A couple consisting of a 21 year -old who who was 20 weeks pregnant and her 45 year old active duty husband came in for a routine OB visit. As I would soon find out, this visit was anything but routine. At first glance I noticed the age discrepenancy between husband and wife; I didnt give this much thought, I just thought to myself, "lucky guy". However, my preceptor soon informed that they were second cousins to eachother. They hailed from Spain, if that makes any difference. Anyway, the woman spoke no English and we needed a translater to help get us through the interview and exam. She smoked a 1/2 pack of cigarettes a day and suffered from anxiety. We had to ask the husband to leave the room as we inquired about her emotional health. During the actual physical exam and assessment, I found that her fundus was at least 2 fingerbreadths below the umbilicus; keep in mind, she was 20 weeks at the time of the visit. I did capture fetal heart tones, around 185, -high, but my preceptor did not seem too concerned. We did an ultrasound and everything seemed to be o.k. The couple were eagerly awaiting to learn the sex of their baby, which they hoped would be revealed during the 20 week ultrasound the next day. What a difference a day makes, when their only concern one day was whether their baby was a boy or a girl. Unfortunately, we found out around noon the following day that the ultrasound showed that the fetus had polycystic kidneys, which was inevitably causing a low amniotic fluid index and growth restriction. We knew that this baby and the parents had a really tough road ahead of them. They were immediately referred to maternal-fetal medicine. I did not have the opportunity to follow-up with this case, for my rotation ended. My preceptor confirmed my suspicion that this defect could very well have been caused by such an incestous relationship, for polycystic kidneys are a recessive condition. How sad, you wonder if this could have been prevented, given all of the information we have about the potential dangers of such relationships. I wish them the best.
greg
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We must not judge others behaviors as we provide them Primary Health Care. Here are some tidbits about Cousin Marriages:
ReplyDeleteSome people are fixated on the fallacy that cousin couples pose a risk to their offspring. Before civil laws banning cousin marriages, it was preferable to marry a cousin in some communities as it is still in many countries. The notion "why marry a stranger" is as prevalent in many countries as the cousin marriage taboo is in America. The wide range of opinions on cousin marriages is fueled by erroneous information and bigotry. Further, civil laws and religious creeds based on obsolete information.
The facts about cousin marriages are much clearer. Fears of cousins who marry having children with birth defects are often exaggerated. Simply marrying within your own race increases the odds of birth defects. Marrying within your own town further increases your chances. Cousin couples have only a slightly higher incidence of birth defects than non-related couples and this is related to the increased chance of sharing genes for recessive traits (like CF and SS). Comprehensive genetic education and premarital genetic counseling programs can help to lessen the burden of genetic diseases in endogamous communities. Also, social, cultural, and economic benefits of cousin marriage need to be fully considered.
-26 states allow first cousin marriages; most people can marry their cousin in the US.
-US prohibitions against cousin marriages predate modern genetics.
-No European country prohibits marriage between first cousins. Nor does Canada or Mexico. The U.S. is the only western country with cousin marriage restrictions.
-Children of non-related couples have a 2-3% risk of birth defects, as compared to first cousins having a 4-6% risk. Genetic counseling is available for those couples that may be at a special risk for birth defects (i.e., a defect runs in the family). In plain terms, first cousins have at a 94 percent plus chance of having healthy children. The National Society of Genetic Counselors estimated the increased risk for first cousins is between 1.7 to 2.8 percent, or about the same as any woman over 40 years of age.
-Second cousins have little, if any increased chance of having children with birth defects.
-The frequency of cousin marriages in the USA is about 1 in 1,000. The frequency of cousin marriages in Japan is about 4 in 1,000.
-It is estimated that 20 percent of all couples worldwide are first cousins. It is also estimated that 80 percent of all marriages historically have been between first cousins. In some cultures, the term cousin and mate are synonymous.
-Albert Einstein married his first cousin. So did Charles Darwin who had exceptional children.
-Franklin D. Roosevelt, the longest serving US president in history married his cousin.
-Leviticus 18 lists all forbidden sexual relationships. Cousin relationships are not included.
-God commanded many cousins to marry, including Zelophehad's 5 daughters, Eleazar's daughters, Jacob (who married both Rachel and Leah, first cousins), and Isaac and Rebekkah (first cousins once removed).
-Current studies indicate that cousin couples have a lower ratio of miscarriages-perhaps because body chemistry of cousins is more similar.
Just some thoughts as we provide total care for our primary care patients. We may be seeing more cousin unions in the immigrant population we encounter. We must provide objective and culturally respectful services for all of our patients. Genetic counseling can be part of our offerings. Remember, there are many reasons for fetal abnormalities, AND incest by definition is the crime of sexual relations or marriage taking place between a male and female who are so closely linked by blood (father-daughter, brother-sister) or affinity that such activity is prohibited by law. Incest is a statutory crime, often classified as a felony-second cousin marriage and sexual relations is not incest by legal definition in the USA, or anywhere in the world. http://www.nsgc.org/news/cousins.cfm
Great discussion, both of you. If you haven't read it already, you might be interested in the book "Middlesex". Quite an interesting discussion of these issues!
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