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Should People with AS Genotype Marry?

Are you considering this question: "should people with AS Genotype Marry"? In this article, we explore the issues around forming significant relationships with people of AS genotype and their implications. No one can make these decisions for another - but having access to accurate information can help those who have to carefully think through and make the best choices for themselves and their families.

Parents with AS genotype may have any number of children with a sickle cell genotype.

"Should people with AS genotype Marry?"

Recently, a client asked us this really important question.

We think there are many people who struggle with this dilemma particularly in Africa.

This is because there are limited treatment options from poor health care access.

And the illness burden is severe.

Putting all the considerations together, we share our reply here for others who may have this on their mind as well.

Your genotype is a very important part of your health care status/profile, and one of those things that you should know because of the life-changing implications it carries.


What is Sickle Cell Disease?

People inherit Sickle Cell Disease (SCD) and it is present from birth.

  The problem in this condition is that the red blood cells in the blood of a 'sickle cell warrior' have changed from the normal 'circular' or spherical shape to a sickle shape.

A child who has 'sickle cell anaemia' has received the sickle genes from BOTH parents.

In a relationship where both partners are AS genotype, it means that for every pregnancy they have together, there is a 25% chance that the child born of the pregnancy would have SS genetic combination i.e. a who will have sickle cell anaemia.

Other forms of sickle cell disease include the AS genotype when just one sickle gene is inherited.

Or Haemoglobin S-C disease when the person inherits an abnormal S gene and abnormal C gene.


Some Complications of having Sickle Cell Anaemia (SCA) / SS Genotype

People with the condition are prone to several health problems through life from childhood.

Some of them are:

  • Episodes of severe pain in the bones and joints called 'crisis' that may happen because of cold weather, infection, dehydration, or exertion.
  • Anaemia - people with SCD have low blood (haemoglobin) levels usually, but sometimes because of infection they can develop even lower blood levels.
    • When they have anaemia, they become very pale, find it difficult to breathe, and very tired. This can affect their normal body functions.
  • Infections - they easily develop infections like malaria or pneumonia etc. which can increase the risk of anaemia.
  • Blocked blood vessels because of the abnormal sickle cells can cause a syndrome with pain in the chest, fever, breathing difficulties.
    • This can also affect important organs of the body and their functions e.g leading to certain types of stroke.

So these are some of the problems that people with SCA suffer - FROM CHILDHOOD.

All of these problems could lead to death if not properly managed. People with sickle cell anaemia need VERY Prompt attention when they become ill.

Fast access to pain relief and oxygen is essential; they need injections and intravenous fluids to manage infections, they may need blood transfusions to quickly treat anaemia.

They need a lot of care and support, but with the right treatment in a timely fashion, they can thrive and lead fulfilled and happy lives.


The decision for 2 people to marry is left to themselves, but we will encourage that they think very hard about the issues, options and implications if they choose to do so when both of them are AS.


Considerations for AS relationships

Issues:

1. These may centre around the financial and psychological support for the family having a child or children who are SS.

Options:

2. The two AS genotype partners can decide to marry and have no children. Or they may decide to marry, have no children and adopt children instead.

3. If they decide to marry and have a family together, they should realise that in each pregnancy, there is a 25% chance that the child that is born from the pregnancy will have the SS genetic combination i.e. having SCD, and can suffer from all of the above problems described.

(Some AS+ AS couples have 1 child with SS, and others have more than one child with SS.)

When an AS+AS couple becomes pregnant, they can have prenatal testing and counselling - this is a procedure carried out early in the pregnancy to determine whether the foetus has the SS gene.

It is not available in every country, and people who want to use this method should check if it is available to them.

The end goal is that if prenatal testing confirms the child will have SCD, a decision may be taken to end the pregnancy at that stage.

Implications:

4. If they decide to keep the pregnancy, it is important to be aware of the child's health needs and how prepared they are to meet these needs.

(Remember we said 'the right treatment in a timely fashion'?). Well these are the KEY Questions you must ask yourselves:

Some Key Questions

*Are there hospitals close by that can manage the condition?

*Is there transportation to get the child to the hospital quickly?

*Do they know what needs to be avoided in children with SS to prevent the risk of developing some of the problems listed above?

*Are they aware of the emergency management and drugs that can be given at home (school) if problems arise?

*Is their home in an area/town/country where there is much support available for people with SS from childhood to adulthood.

Supporting a child with these needs has financial and psychological implications, and can have a huge impact on the mental well being of the entire family.

Some couples can handle this with help from friends and families; some may not.


Concluding Thoughts

These are some of the issues that surround the family with AS+AS parents and are worth considering when making the decision to marry.

Please feel free to contact us if you wish to clarify anything or need more information.

Or comment below if you want to tell us your view of the issue.

The important thing is to realise there are options and for people to decide with their partner which best suits them; and no one else can make this decision for the couple.

Stay Well!


Read More


Editing by AskAwayHealth Team

Disclaimer

All AskAwayHealth articles are written by practising Medical Practitioners on a wide range of health care conditions to provide evidence-based guidance and to help promote quality health care. The advice in our material is not meant to replace the management of your specific condition by a qualified health care practitioner.
To discuss your condition, please contact a health practitioner or reach us directly through info@askawayhealth.org


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13 thoughts on "Should People with AS Genotype Marry?"

  1. How do we handle the incidence of childhood blindness

    1. administrator says:

      Hello Raymond,
      Thank you for your comment. You are quite right – children with Sickle Cell Anaemia (SS genotype) do have a risk of blindness from sickle cells in the blood vessels to the eyes. Reducing the risk of Sickle Cell crises – prevention measures and drugs will be a great help with this. I talk about this more in this article. Best Wishes

  2. Philip says:

    Good morning, please i have a question,

    As parents do they have the chance of giving birth to As children, even if it’s two.

    1. administrator says:

      Hello Philip, thanks for your question.
      Yes, they have a chance – please read on:
      Parents with AS genotype have a 50% chance of having a child with AS genotype in every pregnancy.
      That means when the couple is pregnant, the possibility of the child being AS is 50%. This could happen in the second or third pregnancy as well.
      But always in any of these pregnancies, the chance for AA is 25%; and the chance for SS is 25%.
      This is the same chance whether they are pregnant once, twice or more times.

  3. Justina says:

    I’m As and I married As partner what will our first and second child be?

    1. administrator says:

      Justina, thanks for your comment/question.

      It’s not possible to edetermine the exact genotype of the children without doing tests such as prenatal tests – you can read up more about them here.

      All you can determine without tests given your genotype and your spouse’s is the possible risk of the genotype of each child whether first, second or third etc.
      Best Wishes.

  4. Taiwo says:

    It’s possible for As parents.
    Have a child ss without sickness.
    When the child is age of 5years
    She die when she was taking drip
    In hospital.
    That her first time sickness.
    Since when she was born.
    She brilliant well smart and many more.
    When hospital carried out genotype test
    We are told she SS.
    We still not believe.
    Becasue no any systoms of sick cell.
    In her.
    We are have not pay visit to hospital from the day she was born.
    From my little experience.
    Even thought SS systoms will show up lately in a child.
    It should not more than 6month.
    Hospital can testify that we have not brought the child to hospital.
    From the day she was born.
    Beside she premature child 7month.
    I think if she SS genotype she may not survive it. When she was in the incubator .
    So my question go this way.
    It’s possible SS genotype have no systoms till 5years old.
    While the hospital says is infection.
    When she taking drip she die two days after in the hospital.
    I will love 💘 to hear your feedback.
    Thank you.
    Best regards.

    1. administrator says:

      Hello Taiwo,
      first of all, I am very sorry to hear of your loss and can only empathise with the pain and confusion you are experiencing as I read your comments.

      To answer your questions:
      1. Yes, it is possible for a child with the SS genotype to show no obvious signs of illness that may lead them to the hospital before the age of 5 years. This doesn’t mean they do not have the problem, but they may have little unseen illness going on within their system that does not come to anyone’s attention. While it is common for children under 5 years to be very ill with bone pain or other complications of sickle cell anaemia – but the time each one becomes ill can be different from one child to another – some may begin a little later or earlier than others.

      2. Children are born with their sickle cell genotype, SS. When we are born, we all have foetal haemoglobin. As we grow past 6-9 months, it is replaced by adult haemoglobin. It is this haemoglobin that is the problem in sickle cell anaemia. People with SS have haemoglobin that makes their red blood cells become abnormally shaped under stress. But the foetal haemoglobin is not affected in this way.
      So a baby under 9 months on average may appear ok (unless you test them) because in their blood they still have foetal haemoglobin.
      After 6-9 months, the foetal haemoglobin starts getting replaced. What they now have is the haemoglobin they will keep throughout life – adult haemoglobin. This is the haemoglobin that will be affected by the sickle gene and cause illness.
      This means that the child may not show signs of SS anaemia – even at birth or prematurely because what they have at the time is foetal haemoglobin.

      3. We know some of the possible issues that trigger a SS crisis – most often it is an infection like malaria fever, diarrhoea, chest infection, ear infection – indeed any type of infection could make the person with SS genotype go into illness from crises or loss of their blood cells.
      Stress for example excess exercise, or not drinking plenty of water are other triggers. So illness could be possible for someone with SS anaemia who is not aware to avoid some of these conditions, which is why we advocate all children to be genotype tested at birth; if SS genotype, they are under the care of a specialist and regular monitoring with preventive medicines to keep them healthy.

      If you have other kids, please ensure they are tested.
      As a couple with AS, your chance of having kids with SS is significant – 25% every time you are pregnant- though you can also have kids who are AS or AA genotypes respectively.

      I hope this reply helps address these questions and wish you well at this difficult time and going forward.

  5. john says:

    hi
    please i have a question for a friend
    all his siblings are AA so he assumed his also AA without checking.
    he got married and they are about having their first baby, the doctor taking care of the wife noticed that she is AS so he asked her to confirm the husbands genotype. so the husband checked and found out his AS also.
    so my question is
    1. how is it possible in a family of 6 children their is 5 with AA and 1 with AS….. is it that the test is wrong?
    2. what is the probability that their unborn baby will be SS

    1. administrator says:

      Hello John,
      Thanks for asking.
      The challenge with this issue includes awareness among people generally about how sickle cell disease can happen, but also when some tests are unreliable.
      To your first question – yes it is perfectly possible in a family of 6 children that 5 are AA while one is AS. As long as the parents are AS and AS, this is possible.
      We only know that this parent combination can potentially result in SS, AA or AS for their children.
      But we do not know WHICH children will be AA or AS or SS.
      All we know is that each time they are pregnant, that pregnancy has a 25% chance of AA or SS and a 50% chance of AS.
      Which genotype the child has is not known till they are conceived and the genes are passed from parents to the child, unless special tests called prenatal tests are done while they are still in the womb.

      The probability that the couple expecting a baby now will have an SS child is 25%. The chance the child is AA is also 25%, while the chance they are AS is 50%. They should speak to a genetic counsellor who can advise them more.
      Best Wishes.

  6. Temmytayor says:

    If AS and AS impregnate each other can their first born baby have Ss?

    1. administrator says:

      Hello, thanks for asking. Yes, their firstborn and any other children can have SS. It doesn’t matter the position, firstborn, lastborn or middle – the risk for every child is the same.
      This same couple can also have a child with AA.
      The risk of AA is also 25%.
      But we don’t know which genes one particular child will inherit until they are conceived. As early as 8-9 weeks we can find out, but this process has risks. Please read more here –

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