. Roberts DF. Consanguinity and multiple sclerosis in Orkney. Genet Epidemiol. 1991;8:147-151.
161. Afzal M. Consequences of consanguinity on cognitive behavior. Behav Genet. 1988;18:583-594.
162. Morton NE. Effect of inbreeding on IQ and mental retardation. Proc Natl Acad Sci. 1978;75:3906-3908.
163. Rudan I, Smolej-Narancic L, Campbell H, Carothers A, Wright AF, Rudan P. Inbreeding and the genetic complexity of human hypertension. Genetics. 2003;163:1011-1021.
164. Rudan I, Rudan D, Campbell H, et al. Inbreeding and risk of late onset complex disease. J Med Genet. 2003;40:925-932.
165. Wright AF, Charlesworth B, Rudan I, Carothers A, Campbell H. Polygenic nature of late onset disease. Trends Genet. 2003;19:97-106.