Indian J Pediatr 1992; 59 : 449-454

Reproductive Profile of Mothers in Relation

to Hemoglobin E Genotypes
R.S. Baigir

Department of Hematology, Regional Medical Research Centre, North East Region

(ICMR), Dibmgarh, Assam

The reproductive profile of 190 Ahom-Kachari mothers belonging to Mongol-

oid ethnic stock of Assam has been studied in relation to hemoglobin (Hb) E
genotypes. No significant variations have been observed in the reproductive
performance between the normal population and abnormal hemoglobin ho-
mozygote (HbEE) and heterozygote (HbAE) mothers. However, the repro-
ductive wastage among the hemoglobin homozygote (HbEE) mothers has
been observed to be double than the normal hemoglobin (HbAA) and abnor-
mal hemoglobin heterozygote (HbAE) mothers. The reproductive per-
formance parameters have also been compared with the other available
studies.

Key words: Fertilily; Mortafiby; Reproductive wastage; Hemoglobin E geno-

types,

Human genetic constitution-normal or ab- Earlier, our studies 1,2 have shown that
normal affects the health of an individual, haemoglobin E variant occurs at appre-
family and the society at large from various ciable high frequency in the North Eastern
angles. High incidence of certain genetic India as in the other South-East Asian
traits in a population reflects either the bal- countries. The reasons for the high preva-
anced polymorphism or the diseased condi- lence of abnormal hemoglobin E gene are
tions pertaining to that trait. Hemoglobino- still obscure, ttowever, in Thailand stud-
pathy in the North Eastern region of India ies3'4have indicated that hemoglobin E gene
is a major public health problem.: The confers protection against malaria. The
prevalence of hemoglobin (Hb) E in high North Eastern region of India is an endemic
frequency in the general Mongoloid tribal area for malaria especially for Plasmodium
populations is a major challenge to the falciparum. It is, therefore reasonable to
health authorities and medical practitioners assume that hemoglobin polymorphism in
in the North Eastern region of India. this region has evolved by the heterozygote
advantage in the malarious environmenl.1
Reprint requests : Dr. R.S. Balgir, (Present Studies on sickle cell gene in Africa and
address) Assistant Director, VSS Medical elsewhere s,6have shown differential fertility,
College Hospital, Burla-768 017, Sambalpur complications during pregnancy and deliv-
(Orissa). ery, and the higher foetal wastage than the
450 "17IE INDIANJOURNALOF PEDIATRICS
normal individuals. A few reports3a from
Thailand have demonstrated a higher fertil-
ity in heterozygote females for hemoglobin
E and a reduced fertility in hemoglobin E
homozygous females and thalassaemia
heterozygotes in malaria endemic areas.
Similar studies are rare in India. In view of
the high prevalence of hemoglobin E in this
part of Ihe country, it would be worthwhile
exploring the reproductive performance of
the hemoglobin E afflicted mothers.
The present study has been designed
with the following objectives in mind:
(i) To find out any difference in the repro-
ductive performance of the mothers af-
flicted with hemoglobin E in homozygous
or heteroTygous condition.
(it) To find out whether the normal ol
hemoglobin E genotypes affect the repro-
ductive performance of the mothers.
(iii) To compare the fertility and reproduc-
tive wastage diffcrentiais with the existing
information.
MATERIAL AND METHODS
In the North Eastern region of India, the
majority of the populations are tribals and
belong to the Mongoloid ethnic stock in
whom the frequency of hemoglobin E gene
varies between 50 to 65%? The Mongoloid
tribal people are more vulnerable to the
abnormalities of hemoglobin E than the
nontribal and non-Mongoloid populations
of this region. The present study has been
carried out among the Ahoms and Sonowal
Kacbari tribals of tile Khowang area under
Dibrugarh district, Assam. This area is
mostly inhabited by the Ahoms and
Sonowal-Kachari tribals who belong to the
Mongokfid racial origin. They are char-
actcrised by the black, straight and coarse
head hair, yellow or yellowish brown to
dark-brown skin colour, scanty body and
Vol. 59, No. 4
facial hair, broad flat face with prominent
cheek bones, oblique narrow eyes and the
presence of typical Mongoloid eyefold.
Ahoms originally belong to TaiShan group
of Thailand, whereas, the Kachari tribals
(Bodos) belong to Mongoloid race of Sino-
Tibetan stock) They are endogamous, pa-
trilineal and patrilocal people and practise
monogamy.
For the present study, about 2ml. of
blood was randomly drawn by yenepuncture
from Ahom-Kachari mothers in EDTA
coated vials. The samples were collected
blindly without knowing the hemoglobin
genotype and very well represent the
Ahom-Kachari population of the area un-
der study. Abnormal hemoglobins were de-
termined by the sickling test and perform-
ing electrophoresis on celllulose acetate
strips using the control with each run fol-
lowing the standard procedure?
Regarding the reproductive history, the
information was recorded on a predesigned
proforma from mothers for the total num-
ber of pregnancies, fate of offspring, abor-
tion/miscarriage, stillbirth, surviving chil-
dren and the age at death. The data so col-
lected were analysed in relation to hemo-
globinopathy, i.e. according to the geno-
types such as HbAA, HbAE and HbEE to
know the patho-physiological effects of the
abnormal genotype. The genotypes HbEE
and HbAE represent the homozygous and
heterozygous conditions, respectively of the
abnormal hemoglobin E, whereas, HbAA is
a normal adult hemoglobin genotype.
RESULTS
The reproductive performance of the
Ahom-Kachari Mongoloid mothers studied
in relation to hemoglobinopathy is given in
Table 1. It is apparent from the Table that
the total number of conceptions per mother
 BALGIR: REPRODUCTIVEPROHLEOF MOTIIERSIN RELATIONTO ltbE GENOTYPE 451

does not show any considerable variation flicted with abnormal hemoglobin E in ho-
between the different hemoglobin geno- mozygous (HbEE) and heterozygous
types, i.e. normal as well as abnormal. The (HbAE) conditions does not exhibit nay sig-
average number of pregnancies per mothcr nificant variations (Table 1). These findings
comes out to be 4.47. No difference has are contrary to those found in Thailand,
been found for the average number of live- where a higher fertility in females heterozy-
births per mother for different genotypes. gous for hemoglobin E and reduced fertility
in other words, the mothers afflicted with in hemoglobin E homozygous femalcs in
hemoglobin-E-disease or trait are not malaria endemic areas has been observedY
showing any diffcrence in thcir bchaviour However, our findings are consistent with
towards fcrtility. They are at par with the the fertility studies9 carried out in Malaysia
normal mothers. Although the reproductive on the population of Indian origin where no
wastage (abortions/miscarriages and still- differential fertility has been observed in
births) per mother homozygous'for hemo- sickle cell homozygotes and heterozygotes
globin E is about double than in the normal as compared to the normal individuals. This
homozygous (HbAA) mothers, but this dif- clearly indicates that the molecular basis of
ference is not statistically significant. The the defects in the hemoglobin polymor-
average number of stillbirths per mother in phism in the Indian populations is different
hemoglobin E homo~gote is three times from those of the African and South-East
higher as compared to normal homozygote Asian countries.
(p<0.05) and hcterozygote (p<0.001). As no significant variations for fertility
However, no difference has been observed pcrformance have been observed between
for postnatal dealhs in the three genotypes. the different genotypes of hemoglobin E,
the data were pooled together for compari-
DISCUSSION
son purposes with the other populations of
The present study reveals that the repro- India. Table 2 gives a comparative account
ductive performance of the mothers af- of the reproductive performance of the

TAR~.V.1. ReproductivePcrformance of the MongoloidMothers in Relation to Hemoglobinopathy.

Haemoglobin No. of Total no. of Live Abortions/ Still Age at death

genotypes mothers pregnancies births miscarriages births < 5yr > 5yr

HbAA Total 499 462 19 18 57 9

112 per mother 4.45 4.12 0.17 0.16 0.51 0.08

HbAE 60 Total 269 2,19 14 6 19 3

per mother 4.48 4.15 0.24 0.t0 0.32 0.05

HbEE 18 Total 82 71 3 8 6 1
per mother 4.55 3.94 0.17 0.44 0.33 0.06

All 190 Total 850 782 36 32 82 13

per mother 4.47 2.12 0.19 0.17 0.43 0.07
452 Ti II"~ I N D I A N J O U R N A L ~)F P~L~,')L,k~[RI~.~S VoL 59, No.

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BAL(3IR : R E P R O D U C ' I ] V E P R O F I L E OF M O T H E R S IN R E L A T I O N T O l t b E G E N O T Y P E
mothers in different tribal and nontribal
populations of India where the similar sort
of information is available. It is interesting
to note from the Table that the average
number of pregnancies per mother is the
highest among the Sonwal-Kacharis (7.8),
followed by the Mongoloid populations of
Assam (5.3), Hindu populations of Assam
(5.1), Sikligars (4.9), Muslim populations of
Assam (4.7), Bhoksas (4.6), Ahom-Kacharis
(4.5), Kotas (4.4), Muslim Gujjars (4.1),
Bhil (4.1) and so on in a decreasing order.
This indicates that the average number of
pregnancies per mother is still higher in the
North Eastern region of India as compared
to the aims of the Government of India for
2 or 3 children. This needs effective meas-
ures to be taken to implement the family
planning and wclfare programmes in this
part of the country. While considering the
surviving children in the different popula-
tion groups, the present study shows the
highest number of surviving children (92%),
followed by the Muslim Gujjars (89.3-90%),
Muslim populations of Assam (86.9%),
Vokkaligas (86.3%), Mongoloid popula-
tions of Assam (86.2%) and the Hindu
populations of Assam (86.1%) in a decreas-
ing order, which indicatcs the improvement
in maternal and child health care in these
population groups.
High incidence of spontaneous abortions
among the Sonowal-Kacharis (9.3%) has
been rcporlcd. ~~Among the Sikligars, this
incidence is 4.7% and the present study ex-
hibits 4.2% among the Ahom-Kacharis. Of
the incidences of stillbirths, the highest of
4.5% has been reported among the Hindu
populations of Assam. u This incidence is
3.2% among the Hindu Gujjars and the
present study reveals 3.8% among the
Ahom-Kacharis. Over all, the reproductive
wastage (abortions/miscarriages and still-
453
births) is high (2-9%) among the Mongol-
oid populations of the North Eastern region
of India (Table 2). These findings are con-
sistent with those of earlier studies reported
from Thailand.3
Table 2 reveals that the incidence of
postnatal deaths is considerably high among
the tribal populations of India Such as Kotas
(43.8%), Bhils (26.3%), Bhoksas (23.6%),
Durlas (22.6%), Garasias (20.5%), Dorlas
(19.5%), Sonowal-Kachari (14.6%) and in
some populations (11.2%) of North Eastern
India including the present populations.
This is probably due to their unhygienic way
of living and nonavailability of medical and
health facilities in the rural remote areas of
the country.
ACKNOWLEDGEMENTS
The author is grateful to the Director of this
Centre for providing the necessary facilities.
The co-operation of the subjects in this
study is thankfully acknowledged. Thanks
are also due to Mr. H. Gogoi for typing this
manuscript.
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