I remember my father once warning a distant cousin who used to drink a lot. “Son,” my father said, “you will soon get married; you will have children. You should stop drinking.” The cousin replied: “Uncle, it is not me who will be pregnant. It is harmful when the mother drinks. What’s the harm when I drink?” My father’s concern was not because of biological harm, but to warn our cousin that he had to give up drinking to be a role model to his children. But we now know that the father’s drinking habits have a major influence on the baby during pregnancy, perhaps even more than the mother’s.

“Fetal alcohol syndrome” (FAS) is a disorder that occurs due to alcohol consumption during pregnancy. Consequently, pregnant women are warned to avoid alcohol to protect their baby from FAS and other similar disorders. According to Michael Golding, a professor of physiology at Texas A&M University, birth defects are influenced not only by the alcohol consumption of mothers but also by that of fathers.

“Research clearly shows” writes Golding, “that sperm carry a vast amount of epigenetic information – meaning heritable shifts in the way genes are expressed that don’t result from changes in the DNA sequence – that strongly influences fetal development and child health. Yet most doctors and other health care providers do not take into account the influence of paternal health and lifestyle choices on child development.” According to Golding, “most of the attention is given to the mom’s drinking while pregnant,” but his team’s studies demonstrate that “male drinking before pregnancy is a plausible yet completely unexamined factor.”

Keeping men out of the equation in relation to birth defects – simply because the baby was developing in the mother’s womb and feeding through the umbilical cord – also comes in contrast to the fact that men drink more than women and the likelihood of men developing alcohol-related disorders is as much as four times. According to the CDC (Centers for Disease Control and Prevention), “men have higher rates of alcohol-related hospitalizations, about two-thirds of death from excessive drinking are among males,” which are only two of a long list of problems that place men at higher risk.

“One in twenty schoolchildren in the United States may exhibit some form of fetal alcohol spectrum disorders” reports Dr. Golding, and for many years this was considered to be the fault of mothers. Even when mothers said they did not consume any alcohol, the general assumption was that they were lying. But another point to consider is that reported drinking levels were not directly correlated with alcohol-related birth defects, nor did all women who drank give birth to children with such syndromes. This applies to all diseases; just as not everyone who smokes will get lung cancer, and not everyone who deals with the coronavirus will die from Covid-19, the damage caused by alcohol results from a combination of various genetic and environmental factors.

According to Dr. Golding, the wide range and severity of symptoms point to factors that cannot be explained only with the mother’s alcohol consumption. That’s why he and his team developed a mouse model to see what happens if mom, dad, or both parents drink. So, they studied the mice and recorded results in cases when either or both parents consumed alcohol. They focused on the faces of the mice, for fetal alcohol syndrome is associated with facial abnormalities and reduced growth of the head and brain. Using facial recognition software, Golding and his team analyzed how maternal, paternal, and dual parental alcohol exposures affected the offspring. The results showed that paternal alcohol use negatively affected the offspring’s brain, skull, and facial landmarks, such as the eyes, nose, and mouth. Observations included microcephaly (underdevelopment of the head and brain) and lower birth weight. Alcohol-induced craniofacial (skull and facial bones) abnormalities and growth deficiencies were also found to persist into later life. Additionally, behavioral changes and an increased risk of heart defects were linked to male alcohol consumption.

According to the CDC, no amount of alcohol is beneficial during pregnancy or when trying to conceive, as there is “no known safe amount” of its use. Although the amount and timing of alcohol consumption during pregnancy partially explain the differences in the development of fetal alcohol syndrome, they do not account for the variability in defects and the wide range of symptoms observed in each child. Therefore, it is essential to investigate other contributing factors beyond the mother’s alcohol use. Dr. Golding suggests examining paternal drinking habits, which may provide a missing piece of the puzzle. One indicator is that the probability of achieving pregnancy with IVF decreases by up to 50% when the father is a drinker.

When the first studies on maternal exposure to toxins during pregnancy were published in the 1950s, many in the scientific community were skeptical. Likewise, Dr. Golding thinks, some will doubt the effects of paternal alcohol use on child health, and that we will never know if doctors do not start asking the fathers if they have been drinking.

Previously, the blame for the imperfect development of innocent children was placed solely on the mother; now the fathers will understand that they share the same responsibility. Shouldn’t both mothers and fathers reconsider their actions, recognizing that they are playing with the fate of their innocent offspring, whom they have brought into the world, and endangering them with their own hands?

Resources

• N. Thomas et al. “Paternal alcohol exposure and dental-facial anomalies in offspring”, The Journal of Clinical Investigation, 2023, 133 (19): e174216.
• Golding, “Fathers’ Drinking May Affect Fertility and Fetal Brain Development”, The Conversation, November 21, 2023.
• https://www.cdc.gov/alcohol/fact-sheets/mens-health.htm

“Quick, the cord’s wrapped around her neck. Twice!”

I remember my numb feet in the stirrups. I remember the nurses on either side of me. I remember seeing my baby’s little purple head in the mirror, cone-shaped and strange. The doctor’s hand whirred around it in two circles, concise and quick. But I felt nothing.

“One more push, this is the biggest push!”

Two and a half hours into pushing, and I still don’t know how to push, I thought frustratedly. I tried as best as I could, my teeth crushing each other with determined force, my hands in knotted fists by my ribs. Out! She’s out!

Relief swirled through my exhausted, stretched body. There she was, in their hands, in the mirror. Then on my chest.

My daughter. Katie.

Her pale purple fingers were the first things I could see clearly. They curled and uncurled against my skin, unsure, new. A wet cry joined my panting breaths.

I was always told that a special part of your heart would open up when you held your child for the first time. I had imagined it so many times throughout my pregnancy. I knew just how it would be; they would hand her to me, and it would feel like sparkling, golden honey had flooded my soul as my eyes drank in every delicate feature of her face. 

But here I was, staring at her tiny fingers in shock and confusion instead. This isn’t my baby. Where is the one that lived and hiccuped and kicked in my womb? Surely this isn’t her. It can’t be. There are no sparkles in my heart. Just this strange child on my chest. Purple, alien-esque. And those fingers. Purple. Unfamiliar.

Then she started to slip off of me, and my arms were shaking so badly from the epidural that I couldn’t grasp her well. Her naked rump landed on the bed and I apologized, sorry, sorry! I don’t know what I’m doing. Where is my real baby, where is she?

I glanced desperately at my husband. He was sitting slightly behind me to my right. His face was pale, his gaze distant. He had seen the basins of blood the nurses were taking away. The doctor offered him the scissors to cut the umbilical cord. “No, no,” he said. He had already told the doctor he didn’t want to cut it, but she wanted to give him the chance. “No.” His hands covered his nose in a tent and he slammed his eyes shut, blocking out the images.

So the doctor offered me the scissors. I would’ve laughed if I had the energy; my fitfully shaking arms could barely hold my newborn, much less a sharp object. “Please, cut it yourself,” I muttered, exhausted. “I can’t.”

I can’t. How could I muster the strength to care for this child? How could I even love this child when she felt like a total stranger to me, her own mother? Everything was wrong, so wrong… I closed my eyes and exhaled slowly. They had all lied. They lied about everything and I feel worlds away from my own baby, even my own husband. I felt panic start to prickle in my stomach. Perhaps I was in shock, I’ll never know. I handed the baby girl to a nurse, feeling dazed and alarmed at the emptiness in my chest.

I can’t do this.

The words would drift through my mind many times throughout the next few weeks like a cold, gray breeze. They would chill me to the core, and I’d wrap my fuzzy purple robe tighter around myself to stave it off. “Being a mother is the most natural thing in the world,” they had told me. Oh, but it feels so unnatural! Please help me, God! The tears would squeeze out from my clenched eyelids, falling gently on my baby’s swaddle in the dark. I’d try one more time to get Katie to latch for breastfeeding, only to have my toes curl in pain against the flattened rug. I can’t. Not one more time can I do this.

It was then just past two in the morning. I got up twice more that night to nurse her. I gasped in pain, curled my toes, and rocked back and forth to soothe us both. Back and forth. Back and forth. Please God, help me. Take my pain away. Give me strength. Help my baby. Back and forth.

They called them the “baby blues.” I thought of them as the “baby grays,” because the days were gray and the nights were darker gray. I felt as though I were feeling my way through a heavy fog; it filled my lungs with its oppressive weight and made it hard to breathe at times. But I kept feeling and forging on, one day at a time, one hour at a time. There was no other choice. I felt duty-bound to my daughter.

Yet mercifully—out of that horrible, stark grayness—glimmers of light began to beam. Little moments, like tiny fireflies, glowed gently among the struggle-filled weeks.

I held Katie against my shoulder. Her panting was pleasant against my neck, warm and rapid. Her eyelids flickered. Baby dreams. Downy, blond hair tickled my cheek and her tiny hand jerked in a startled reflex. I was touched to see her smooth skin, her plump pink cheeks, her rosebud lips, and know that they were created inside of me.

Then there was my own body. The skin on my belly draped like a loose curtain. My under-eyes were sunken and purplish. Angry stretch marks streaked across a large portion of my body. Sometimes I would see myself in the mirror and think, I’m only twenty-two years old. Should I have waited? What have I given up?

Then I would see her, my beautiful child sleeping blissfully in her crib. I had exchanged my smooth skin for hers. I gave up rest and ease so that she could enjoy both of them. I sacrificed my body’s youthful form to stretch and bulge and itch and creak, all in the hope of granting Katie her chance at life.

During the lonely nighttime feedings, I would ponder how a daughter is not only created in her mother, but from her mother. And that sense of giving, that feeling of servanthood and sacrifice, became sacred to me. I felt as though I had wandered into a humbling sisterhood of billions of women, not really knowing what to expect. Did any of us understand what we were taking on when we felt that gentle stirring in our wombs? But here we were anyway. We were all trying. We were all grappling with this heavy and holy work of raising our children.

That invisible bond pulled me to other women: my mother, my sisters, my mother-in-law, my friends. Drawing from their experiences, their hardships, and their successes was like sipping a warm, soothing beverage for a sore throat. I wasn’t alone in this wrestle. We all had long days that had dissolved into evening tears. We laughed until our bellies ached from the funny stories our children provided. Our hearts had swollen at the sight of our precious children, smiling their crooked smiles and giggling their throaty giggles.

I learned that it might take a village to raise a child, but it also takes a village to raise the mother of that child. These women listened to me, they gave advice, they brought meals, they donated clothes, they babysat, and they mentored me. But their various examples were also crucial. I saw how these women hadn’t just accepted their roles; they had grown into them and flourished. I saw that I could do it, too.

As with any growth, though, it would take time. Like my daughter, I was in an unfamiliar infancy—trying to figure out how to gain control of myself, how to form a bond, how to communicate with another being that didn’t speak the same language. We really weren’t that different; I was merely further along on the same path. That perspective helped me develop patience through the exhausting nights and the drawn-out days. Each hour held another lesson. I kept trying to figure out what a specific cry meant, then how to coax a gummy grin out of Katie, and eventually how much pear purée she could comfortably stomach. She kept learning how to get my attention or tell me that she didn’t like having her hair washed. And so we grew and learned together.

My newborn mother-self slowly developed until I was metaphorically toddling along. After five months of having a baby, I finally felt like I had my feet under me. I was confident that I could care for Katie and meet her needs. But like any toddler, I had my stumbles. What do I do when she has a fever? How do I care for her eczema? Oh no, she whacked her head on the bookshelf, how could I have let this happen? Thankfully, my husband was there to assist and calm me in such moments of insecurity. We had made it this far, hadn’t we? We could continue to figure it out.

One of my biggest growing moments occurred when my husband was away for military training. I was at home with my eight-month-old, and the monster Hurricane Michael was bearing down on the Florida Panhandle. It was predicted to make landfall an hour east of our home. My husband and I hadn’t been able to communicate due to strict regulations, so I couldn’t update him on the potential danger I faced. I felt extremely alone and anxious as I debated whether to leave or stay.

Finally, I held my crying daughter in one arm and raced from room to room with my phone in the other hand, taking videos of our home and possessions in case we needed them for insurance purposes. My heart beat wildly as I threw clothes, formula, and other necessities into a suitcase. I grabbed our cardboard “Important Docs Box” and threw it in the trunk.

We were leaving. There was no time to keep debating about an evacuation. I prayed silently as I buckled Katie into her carseat. Please protect my home, Heavenly Father. Keep us safe on the roads.

I might have stayed if it were just me at the house. But with my child, it was different. I alone was in charge of her safety. The responsibility weighed heavily on my heart as we drove from our home to Baton Rouge. My husband would understand the cost of a hotel for a couple of nights.

I stopped at a gas station halfway to our destination. Again, I held my whimpering baby in one arm. With the other, I filled a paper cup with hot water from a coffee machine to warm Katie’s formula. I was so distracted that the scalding water overflowed onto my hand. I angrily dropped the cup and gritted my teeth, blowing on my burned skin to cool it down.

My startled baby had stopped crying and was staring at me in confusion. Oh, my precious girl. She has no idea why we’re here in a gas station, why I’m getting hot water, why we’re leaving our home. Looking into Katie’s concerned blue eyes, the burning sensation slowly lessened and I suddenly felt grateful. To spare her from worry or fear, I had taken the leap to evacuate. That thought filled me with peace. Sometimes the best antidote for fear is to simply make a decision and follow through, and I was proud that I had done that, even in my frazzled state.

The strength to make my decision came out of necessity. I couldn’t talk to my husband about our options. I had to weigh them myself and decide on a course of action in a short amount of time. The pressure helped streamline my thoughts and clear my vision. I didn’t realize my own ability until I was forced to look it square in the face and ask myself what I was willing to do to protect my child. So there I stood in a middle-of-nowhere gas station with a burned hand, a tear-stained baby on my hip, and a calmness in my heart. I felt as if I had grown three inches in the last few hours. While the process was nerve-wracking and soul-stretching, I could stand a little taller.

I refilled the cup—more carefully, this time—and warmed Katie’s bottle. We got back on the road fifteen minutes later and arrived safely in Baton Rouge. Our home ended up being safe, and my husband and I were able to talk about the situation a couple of days later. Things were good, and I was a more developed person because of the setbacks I had faced.

Now, my daughter is freshly two years old. A few days ago, she ran around our living room in delight, herding purple balloons into a huddled mass. “It’s been two whole years since the morning we held our newborn in that hospital room,” I stated, looking over at my husband. Katie squealed and tossed a balloon in the air between us.

My husband shook his head and tented his hands over his nose, the same way he had in the hospital. “Ugh,” he muttered. Then he lifted his head. “It’s so much better now. So much better.” After a small pause, he added, “I do love her. I do love my little girl.”

I smiled in agreement. “I love her, too.” I got on my hands and knees and chased Katie through the balloons, and her joyous giggles filled the room.

There was that sparkling honey again. That same love that I had felt many times in the last two years flooded my chest, warm and soothing and sweet. I gazed adoringly at my beautiful daughter in a way that I used to think wasn’t possible. I had changed. I had been refined. I had grown into motherhood. And in that agonizing, hand-reaching, soul-rending, prayer-filled growth, I had found the most beautiful love for my Katie.

I have experienced many external and internal challenges in my life. But none of them amount to the transformation I’ve had in learning how to love and serve a little being that is my very own. To love is to serve, and to serve is to sacrifice. To sacrifice pride, comfort, ease, sleep, time, peace, and your very body is a sacrifice that all mothers make, and I’m now bearing that staggering and magnificent weight myself. The weight strengthens me each day, and I am able to press on stronger and more capable the next day—because I am a mother, and I love my child as only a mother can.

When you ride a rollercoaster for the first time you feel a surge of emotions that grab, terrify, and haunt you all at once – well, at least at the start. But once you get over that first drop, that first mind bending, gut wrenching drop, you suddenly realize that your life isn’t over. And not only is your life not over, it’s also exciting anticipating what else is around the corner.  When the adrenaline takes over, the fear of the impending disaster dissipates.

That’s what pregnancy was for me. I had the initial fear seeing the digital test flash “pregnant.” That fear wasn’t because it wasn’t planned – technically, we did plan. We got married, bought the nice house in a subdivision, and had a fantastic waiting period of five years so that we could explore married life without kids. The fear was the feeling of “oh no, what have we done?!”

And I wasn’t the only one who felt it! My husband had that look on his face when I showed him the test. He didn’t jump around with joy or even smile; he just looked at me with an expression of confusion and worry that settled somewhere closer to acceptance. You would have thought we were two fifteen year olds still in high school with no life achievements. But what mattered most wasn’t our initial reaction. What mattered was the journey we were embarking on together as husband and wife. The excitement hit us quickly enough, along with the extreme nausea and vomiting that plagued me for months.

My husband always wanted a beautiful baby girl. That was his desire from the start. I don’t have to explain how happy he was when the ultrasound tech told us what we were having. We decided to have a nice small and intimate reveal party, just for the grandparents. We got the idea to get cute pink build-a-bears to give to the prospective grandmothers and we revealed our daughter’s name along with the due date. It was exciting and wonderful.

But life always has a drop waiting around the corner. It never fails: impending doom lurks, waiting for its next victim. It wouldn’t be a journey if it didn’t have obstacles. So that is what I first thought when my OB/GYN called me to come to the office exactly one week after the reveal party. But I could have never prepared myself for the words “positive for Down syndrome.” I kept thinking, how could this be? My husband and I were both still in our twenties and healthy, with no family history of anything more than diabetes. This couldn’t happen to us! I stared at my husband, and he had the look of suffocation, as if the room had been stripped of oxygen. We rushed home to do research, to ease our minds into believing that the prenatal test was inaccurate or wrong. We even grasped at the straw of someone in a lab mixing my blood with someone else’s. Our parents reassured us that it was a faulty test, it happened all the time in the eighties and early nineties. My husband held fast to thoughts of positivity, but I ventured into the realm of realism very early because I knew that life always gives you something that you perceive to be unfair and unbearable. That drop was unbearable.

The twist and turns came in the next few months with the fantastic ultrasound test that showed no signs of Down syndrome at all on our little one. But of course, me being the president of the realm of realistic notions, I couldn’t allow myself to be too relieved. But could anyone really blame me? I mean if my child was to be born with Down syndrome, wouldn’t I, as her mother, need to be there for her? If the doctor pulled her from my womb and the true visualization of her features set in, and she bore obvious signs of that extra chromosome, I would still reach for my child and hold her tighter than a mother bear.

My husband and parents could step out of the room and regain their composures, while going through the stages of grief all the way to acceptance and unconditional love. But me, being momma, I needed to go through that ahead of time, so when my baby girl was handed to me the only thing she would feel was my undying and unwavering love for her.

I did the only thing I could do: I prayed. Not to take away any disabilities or deformities. How could I? How could I be so presumptuous to ask God to make my life any easier than the next person’s? No one has it easy. No, instead I prayed for a healthy beautiful baby girl. And I spent hours telling God “thank you.” I was grateful that I could conceive, and that I had a great husband who also would love our daughter unconditionally. I was thankful for the roof over my head and the qualities that my loving parents instilled in me, because during my pregnancy there was barely a week that went by without hearing about a woman killing or abandoning the baby she didn’t want. I was thankful to have compassion and natural human affection. I spent hours crying and speaking my peace with God, knowing that no matter how different she might be, my daughter was a direct gift from Him and I knew that I only wanted what was best for my child, which is to be better than me. That is what all parents truly want.

When the delivery was over, so was that ride of loops and drops. Because when they handed me my little girl all I saw were her perfections, no flaws. And my husband thanked me for bringing our child into the world. Even now, two years later he still thanks me, and I still thank God because he answered my prayers.

This entire ordeal taught me many lessons about life and our ability to make it harder than it needs to be. Sometimes we ourselves are the disasters we try so hard to avoid. It’s our thinking and our mindset that end up getting the best of us and turning something that can be conquered into a mountain of pain. I learned that you don’t have to be a saint to put trust in a higher power to guide you. I could have allowed the fear of the unknown to destroy me, to cause me to become so paralyzed that I lost my ability to avert a disaster. We all have that ability, regardless of what life sends our way. Beauty is in the eye of the beholder, but also what we perceive as a catastrophe is ultimately left up to our own interpretations.  

Now I am on a new rollercoaster ride. New twists, turns, and drops, each one filled with thoughts of fear and despair. But this ride is called motherhood. Every day I am forced to reset my thinking and my viewpoint on things. I remind myself that it is my choice as to whether something is a mountain or a molehill. Do I choose to wallow in negative thoughts of impending doom or do I look for the way out of the tunnel, the light that is always at the end? Because when I look at my life over the past couple of years, every disaster that has come my way has made my family and me stronger and more versatile. And every blessing that has come our way is received with gratitude and graciousness.

Do I see everything through rose colored glasses now? Not in the least. I was and will always be a realist. Seeing life for what it is will constantly require an endless readjusting of our minds. The truth is, we never truly stop riding the rollercoaster. We can only hope to learn how to enjoy it as much as possible. If we don’t, we are doomed to see every event as something to cower in front of. You don’t get to know when it is coming, and you don’t get to know what it will be, but you do get to choose how it will affect your life: mountain or molehill? I choose to see the twists and turns of my pregnancy as the blessing they always have been. My daughter has no real health issues or problems, no heart defects and no developmental delays. She is healthy and beautiful, with a smile that will bring the world to its knees. All that I truly wanted was for my baby girl to be healthy and smart. She is beyond everything I could have dreamed possible. When I look into her eyes, I am aware that she may have difficult days ahead, but she will have many happy ones, and on her worst day she is still better than I am.

Harming our bodies or health is a betrayal against this incredible gift. One of the major ways people harm the body is through smoking cigarettes.

Smoking harms human health in countless ways. It is one of the main causes of many diseases, such as lung and throat cancer, along with cardiovascular and respiratory track diseases, such as chronic bronchitis. According to the latest report from the World Health Organization, smoking remains the fourth of the top ten risks that threaten human health. Approximately 20-30% of adult fatalities are caused by ailments contributed to by smoking. Recent studies have shown the negative effects smoking has on human reproductive functions.

Effects on fallopian tubes

Smoking has a negative impact on female reproductive organs; this impact is determined by how long, and how much, a woman smokes. It may cause infertility by damaging the fallopian tubes that serve as a ground for the egg to be fertilized by sperm. In many studies, the risk of damage to the fallopian tubes was very high – this danger increases if a woman starts smoking a pack a day before the age of 18.

Effects on female hormones

Many toxic substances in cigarette smoke, including nicotine, directly inhibits the activity of the enzyme called aromatase, which plays a major role in the synthesis of the female hormone (estrogen) in the ovaries. Depending on the biological function, estrogen can be found in three different forms: as estrone, estriol and estradiol. Polyaromatic hydrocarbons found in cigarette smoke stimulate the microsomal cytochrome P-450 enzyme system that degrades hormones in the liver and, consequentially, increases conversion of estradiol with high biologic activity into estriol with the lowest activity. Alkaloids, one of the harmful substances found in cigarette smoke, were discovered to prevent production of progesterone in the ovaries. This plays a role in preparing the womb and in continuation of the pregnancy during the first three months. Therefore, smoking leads to progesterone deficiency during the early stages of pregnancy, causing miscarriages.

Effects on the maturation of the egg

The concentrations of the FSH hormone that is involved in the maturation of reproductive cells in the ovaries are especially high in young female smokers. In other words, a resistance develops against the FSH hormone in the ovaries and higher FSH hormone levels are required for the maturation of the egg. Thus, fertilization problems and missed periods can occur because of an absent reproductive cell. During the treatment of such patients with insufficient egg cell maturation, there is a 50% decrease in the success of the implantation (placement of the fertilized egg into the womb) and the continuation of the pregnancy in smokers when compared to nonsmokers. This means smoking significantly reduces ovarian functions, and ovarian stimulation becomes inadequate at earlier ages in women.

The negative effects of smoking on the reproductive system are also observed during the implementation of reproduction methods such as in vitro fertilization and assisted fertility technologies. The presence of high androgenic hormone levels (pre-metabolites of gender related hormones: androstenedione, DHEAS and testosterone/SHBG) in female smokers has been found to decrease the possibility of pregnancy during in vitro fertilization efforts.

Effects during pregnancy

There are many harmful consequences of smoking during pregnancy, especially for older women who are pregnant. Some of these consequences are premature birth, miscarriage, retardation of development, inadequate baby weight, perinatal mortality, ectopic pregnancy, placental praevia, and placental abruption. Placental praevia is the abnormal placement of placenta in the womb. In this case, depending on the excessive bleeding that occurs after the eighth month of gestation, the lives of the mother and fetus become imperiled, and fetal development is hindered. Placental abruption occurs depending on the premature separation of placenta from the womb, causing excessive bleeding that can also endanger the lives of the mother and baby.

In pregnant smokers, the postnatal ratio of infant mortality and disability increases as a consequence of deficiencies involving lung function and nerve development. These effects are directly proportional to how much a woman smokes. There are also negative impacts when a pregnant woman is exposed to second hand smoke by a spouse or close friend. Harmful metabolites of nicotine reach the baby via the placenta. Furthermore, nicotine is degraded slowly in the liver of a pregnant woman. Inadequate baby weight is related to smoking dosage and time.

Due to smoking in the early stages of pregnancy, the hormone levels of estriol, estradiol, progesterone and hCG, hPL which is secreted from the placenta, have been found to decrease. This reduction, which is observed in parallel with the amount of smoking, can result in miscarriages.

Toxic polyaromatic hydrocarbons have been found to accumulate at elevated ratios in the wombs of women who were exposed to cigarette smoke for a long time. During pregnancy, this situation leads to the deterioration of sertoli cells located in the reproductive glands of male fetuses. These glands assist in sperm production during adulthood, and damage to them can therefore cause a reduction in sperm generation.

An insufficient placental development occurs because of the negative effects of nicotine, cadmiums, and polyaromatic hydrocarbons damage the reproduction of trophoblast cells that make up the placenta. This situation explains the increasing miscarriage ratios among female smokers.

The free T4/TSH ratio in the serum of the umbilical cord, which connects the fetus to the placenta, increases in the babies of smokers compared to those of nonsmokers. This means that in babies of smokers, the thyroid glands may become overactive during birth. Depending on a mother’s smoking habits, this hyperactivity of the fetal thyroid increases the metabolic speed and the amount of consumed oxygen in the body, thus leading to the inadequate development of fetus.

Menopause occurs two-to-four years earlier due in women who smoke, as compared to non-smokers. This is due to the aging of the eggs. The risk of entering menopause before the age of 45 in women who quit smoking at least ten years prior is 87% less than smokers who don’t quit. Therefore, the earlier a woman stops smoking, the lower the risk of early menopause.

Effects of smoking on men

In research studies, it has been discovered that smoking has many harmful effects on testicular development and functions. These effects can be summarized as follows:

• Reduction of semen volume and quality, increase in its adhesiveness, delay in its becoming liquid, and resulting deformation of the sperm.

• Reduction in the number and mobility of sperm cells.

• Delayed sperm nucleus maturation, deteriorated DNA integrity.

• Decrease in the production of testosterone from Leyding cells.

• Decrease in the egg fertilization capacity of the sperm.

As a consequence of these negative effects, male infertility can occur. As the amount of daily cigarette consumption increases, the number, strength, and types of anomalies also increase. In a study conducted in 2010, smoking has been showed to decrease zinc levels in the seminal plasma. As a result of this decrease, oxidative agents populate and DNA breaks take place, thus causing a disruption of sperm functions and infertility. Zinc deficiency at the same time leads to the destruction of seminiferous tubule cells where sperm cells are produced. Paternal smoking generates negative results during the application of assisted fertility methods (such as in vitro fertilization). The damage in the sperm DNA of the father can disrupt the embryo development. The risk of anomalies, cancer, and genetic diseases increases for the fetus.

Cigarette smoking clearly occupies a position as one of the worst enemies of mankind because of its destructive effects on the body. In this case, it does not make any sense to try finding excuses for smoking, for it is harmful to the body that has been loaned to us as a gift and a temporary property.

Cihanoglu is a professor of medicine in KATU, Trabzon, Turkey.

I could not talk to him for awhile, because I was worried about disappointing him. However, it was not fair not to tell him as soon as possible. In a few months I would need some time off and he would need some time to find a new person to replace me. I was aware of the fact that he actually would not be able to lay me off because of my pregnancy. He would not act against the Pregnancy Discrimination Act. According to this amendment women affected by pregnancy or related conditions must be treated in the same manner as other applicants or employees with similar abilities or limitations. In academia, on the other hand, there is a high risk of getting scooped by a competitor if you delay publishing and that’s why scholars are pressured to publish new work quickly. The saying “publish or perish” is well-known in academia; therefore, my boss would need to find somebody who will be able to work significantly more hours than I can work. It was not ethical to delay telling him anymore even if I did not want to quit and knew that when I want to go back to work, it will not be so easy to find a job. I was also aware of the fact that in scientific research, if I slow down and take a couple years off, I am done. It is not good enough to have a PhD degree to set me apart from my competitors on the job market. I am expected to get high-quality publications out to apply for a tenure-track faculty position. I need to constantly be an active and productive researcher.

At last, I have talked to my boss. He was very rational. He asked me if I could manage doing research and raising two kids because research was never meant to be an 8 am to 5:30 pm job. It was not a simple question to answer. I knew that with kids, no matter where I am or what job I have, my life will be challenging. To keep both a family and an academic career intact I need discipline, planning, and some help at work and home. I won’t have time for chatting with colleagues, talking on the phone with friends, reading e-mails or taking lunch breaks at work. I will make long to do lists, and prioritize each item and if I can not get all of them done. I will not stress myself out. Instead, I will be happy with the things I have accomplished. Furthermore, balancing career and family life is a team effort so I need to share parenting duties with my husband, who is also overwhelmed at work. The most difficult part is that I have to deal with the guilt associated with leaving my children to go to work everyday. I love them with all my heart and it is so hard to see them crying behind me when I leave them for work.

The actual question was if I really want to go through all this trouble. I began to think about my motivation for my academic career. Many years ago, as a young woman who was trying to find a direction for my life, I had heard about a Turkish Muslim scholar, Fethullah Gulen. As I studied his teachings more, my perception on the roles of women in society had changed. I realized that I can take on many roles besides being a wife and a mother. My conclusion from his teachings was that men or women, every single human being, should serve God, and that serving humanity is serving God since it is done for the sake of His love. Then I thought that doing science, especially studying biochemistry, would be a great way to serve humanity. By the divine grace of God and with the help of biochemistry, I might prevent the spread of diseases, find cures for them, enhance the nutritional value of crops or even improve plant resistance against environmental stresses, and thus help so many people around the world.

Furthermore, the first word revealed in the Quran was “iqra” meaning “read” (96:1) followed by:

In and with the name of your Lord, Who created–
Created human from a clot clinging (to the wall of the womb).
Read, and your Lord is the All-Munificent,
Who has taught (human) by the pen,
Taught human what he did not know.

“Iqra” is a command to read the signs the Creator placed in creation. So, for me, biochemistry is not only the study of the chemical processes that happen in living things but also a way to better understand God’s Mercy, Wisdom, and Power. When I look at a tiny cell under a microscope, or study its biology in a book, I am fascinated by its perfect structure created in such a small size. This little thing controls so many complicated biological pathways at the same time without messing them up. Then, I ask myself who makes cells from nothing and inspires each one to do all those complex functions. The creation of the little cells, the delicate balances in all the cellular pathways, the nutrients and minerals provided to maintain their lives etc. allow me to better understand God’s eternal wisdom, power and mercy. Furthermore, the Prophet Muhammad, peace be upon him, has said: “Seeking knowledge is mandatory for every Muslim (male and female)” and “Whoever takes a path for knowledge, Allah will make an easy way for him or her to paradise.” In brief, knowledge and science are my vehicles that can take me to God and heaven. When I re-thought all the reasons why I got into this field, I decided to continue on my journey as a scientific researcher, but this time with some “obstacles.”

After 2 months of thinking, planning and contemplating, I told my boss that I would do as much as I can to be a successful scientist and a mother. Afterwards, I even started enjoying my pregnancy and being a mother for the second time. I found comfort and inspiration from a saying of the Prophet Muhammad, peace be upon him: “Heaven lies under the feet of mothers.” This means a lot to me. I am so happy that all the hard work I do as a mother to raise my kids to become good individuals will be awarded hereafter by God. So, motherhood was an opportunity and honor God has given me, not a burden. I said to myself that as millions of other working women, I will face many difficulties, but this should not prevent me from celebrating every milestone in this pregnancy and afterwards. I would try my best to be a mother like the one in Gracie Harmon’s memorable quote: “My mom is a never ending song in my heart of comfort, happiness, and being. I may sometimes forget the words but I always remember the tune.” I may not prepare dinners like the ones in cooking shows for my kids; I may not do it all and do it well all the time; but I can still be a mother who provides the most care, love, and compassion for her kids. In addition, no matter how tired I am after a long and busy day, if my two little angels greet me with hugs and kisses that will make me happy. They will cheer me up at home so that I will forget all the problems and stress at work. Besides, it will be wonderful and so much fun to explore their world which is so innocent, lovely and full of joy. I am so blessed to have these tiny, cute and adorable creatures around me.

Going through all of this and reading a lot on this subject have helped me realize a few things. First of all, there is no convenient time for me to have babies in academia. It is a dilemma whether pregnancy is more reasonable during graduate school even with dissertation writing and teaching than it is when I am on the job market or have a tenure-track job or a postdoctoral research position. Second, I need a lot of support and encouragement to maintain my motivation. I need my husband’s help to overcome the challenges of managing a family and an academic career. He can’t do anything about 5 months of morning sickness and another full year of nursing and sleep deprivation, but he can share parenting responsibilities and household chores. Third, according to a study done by Virginia Valian, who is a distinctive professor of psychology at Hunter College, females are only 13% of all the full professors at universities and 21% at colleges ; therefore, more universities started to promote their female faculty’s research programs in the science and engineering departments to ensure that more women are walking the halls of academia. For example, Brown University and the University of Rhode Island got $3.3 and $3.5 million grants respectively from the National Science Foundation in 2007 to develop the careers of women in science and engineering departments, where they are significantly underrepresented. There is also a Women Faculty Mentoring Program at the University of Wisconsin-Madison which seeks to support and retain women assistant professors throughout the tenure process. These kinds of programs, which provide funding for principal investigators with their own research projects, or for the inclusion of female researchers, are exciting opportunities and show the support of society and the academic community for women and mothers. This highly encourages me to pursue research and helps me know that I am not alone.

As a result, I am happy with my choice about being a mother and an academic even though it is tough and stressful. I did not deliver my baby who was a beautiful gift from heaven on Friday and go to work on Monday. I took a month off after the delivery, so my research halted for a month; however, I am back now. Am I ever going to get a tenure-track job and get tenure? Am I going to be my little ones’ unforgettable tune? Simply, I do not know, but I sure hope so.

Safiye Arslan is a research fellow in the area of biological chemistry and lives in Nevada.

All parents do everything they can to keep their children healthy. The creation of a baby in a mother’s womb still remains a wonder not fully explained by scientists. Birth has been a mystery in the life of human beings since the beginning of history. Religious sources show the phases of a baby’s growth in the mother’s womb, the perfect design of the environment that supports the needy baby with everything it needs, and its birth, all as examples of God’s mercy and power. Although the whole process of pregnancy develops with almost no interference from outside, there are some precautions that parents can take to have a healthier baby.

How to start taking care of a baby even before pregnancy

Science makes it clear that we should not wait until we hold a baby in our arms before we start taking care of him or her. But how can we take care of a baby even before conception? Well, one of the answers is quite simple: by taking folic acid! If women have enough folic acid, vitamin B complex, in their bodies before pregnancy, this vitamin B complex can reduce the risk of neural birth defects by up to 70%. Neural tube defects (NTD) are a group of congenital birth defects that influence the central nervous system. The neural tube forms in the embryo between 4 to 6 weeks after conception and then closes. The neural tube eventually becomes the baby’s spinal cord, spine, brain, and skull. If the neural tube does not close properly, the baby may have neural birth defects, in which case the baby lacks either a developing brain, spinal cord or both. NTDs occur very early in pregnancy, even before most women know that they are pregnant. The most common neural birth defects are anencephaly and spina bifida. In anencephaly, the brain is either not fully developed or is completely absent, while in spina bifida part of the baby’s spinal cord remains outside the body.

Folate deficiency and folic acid

Folate, also called vitamin B9, is a water-soluble vitamin. It is essential to human life and is found naturally in some foods such as liver, citrus fruits and juices, whole grains, and dark green leafy vegetables. Folic acid is the synthetic form of folate. Folic acid can be obtained from supplements and fortified breads and cereals. Both folic acid and folate work for the same purpose, and in this article the terms are used interchangeably.

In folate deficiency, the body is unable to transport folic acid to the brain, resulting in mobility problems, blindness and seizures. Pregnant women in particular can be at great risk of giving birth to low-birthweight, premature babies who may have neural birth defects. In children, folate deficiency can slow general development. In adults, a type of anemia appears in long-term folate deficiency. There are also other signs of folate deficiency such as headaches, loss of appetite, sore tongue, diarrhea, forgetfulness and irritability.

Why folic acid is important

Folic acid plays a very important role in various body processes including cell maintenance and repair, formation of red blood cells (which provide oxygen to tissue), formation of white blood cells (which defend the body against infectious disease), synthesis of DNA (hereditary material) and amino acid metabolism. It also plays a crucial role in preventing human illness. Folic acid supplements cannot prevent stroke or heart disease, but studies have shown that it can reduce the risk of heart attack and stroke. Recent research shows that it supports the functioning of blood vessels, which improves the blood flow to the heart. In addition, folic acid helps to protect against the development of some forms of cancer, particularly colon, cervical, esophageal, breast, and stomach cancers.

A number of scientific experiments have shown that people who suffer from Alzheimer’s disease have low levels of folic acid in their blood. Thus, it is not surprising that folic acid is crucial for brain function and plays an important role in mental and emotional health.

If you are a married woman and have plans to have a child some day, you should definitely start to take folate because by the time you know you are pregnant, your baby’s brain and spine will already have been formed. This is why it is important for women to maintain sufficient levels of folic acid all through their child-bearing age even if they are not planning a pregnancy.

Should only women take folic acid?

No, not really. Every adult man and woman should consume it every day to reduce their risk of heart disease, colon cancer, and stroke.

If this is a vitamin that could change our life forever, how much should we consume and where can we get it from? You can get your folic acid naturally from foods such as liver, nuts, peanut butter, dried peas and beans, oranges, tomato and pineapple juice, avocados, cantaloupes, asparagus, and leafy green vegetables. Some breakfast cereals with 100% of the recommended daily allowance per serving are Crunchy Nuggets, Multi-Grain Cheerios Plus, Product 19, Whole-Grain Total, Total Corn- Flakes, Total Raisin Bran, and Special K. It can also be obtained from other, less processed grain products such as bread, pasta, and rice. Taking a multivitamin containing the recommended daily allowance of 400 micrograms is another option. The following table suggests a variety of dietary sources of folate.

Table 1: Selected Food Sources of Folate and Folic Acid

* Items marked with an asterisk (*) are fortified with folic acid as part of the Folate Fortification Program.

^ DV = Daily Value. DVs are reference numbers developed by the Food and Drug Administration (FDA) to help consumers determine if a food contains a lot or a little of a specific nutrient.

Sehnaz Dogu Ekicikol obtained a master’s degree on Microbiology from Georgia State University.

References

• Zittoun J. Anemias due to disorder of folate, vitamin B12 and transcobalamin metabolism. Rev Prat 1993;43:1358–63.
• Herbert V. Folic Acid. In: Shils M, Olson J, Shike M, Ross AC, ed. Nutrition in Health and Disease. Baltimore: Williams & Wilkins, 1999.
• Kamen B. Folate and antifolate pharmacology. Semin Oncol 1997;24:S18-30-S18-39.
• Agriculture’s Nutrient Database Web site: http://www.nal.usda.gov/fnic/cgi-bin/nut_search.pl.
• http://dietary-supplements.info.nih.gov/factsheets/folate.asp
• http://www.cdc.gov/ncbddd/folicacid/

The problem of pulmonary tuberculosis in pregnancy has attracted the attention of doctors for many years and it is still a current issue. Modern researchers and physicians divide tuberculosis into several independent problems which have difficult solutions. On the one hand, there is the influence of tuberculosis on the course of pregnancy and child delivery as well as on the health of a mother and her child. On the other hand, there is the influence of pregnancy and childbirth, the puerperal period and lactation on the course and progress of tuberculosis.

Research on how pregnancy influences the course of tuberculosis has been carried out for many years. Even in the oldest available documents we can find instructions for “personal precautions” and preventative measures against tuberculosis, as well as thoughts about pregnancy and tuberculosis. In 1400 BC the Law of Manu from ancient India prohibited marriages to girls from families with tuberculosis. In different world religions, including Islam and Christianity, there are special restrictions concerning people who suffer from this illness.

In ancient times Hippocrates and Galen taught that pregnancy has a positive influence on the function of lungs. But the Islamic doctors, Arabian as well as Spanish, of the Cordoba Caliphate considered that the blessed process of pregnancy must not be complicated by pulmonary diseases.

With time European medical science changed its point of view. From the second part of the 17th century until the beginning of the 19th century doctors considered that pregnancy had a bad effect on the course of tuberculosis, but then the situation, for some reason, changed. Doctors began to think that pregnancy had a good influence on lung diseases. They even started to advise girls who were susceptible to tuberculosis to marry. Time passed and doctors began to change their opinion on tuberculosis in pregnancy and the extremes in views became less obvious. This happened due to the introduction of an artificial pneumothorax into the treatment of tuberculosis.

Since then the third period in the understanding of the relationship between pregnancy and tuberculosis has begun. The opinion about the course of tuberculosis in pregnant women has changed due to the successful therapy of tuberculosis with the help of the artificial pneumothorax.

During the gestation period, all the organs and tissues of the entire organism experience an increased load, as they are trying to satisfy both their own needs and that of the developing fetus. These morphological and functional changes do not lead to any pathological state in the mother if she is healthy and her course of pregnancy is normal. If the woman’s organism has been weakened by a chronic immunodeficiency due to poor environmental conditions or if she has a tuberculosis process in her organism, then functional changes and tissue dystrophies can develop in her nervous system which will lead to metabolic disorders. Changes in ergasia caused by pregnancy and connected with changes in higher nervous activity, as well as with endocrine reorganization, can influence the development and the course of the tubercular process.

Before penicillin was discovered, pregnancy usually led to the progression of the disease and in many cases even ended fatally. Nowadays due to the use of effective antituberculous medicines the attitude towards possible pregnancy of women who have active tuberculosis has considerably changed.

Tuberculosis in a pregnant woman usually starts in an acute form; at this stage infiltrative forms of the disease with necrogenic and bacterioexcretion prevail, often combined with exudative pleurisy, trachea, larynx and bronchi lesions.

Frequent consecutive pregnancies have a negative effect on the state of women who suffer from tuberculosis; they weaken the organism and can cause the recrudescence of the tuberculosis process. This is very typical of many families in poor Asian and African countries. More than half of all pregnant women suffering from an active form of tuberculosis experience a progressive iron deficiency anemia during the first three months of pregnancy and in the second trimester of pregnancy this can be observed in almost all patients. Malaria is also widespread in Asian and African countries that are situated to the south of Sahara and are the second reason for iron deficiency anemia.

According to modern views, one of the reasons for the recrudescence of the tubercular process during pregnancy is an irregular or non-systematic treatment of this illness or the absence of any treatment at all. The recrudescence of the process observed in those suffering from destructive pulmonary tuberculosis is caused by the severity of the illness itself when new conditions for the organism occur. In this case, pregnancy begins against the background of an advanced chronic immune deficiency. At the same time, due to the feto-placental complex operation, functional changes in the nervous, respiratory, cardiovascular and urinary systems, as well as hormonal changes, in the organism of a pregnant woman take place.

Moreover, the development of the fetal skeleton requires calcium which is absorbed not only via the blood of the mother, but also from the healed niduses of tuberculosis and as a result, the progression of a specific process can appear.

The reactivation of the tubercular process happens due to a decrease in the responsiveness of the organism and because of an increase in the activity of the reproductive hormones and the loosening of the connective tissues which are physiologically involved in pregnancy. The amount of plasma and extra vascular fluid increases. Due to these changes, a swelling and loosening in the inactive tubercular niduses with the mycobacteria of tuberculosis can appear. And loosening, in its turn, enables a lymphohematogenous spread of mycobacteria.

In addition to these, the delivery of a child leads to a speedy reorganization of all the functions of the organism; lactation and nursing in their turn are combined with an increased loss daily of nutritious matters and a large amount of protein and fats. In case of destructive pulmonary tuberculosis, due to the fact that the diaphragm descends (resulting in the abdominal decompression ceasing to have a therapeutic action of pneumoperitoneum) bronchogenic dissemination appears in the unaffected parts of the lungs.

A specific active process can be observed in women belonging to the high-risk group in connection with tuberculosis. The high-risk group combines women who have recently suffered from tuberculosis (less than one year after treatment), those who have just been operated on for a tuberculosis connected illness (less than one year), women with tuberculosis of different localizations younger than 20 years (for Asia and Africa) and those older than 35 years (for Europe and the USA), those with widespread forms of the tubercular process withstanding its stage, women who have had contact with people discharging bacteria or people suffering from tuberculosis but not discharging bacteria, and also those who have coexisting illnesses (diabetes, chronic nonspecific pulmonary illnesses, problems with kidneys, stomach and duodenum ulcer), and also women who use alcohol, narcotics, those who smoke and lead asocial ways of life. In these cases, the women must be properly examined during the gestation period, including X-rays.

Treatment of tuberculosis during pregnancy

All other conditions being equal, the timely detection of active tuberculosis during pregnancy allows doctors to provide a full course of treatment, allowing the woman to recover and give birth to a healthy child. Untreated active tuberculosis of the mother is much more dangerous for the fetus than anti-tuberculosis chemotherapy.

Special attention must be paid to healthy women who are in contact with bacillary patients. Quite often these women might undergo active tuberculosis for the first time during pregnancy or after the delivery itself.

In the pre-penicillin era the recrudescence of the tubercular process during pregnancy and after the delivery proceeded in an acute form with frank infiltrative changes, a necrogenic process, bloody expectoration and very often a generalization of the process. Nowadays, the clinical outlook for complications and the recrudescence of tuberculosis against the background of pregnancy is less gloomy. It more resembles the toxicosis of pregnancy or respiratory diseases.

While examining a patient, special attention must be paid to chest problems like moist or dry coughs, bloody expectoration, pain in the chest and shortness of breath. If the patient coughs with expectoration for 2 weeks then she must be examined for mycobacteria with the usage of a microscopic technique.

Another syndrome, which is also very important, is a complex of intoxication symptoms (weakness, hidrosis, anorexia, weight loss, long-lasting low grade fever and hyperirritability) which need to be detected to discover the reason for their development. While examining the anamnesis of a pregnant woman it is necessary to learn if she has ever suffered from tuberculosis before, if she has had any possible contacts with infected people, whether there are cases of tuberculosis or concomitant diseases in her family as all of these can be very useful for the verification of tuberculosis.

When active pulmonary tuberculosis is suspected an X-ray examination is necessary. When the chest is in frontal projection, the X-ray exposure of the fetus is 10 times lower than that of its mother (with compulsory use of a protective apron). Examination of the cough expectoration for the presence of tubercular mycobacteria is one of the easiest, most effective and informative diagnostic methods.

Chemotherapy, which destroys the tubercle bacillus that spread in the organism, plays a leading role in the variety of methods for tuberculosis treatment. By reducing the population of bacteria, chemotherapy supports the healing process, the dispersion of inflammatory changes, the closing of caverns, the encapsulation of the remaining loci as well as preventing the development of sclerosis. When the patient suffers from tuberculosis, the healing processes are very slow; the first stage of the recovery process of mycobacteria ceases and only after some months, in the case of a successful treatment of tuberculosis, does the healing process finish.

The necessary treatment of pregnant women who suffer from tuberculosis must start as soon as the diagnosis has been made. Chemotherapy implies taking antibacterial medicines (isoniaside, rifampicin, pyrazinamide, ethambutol, ethionamide and etc.) in different combinations. The choice of this or that combination depends on the stage of the disease as well as on any undesirable reactions to the medicines prescribed.

The treatment of tuberculosis (if there are indications) continues during the entire pregnancy and lactation period. In particular, patients with tuberculosis that has been diagnosed during the pregnancy are in need of treatment. When there is a systematic treatment, up to the moment of delivery and in the puerperal period, positive clinicoradiologic dynamics can be observed regarding the specific inflammation (stoppage of bacterioexcretion, closing of caverns, dispersion of loci, infiltration and exudate). Patients who reject treatment during the process of pregnancy suffer from an advancement of the illness.

Transplacental infection of the fetus with tuberculosis almost never occurs, but the baby can be infected from the mother in the puerperal period. There is also a possibility of contamination during delivery, but this is a rare occurrence.. God truly protects the innocent!

Permission to breast feed must be given by a joint resolution of an obstetrician, a pediatrician, and a specialist of tuberculosis taking into account the state of a woman and the form and the stage of the tubercular process. Overall precautionary measures must be taken (a nonbacterial mask of 5-6 layers covering the nose and the mouth, a kerchief covering the head and thoroughly washed hands).

A bacteriological study of the breast milk of women who suffer from tuberculosis shows that typical mycobacteria rarely vegetates (no more than 0.33%). Human milk has the ability to suppress the development of the mycobacteria of tuberculosis. This must be connected with the rich spectrum of ferments, immunoglobulins, cellular elements, macro-phages, the complement system, interferon and other factors of nonspecific protection which human milk contains.

The contraindications for nursing are as follows: tuberculosis of the lactiferous gland, an acute form of tuberculosis, active pulmonary tuberculosis with bacterioexcretion, active tuberculosis of any organs detected at the end of the pregnancy or after the delivery, and recrudescence of tuberculosis during the pregnancy. Children born to such mothers are immediately isolated after their birth and bottle fed, they are vaccinated and stay in the hospital for 6 weeks if possible (the minimum period for compulsory postvaccinal isolation).

Thus the tubercular process in the lungs, especially an active one, will have a negative influence on pregnancy and delivery. Babies born to such mothers belong to a high-risk group as far as the possibility of neonatal pathology and antenatal death of the fetus are regarded. Women with pulmonary tuberculosis must undergo regular consultations with both an obstetrician-gynecologist and a phthisiologist from the very early stages of their pregnancy. They must also receive special treatment until all the signs of active tuberculosis have been eliminated.

A wanted child brings happiness to a family; it is a gift from God. And, of course, every woman who wants to give birth wants to bring up a healthy and beautiful child. Unfortunately, the health index of the modern generation of women at child-bearing age is not very high (there are many chronic diseases, spiritual poverty, with a high vulnerability to different infections due to a variety of reasons). Due to this reason, medical interference in what is a natural process has become more frequent recently. Statistics show that more than 92% of women use different drugs at different stages of pregnancy. The question is to what extent this medication is safe for the future baby. This is a fundamentally important matter to investigate because a pregnant woman taking any chemicals is in essence applying a kind of experiment on her as well as the baby’s health which can have a variety of different consequences.

The problem of medical effects on the development of a fetus has recently become very acute. This is because there are many different medications that are common and easily available nowadays, and they are very often taken without a doctor’s prescription. Unfortunately, the consequences of this fact are not pleasant. Prenatal development is one of the most important and difficult stages in a person’s life. Just in 9 months an ovicell (an egg cell) and a sperm cell form an extremely complex living organism that consists of millions and billions of cells! Moreover, all these cells are combined into tissues, organs and systems that are always interacting. The fetus has a fascinating rate of growth to become a structure with an ever-increasing complexity. In addition, all these processes do not happen chaotically but in a strict order. This order is supplied by two factors: the first is a sound genetic program. It is obtained by the fetus from its parents and the decoding of the genome vividly denotes the existence of Divine Power. The second factor is the state of a maternal organism which supplies everything necessary for the realization of the genetic program and protects the fetus from the negative influence of the environment. In this way the failure of one of the mentioned factors can lead to different deviations and to the disturbance of the development, including the formation of congenital malformations of the fetus and even prenatal death.

The history of medicine shows that medications can be the most harmful etiological factor in relation to the fetus. Today, there are many examples proving this fact. One of the best-known is the thalidomide tragedy which happened in Europe in the 1950-60s. As a result of taking a poorly studied medicine (a light tranquilizer) the children of hundreds (!) of women were born with serious physical defects. Unfortunately, the list of drugs that causes fetal malformation is not short. Nowadays doctors are aware of syndromes caused by hydantoin, warfarin, aminopterin, and many other medications. Each of these has a specific effect on the fetus (mostly leading to serious abnormalities) when taken by a pregnant woman. In the past, people believed that such children were marked by Satan. But nowadays we say that it is the unpredictable effect of the medicine on the realization of the Creator’s program. Medical interference can lead to a disruption in the rate of development and affect the order of differentiation in the tissues and organs of fetus. Moreover, drugs can interrupt the blood circulation in the placenta, change the metabolic process between the fetus and the mother, causing a retardation of intrauterine growth or premature labor, or they can be the reason for a falloff in the health of the child in the first years of life.

The influence of drugs on the fetus depends on different factors, such as the term of gestation at which the drug is administered, the dosage, and the length of time that the medicine is taken, as well as the ways that the drug is excreted, the health of the mother and her inherited sensitivity to medicine, and, of course, the properties of the medicine itself. There are many drugs whose influence on the fetus have not yet been examined, as such research is very difficult, expensive, or in many cases simply impossible. If we understand this, we can see that the outlook for scientific interference in God’s creation of human beings is not good.

You may wonder why the wide-spread usage of medication by pregnant women throughout the whole world has not lead to a continuous increase in congenital malformations if it is really this dangerous. Thanks to a happy concourse of circumstances, this process has not become too wide-spread, as there are many factors that allow the fetus to “escape” medical danger. For example, there may be an inherited insensitivity on the part of the fetus to the influence of different medications, the placenta has its own inherent protective function, the medication may be taken in a small dosage, the developmental stage of the fetus may be at a “non-critical” period, plus many other factors. Doubtless, although this has not been proven, is the fact that the mother has a sincere faith in God and believes in God’s protection of her and her child, which has a positive influence on the development of the fetus.

The initial clustering of embryonic cells and the formation of all the fetus’ organs and systems occur in the first trimester of pregnancy. It is particularly in this period that the fetus is very sensitive to the influence of different factors, including different drugs.

It is quite common that the results of the use of some teratogens¹ by pregnant women, which can have fatal effects, can simply go unnoticed in some cases, resulting in the death of the fetus during the first two weeks of development. In this case, the woman does not even know that she is pregnant. Such cases are not rare (according to some researchers, up to 70% of all pregnancies finish in the early death of the fetus).

What should a pregnant woman do if she is ill or feeling unwell? How can she effectively help herself and minimize the risk of any medications on her baby at the same time? It is never a good idea to self-medicate if you are pregnant, particularly in the case of little-known or untested medications. In any case, it is better to consult an experienced doctor or pharmacist. If for some reason this is impossible, please read the prospectus which is to be found with the medicine carefully. Which dangers the medicine can cause are probably mentioned on the prospectus, and it may be written that the drug should not be used if pregnant. If a drug has been used while being unaware of pregnancy (for example, during the first 2 weeks) then immediately consult a specialist about any possible negative effects there might be for the fetus as soon as you found out that your are pregnant. Going to see your doctor early will allow you the necessary time to avoid any dangers and allow you to arrive at a decision about this pregnancy. If the medicine has been prescribed by a doctor then be sure to ask about possible unwanted side effects for the fetus. Don’t hesitate to ask such questions. If it seems to you that your doctor’s attitude to this question is not serious enough (unfortunately, this happens quite often) then consult a competent specialist (a geneticist or a clinical pharmacist).

If you are just planning your pregnancy, then try to predict all the negative factors beforehand. If you have some chronic diseases which may become acute during the pregnancy, or if you have an allergic predisposition or high sensitivity to acute respiratory diseases, then you should consult a doctor. Preventive methods which have been worked out especially for you minimize the risk of the illness and the risk of using drugs that are potentially harmful to the fetus.

During early stages of ontogenesis the fetus has almost no adaptation mechanisms or specific reactions in its response to the influence of pathogenic agents. Only with time will the fetus’ main organs and systems become mature and the functions of the placenta fully form the morphological and functional backgrounds of the response characteristics peculiar to a new-born baby. We usually say that everything happens according to God’s Will but He has created us for a full, vivid, and creative life. And He wants us to understand and be attentive to the miracle that happens during pregnancy.

Note

1. Agents such as drugs, chemicals and infections that can cause birth defects when a mother is exposed to them during pregnancy.

There are many reasons why a developing baby may have congenital problems (Moore, 1989, p.lO8). Exposure to infections and certain drugs (most commonly, alcohol), chromosomal abnormalities and inherited congenital conditions have all been shown to disrupt normal fetal development. In this article we will concentrate on the diagnosis of chromosomal and genetic disorders during pregnancy.

PNT procedures and their interpretation can be extremely intimidating for parents. It is therefore important that tests are done only after a full explanation of the procedures involved and their possible consequences. The aim of PNT is to inform and prepare parents for the birth of an affected infant, so that they can choose between the possible courses of action (Aksoy, 1996). The possibilities will include: (1) in utero treatment; (2) delivery at a special centre for immediate postnatal treatment; and 3) termination of an affected fetus, i.e. abortion.

Over the years, professional standards and laws have evolved which influence the clinical application of PNT and help to tackle many of the complex ethical issues involved. There is little doubt that relatively non-invasive techniques whose primary purpose is to diagnose treatable disorders and then treat them, before or after birth, would be warmly welcomed by all, especially the parents. The fact is, however, that in practice PNT is generally being used to diagnose abnormality and then terminate the life of the unborn babies. The reality is that prenatal diagnosis rarely leads to fetal therapy

In what follows, we will try to explain the range of prenatal tests available and indications for their appropriate use. We will consider some of the technological advances on the horizon in this field of medicine, as well as some of the ethical dilemmas that arise.

Prenatal Diagnostic Tests

Prenatal diagnostic tests can be divided into two types, invasive and non-invasive. Non-invasive tests simply involve a blood sample taken from the pregnant woman or an ultrasound scan. Invasive tests on the other hand are more complicated and involve obtaining a sample of cells or tissue from the developing foetus, either by amniocentesis or chorionic villus biopsy. The samples obtained by invasive tests can be used, specifically to assess the fetal chromosome pattern, to determine if the fetus has a particular genetic mutation, or for a whole range of biochemical assays.

Maternal Blood Sampling. Between 15 and 19 weeks of pregnancy, the pregnant woman attending ante-natal clinic will be offered a blood test. The blood sample will be analysed to assess the level of three proteins, b human chorionic gonadotropin (b HCG), oestriol and a -fetoprotein (a FR). The three levels in combination with the mother’s age can be used to estimate the risk of the baby being affected by a chromosomal problem, especially Down’s syndrome (Wald and Cuckle, 1992, pS63). If the test result indicates a high level of risk, the mother will be offered further tests to assess the status of her baby.

Ultrasound Scan. Ultrasound uses high frequency waves to form a picture as the waves are reflected back by tissues of different density. The developing fetus grows in a liquid filled sac (amnion). As fluid shows black on the scan, this provides a good contrast with the fetal parts allowing high resolution images. Early in the first trimester an ultrasound scan can be used assess the viability of a fetus and to estimate its stage of development. Most women will be offered a formal high resolution scan at between 16 and 19 weeks (Sutton, 1990, pp.20- 1). The images from the scan will be the first time the expectant mothers see the baby. For many, this is a happy event; for the others it could be a very sad event if the scan indicates an abnormality.

Amniocentesis. In this test, done between 15 and 20 weeks of pregnancy (Cohen, 1990, pp.19- 20), a very fine needle is passed through the abdomen under ultrasound guidance, avoiding the fetus, and a sample of amniotic fluid containing fetal cells is withdrawn. The sample is cultured to grow more cells so that the chromosome pattern of the cells can be examined or DNA extracted for genetic analysis. This process can take three weeks, a period of considerable anxiety for the parents. There is also a small risk of miscarriage occurring after an amniocentesis.

Chorionic Villus Sampling. In this test, done in the same way as than amniocentesis but five weeks earlier, a sample of tissue is taken from the developing placental tissue. Both chromosomal and genetic analysis can be performed on this tissue, and the results are available quicker and at an earlier stage of the pregnancy than with amniocentesis. However, there is a higher miscarriage rate following chorionic villus sampling than amniocentesis (Boss, 1994).

Fetal Blood Sampling. Occasionally, when there is concern that a pregnant woman has been exposed to an infection early in her pregnancy, a sample of blood will be taken from the umbilical cord with a very fine needle under ultrasound guidance. This sample is used to assess if the fetus has become infected and at high risk of development problems following the maternal exposure.

New Advances

Advances in prenatal diagnosis have followed rapidly from technological improvements in ultrasound equipment, refinement and experience of current techniques, and the development of new tests. The aim of research in this area is to provide the earliest possible accurate information about the health of the developing baby, and to do so in the way safest for the expectant mothers and their babies. If the information is reassuring, the couple can enjoy the remainder of the pregnancy in the knowledge that everything will progress normally. However, if the result are unfavourable and an abnormality is diagnosed, earlier decisions about potential treatment or termination are possible and so may be less traumatic for those involved.

Fluorescent in situ Hybridisation (FISH). FISH is a technique which uses a specific DNA sequence as a probe to recognise its complementary sequence on a chromosome. The probe has a fluorescent tag attached which lights up when it is attached to the recognised chromosome segment. Recently FISH has been applied to analysis of amniocentesis samples to assess if an extra chromosome 21 is present or not in the cells. Because the amniocentesis cells do not require culturing for this technique the test results can potentially be available sooner than following standard amniocentesis.

Fetal Blood Cells in the Maternal Circulation. At about 6 weeks fetal blood cells can be found in a blood sample taken from a pregnant woman. These cells exists in very small numbers. Recent work has extracted and purified these cells to allow assessment of the fetal chromosome pattern and to determine if the fetus has a specific genetic mutation. Although this technique is very new it has the potential to make the currently used invasive techniques obsolete and will allow very early diagnosis.

Preimplantation Diagnosis. This procedure involves the use of technology developed with in vitro fertilisation (IVF). An oocyte is removed from the woman and brought into contact with spermatozoa from her partner under controlled conditions. One of the spermatozoa effects fertilisation to form a zygote. Following three stages of cell division (this eight-cell stage is termed, the blastocyst), one cell can be removed and used for analysis (Aksoy, 1997a). The DNA sequence of this cell can be determined to identify the presence or absence of a gene mutation that has caused illness in one of the parents. If the cell does not contain the mutation, the blastocyst can be implanted in the womans uterus (womb) to develop into a fetus which is unaffected by the condition that has affected other family members.

Human Genome Project. The aim of the Human Genome Project is to have identified the entire human DNA sequence (genome) by 2005. The extra information generated about specific genes and their association with specific disorders has the potential to expand dramatically the number of genetic tests available to couples with a family history of a genetic condition.

Ethical Issues

It is important to understand the purpose of prenatal diagnosis. It is done to provide parents with information about the health and development of their baby, not to provide them with a reason to have a termination of pregnancy. There are 180,000 terminations performed each year in the United Kingdom, of these 5000 are because of fetal abnormalities diagnosed by prenatal tests. Abortion is a serious problem itself in all regions of the world, developed and developing, and we discussed it in an earlier issue of this magazine (Aksoy 1997b). When prenatal tests reveal that a baby has health problems, parents face a number of difficult questions. Is any treatment available? What are the baby’s chances of survival? What would be the baby’s quality of life if he or she did survive? Some illnesses can be treated during pregnancy and after delivery. One of the main aims of fetal medicine is to develop therapies to treat fetuses and improve the survival. However, some conditions are fatal despite all treatment. In these circumstances couples sometimes take the extremely difficult decision to have a termination of pregnancy

For religious, moral or other reasons many couples opt not to have any tests performed during pregnancy. They feel that even if the results of any test indicated that their baby was affected by a serious condition they should and would continue with the pregnancy. It is important in each situation that the parents’ decisions are respected and supported. The parents need to be given appropriate guidance and counselling rather than be met with disapproval.

In some countries prenatal testing has been extensively used to determine the sex of the baby at an early stage, with the intention of ensuring that only male babies are born (Kusum, 1993). In the United Kingdom, as in many other places, prenatal diagnosis to determine fetal sex is deemed morally unacceptable. It is important that new advances in medicine are paralleled by an informed ethical debate. Prenatal tests should reflect what is appropriate within a society rather than just allowing what is technically feasible. A number of regulatory groups have been formed, including the Human Fertilisation and Embryology Authority (HFEA), to monitor and regulate new advances in this area.

In sum: prenatal diagnosis is a rapidly expanding area of medicine. New techniques are constantly being developed which are aimed at allowing earlier diagnosis, less invasive methods and, ultimately, treatment. It is important that developments are monitored and regulated to ensure that the techniques available are applied within an ethical framework.

REFERENCES

Aksoy, S. (1996) ‘Prenatal Testing: An Ethical Perspective’, The New Journal of Medicine, 13:2, pp.12-14.

Aksoy, S. (1997) ‘Moral Controversies on Preimplantation Genetic Testing’, paper presented at UNESCO Asian Bioetlncs Conference, Kobc-Japan, November 1997.

Aksoy, S. (1997), ‘Abortion: Mercy or Murder?’, The Fountain, 2:17 pp.32-5.

Atkins, A.F.J. and Hey, EN. (1991) ‘The Northern Regional Fetal Abnormality Survey’, in Drife, jO. and Donnai, D.(cds) Antenatal Diagnosis of Fetal Abnormalities, Springer-Verlag Ltd., London.

Boss, J.A. (1994) ‘First Trimester Prenatal Diagnosis: Earlier is not Necessarily Better’, JME, 20 pp.l46-5l. )

Cohen, L.G. (1990 Before Theýr Týme at Risk, American Association on Mental Retardation, Washington DC.

Kusum (1993) ‘The Use of Pre-natal Diagnostic Techniques for Sex Selection: The Indian Scene’, Bioethics, 7: 2/3 pp,149-65.

Moore, K.L. (1989) Before We Are Born: Basic Embryology and Birth Defects, WB. Saunders Comp., Philadelphia.

Sutton, A. (1990) Prenatal Diagnosis: Confronting the Ethical Issues, The Linacre Centre, London.

Wald, NJ. and Cuckle, H.S. (1992) ‘Biochemical Screening’, in Brock, D.J.H., Rodeck, C.H. and Ferguson-Smith, MA.(eds) Prenatal Diagnosis and Screening, Churchill Livingstone, Edinburgh.

Genetic counselling is the process whereby an individual or family obtain advice and information about a genetic condition that may affect the individual and family, their children and the wider community. The aim of such counselling is to enable appropriate decisions to be taken regarding marriage, reproduction, abortion, and health management.

Islamic teachings encourage counselling. The Prophet Muhammad, upon him be peace and blessings, said: The religion (i.e. Islam) is sincere counselling and good advice (Bukhari, Muslim). He also said: The counsellor should be trustworthy. Genetic counselling is a new field of medical practice that demands extensive knowledge of genetics, the management of genetic disease and how it impacts on the individual, the family and the community at large. The counsellor must therefore be knowledgeable in the field, otherwise he will be answerable. The Prophet said: If a person practises medicine without appropriate knowledge, then he is liable (Abu Dawud). Experts in Islamic law explain that the person must be proficient in the particular field of medicine he is practising; it is not sufficient to know general medicine, the person must have obtained the appropriate specialist training. The Prophet said: No man is wise except through experience (Bukhari, Muslim).

In addition to knowledge and proficiency, the counsellor needs also to be considerate, compassionate and able to guard the confidentiality of the information he is given. The Prophet said: Whoever guards the secrets of a Muslim, God will guard his secret in this life and on the Day of Resurrection (Muslim). And: God will show mercy to those who are merciful to people (Bukhari, Tirmidhi, Ahmad, and others). Being considerate and kind, and giving good advice to those who seek it, is the basis of Islamic ethics in general and medical ethics in particular. The worst thing of all is doing harm intentionally or even unintentionally, the former being a crime and the latter an offence. This rule is derived from the explicit injunction of the Prophet: Do no harm nor return harm with harm (Abu Dawud).

The genetic counsellor may not impose his views on his clients. Rather, he must let them reach their own decisions. The counsellor’s responsibility is to enable his clients’ responsibility by providing them with the necessary facts and information in plain language that they can understand easily and fully.

The Islamic creed places the highest value on personal freedom and hence upon personal responsibility for one’s actions. The genetic counsellor should therefore provide the best available information, and then give the most sincere advice without trying to impose it: the clients must reach any decision themselves.

Genetic diseases

Monogenic diseases, i.e. diseases inherited through one gene, constitute only 10-15% per cent of congenital diseases and malformations in the population as a whole, but account for a much larger percentage of childhood diseases: in many Western countries, for example, some 50% of all deaths of children up to age 15 are attributed to hereditary factors.

Many of the most common diseases world-wide, e.g. diabetes mellitus, hypertension, ischaemic heart disease and cancer, have a hereditary component. Many neurological and psychiatric ailments are either monogenic hereditary diseases or heredity is a major causative factor. Similarly, diseases of the blood are either directly caused by a monogenic hereditary factor, or other hereditary factors have a major causative role. Thalassemia and sickle cell anaemias are examples of autosomal diseases that cause malady and high morbidity in many countries, notably in the Mediterranean and Arab world.

Close-cousin marriages and their consequences

Consanguine or close-cousin marriages are commonplace in most Arab countries. The incidence of genetic diseases is correspondingly high; for example, 5-10% of the population as a whole carry the gene for thalassemia. Islamic teachings do not forbid but do discourage first cousin marriages – i.e. insofar as they are permitted at all, such marriages are only allowable exceptionally, not encouraged as the norm. It is narrated that when it was brought to the attention of ‘Umar ibn al Khattab, the second Caliph, that the children of the Bani Assayib were often weak and sickly, he advised this tribe to avoid close-cousin marriages and to seek spouses for their children from remote tribes; he said: ‘Marry from remote tribes, otherwise you will be weak and unhealthy.’

Responses in the Arab world

In the first half of this century, many Arab governments (Egypt, Syria, Lebanon, Tunisia, Morocco and others) made a premarital medical examination mandatory. However, this had little effect on the incidence of consanguineous marriages or hereditary diseases as there were no means for searching out carriers of genetic diseases. In any case-as we are bound to note with deep regret-a medical certificate was often provided without even a routine medical examination.

Several recent symposia (for example, in Amman, Jordan, 10th August 1994) have discussed the implementation of a law making it obligatory to test for the thalassemia gene as a precondition for granting a marriage license. However, there are immense difficulties with this policy. The cost of such a test would be huge. Who would bear the cost? Most governments could not do so, and if they could, it would be by diverting funds from other more urgent medical needs. Individual citizens might decline the test or evade it on the grounds of poverty. If made compulsory, it is possible that medical certificates might be forged or false certificates sold for money. More serious is the question of personal autonomy: even if such tests could be funded and carried out with integrity, who could compel a couple, either or both of whom showed positive, not to marry? Attempting to do so would surely be, if at all practicable, wholly unethical.

In the case of such a couple, a number of alternatives might be put to them:

1. contraception or sterilization to avoid pregnancy;
2. adoption;
3. donation of a sperm or ovum or pre-embryo;
4. pre-implantation diagnosis;
5. diagnosis during pregnancy (e.g. chorion villus sampling, amniocentesis, blood tests from the expectant mother and the foetus, ultra sonography, etc.)

Each of these procedures needs to be scrutinized from an Islamic perspective:

1. Contraception and sterilization

Contraception is allowable under Islamic law as a temporary measure if the couple decide upon it and if there is no harm from the particular method used. Sterilization, however, is not acceptable unless there is danger to the mother’s health from pregnancy. Most couples long to have children and will not choose sterilization unless there is a serious impediment preventing safe procreation in their case. As infertile couples are willing to pay out huge sums of money and go to great lengths to have a child, it is impractical to expect couples carrying a recessive gene such as for thalassemia to opt for sterilization. Everyone of us carries some recessive genes and no-one will choose celibacy or sterilization for that reason alone.

We may note that there is support for sterilization from at least some of our jurists in the situation where a couple have already had some congenitally affected children and some not so affected, in which case they might accept this option.

2. Adoption

Adoption was abrogated by the Qur’an, and in Islamic law adoptive parents are not recognized as parents in the way that natural parents are. The child must be attached in lineage to his or her natural parents, and legitimate pregnancy is, according to the law, only within wedlock. The Qur’an says:

He did not make your adopted ones your sons. That is only a saying from your mouths which has no reality. Call them by [the names of] their [true] fathers. That is just in the sight of God. But if you do not know their fathers, call them your brothers in faith or your mawlas. There is no blame on you if you are mistaken. What counts is the intention of your hearts, and Allah is oft- forgiving and most merciful. (33, 4-5)

Bringing up orphans is a highly commended act of charity, encouraged by Islamic teachings, but even then the lineage of the child must remain to his or her natural father. Therefore, while a couple who are carriers of a lethal gene or a gene that carries a risk of great malady and morbidity for their offspring cannot become natural parents, they can nevertheless adopt one or more orphans in the sense that they can look after and care for them and have all the rewards of bringing them up.

3. Donation of a sperm, ovum or pre-embryo

In the West, a new technology of procreation is being made available to infertile couples. This technology, making use of semen banks and in vitro fertilization techniques, may involve donated sperm or ova, a donated pre-embryo (blastula or morulla), or, in the case of surrogate motherhood, a None of this technology is acceptable in the view of Islamic teachings which recognize procreation only within the bounds of wedlock excluding any third party from the process. Therefore, a Muslim couple who are carrying a lethal gene or serious disease gene cannot make use of either donated sperm or ova or pre-embryos or surrogate motherhood. These methods are refuted by all Islamic jurists on the grounds that procreation must be limited to the spouses alone, without the intervention of third parties.

4. Pre-implantation diagnosis

Advances in medical technology over the last decade or so have made it possible, at least in some specialist clinics, to remove one or more cells from donated womb, the blastula (pre-embryo) prior to its implantation in the womb. A husband’s semen is allowed to fertilize in vitro the ovum taken from his wife; when fertilization occurs, the zygote is allowed to grow to the blastula or morulla stage – this happens a few days after fertilization. If genetic disease or chromosomal abnormality (e.g. triosomy 13, 18 or 21) is suspected, one or more cells are taken from the blastula for appropriate testing. If the blastula is shown to have the defective gene or chromosome, it is discarded and another one tested. Only the unblemished blastula is reimplanted.

The main disadvantage of this technology is the low rate of success after reimplantation (pregnancy rate 30% in the best centres; while take-home-baby rate is around 15%). The merit of the method is that it avoids abortion. The technique is also paving the way for gene therapy and manipulation at an early stage: as yet unfeasible, this will surely be possible in the near future. However, along with the technical problems facing gene therapy, there are also a number of ethical problems (see below).

5. Diagnosis during pregnancy

Better and more accurate diagnoses of congenital malformations, genetic diseases and chromosomal abnormalities are becoming available with the tremendous advances in medical technology.

Simple blood tests from the expectant mother can help the diagnosis of, for example, alpha feto proteins in cases of neural tube defects, viz. anencephaly and spina bifida. Ultrasound can detect many dysmorphic abnormalities as well as congenital defects of the heart, brain and kidneys. CVS or chorion villus sampling, which can be done during the 8th week of pregnancy, can detect genetic and chromosomal defects when suspected. So too can amniocentesis but at a much later stage of pregnancy, between the 14th and 16th weeks. The advantage of early diagnosis by CVS is offset by higher percentage of abortions and complications (2-3%), compared to amniocentesis which is safer albeit giving a much later diagnosis. The couple are offered the choice of abortion when a serious congenital or hereditary disease is discovered.

The Islamic Jurisprudence Council of the Islamic World League in its 12th session (Makka, 10- 17 February 1990) agreed a fatwa by majority vote which allows the option of abortion to the parents on the condition that the pregnancy is less than 120 days old (computed from fertilization and not last menstrual cycle); that a committee of specialist experts have decided that the foetus is grossly malformed and that its life would be a calamity for the foetus and for the family; and that the malformation is very serious and neither treatable nor manageable. On the basis of this fatwa, abortions of foetuses with serious congenital diseases are carried out in the hospitals in Saudi Arabia.

Unanswered ethical questions and dilemmas

There are many dilemmas. Is it allowable to abort a foetus showing Downs syndrome although even with this condition it is possible to live a quiet, peaceful life? If the Huntington’s disease gene is detected, is an abortion justified, although the disease will not appear until age forty or even sixty? Is it permissible to abort those who are homozygous for sickle cell disease or thassalemia or phenyl ketonuria or homocystinuria? For the last two diseases mentioned there is a treatment, namely to avoid foods that contain phenyl alanine or methionme. There is some treatment possible also for the haemolytic anaemias, namely blood transfusion and iron chelation therapy (desferrio-xamine injections).

It is greatly to be hoped that in the not too distant future advances in gene therapy will remove the need to consider abortion in such cases. In the meantime, the best policy is to encourage couples considering marriage to have pre-marital medical examinations for the infectious and hereditary diseases common in their community. It is also important to educate people more effectively and actively about the dangers of consanguineous marriages which, as noted earlier, are very common in most Arab countries.