































ARESTY RUTGERS UNDERGRADUATE RESEARCH JOURNAL, VOLUME I, ISSUE VI 
 

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MENA DESCENDANTS & 

GENETIC ABNORMALITIES 

MAYA P. GUENNOUNI 

✵ ABSTRACT 
This study aims to assess the impact of con-

sanguinity in the Middle East and North Africa. The 
region, also referred to as the MENA region, spans 
from Morocco to Iran. These identified Arab coun-
tries (Figure 1) have an increased risk of genetic dis-
orders that can result in sickle cell anemia and thalas-
semia (“Middle East & North Africa” 2024). Specifi-
cally, this study investigates the increased preva-
lence of these disorders in the MENA region, as well 
as the contributing factors behind the practice, such 
as education level and age at the time of marriage. 
An in-depth comparative analysis of previous re-
search on this topic was undertaken to draw the cor-
relation between the levels of consanguineous mar-
riages in the MENA region and the levels of genetic 
variation disorders. The analysis shows that there is a 
correlation between the two variables while high-
lighting the practices to counteract such variations in 
the Middle East. These findings suggest a greater 
need for adaptive medical practices in the United 
States to adequately assist the growing number of 
Arab Americans nationwide.  
 

1 INTRODUCTION 
The MENA region is an encompassing term 

used to describe the Middle East and North Africa, 
consisting of 26 countries overall. Comparatively, the 
MENA region is also home to one of the highest rates 
of consanguinity, defined as the intermarriage of 

either first or second cousins sharing the same blood-
line. According to a study published in the Iranian Public 
Health Journal, the prevalence of consanguinity ac-
counted for 20-50% of the overall population in both the 
Middle East and North Africa (El Goundali et al. 2022). 
In a similar study published in the European Journal of 
Public Health, researchers found that “consanguinity is 
common in North Africa (NA), and the estimates range 
from 40 to 49% of all marriages in Tunisia and 29–33% 
in Morocco” (Anwar et al. 2014). Furthermore, the detri-
mental effects of consanguinity have been proven to 
cause “Thalassemia and sickle cell disease/anemia, [as 
they] constitute the most common inherited recessive 
disorders” (Anwar et al. 2014). In order to understand 
the identification of these genetic variation disorders, 
one must further consider the social and economic im-
pact on the affected individuals. The age of women at 
the time of marriage accounts for the most prominent 
factor within consanguinity, specifically in Morocco. As 
per the Iranian Public Health Journal, “almost all of the 
included studies reported that consanguineous mar-
riage occurs in younger ages compared to non-consan-
guineous marriage” (El Goundali et al. 2022).  

The results obtained in Morocco from 9,969 
women ages 15–49 years showed that the highest pro-
portion of consanguineous marriage was observed in 
the 15–19 age group, which not only highlights the dis-
parities of age, but the level of education at the time of 
marriage as well. Geographical location is the second 
most important factor when connecting the elements 
associated with consanguinity in the MENA region. In 
that same study, researchers found that “in the latest de-
mographic survey in Morocco of 9,969 women, consan-
guineous marriage is more common among rural resi-
dent women. The probability of entering into consan-
guineous unions among women is significantly higher 
for those who spent their childhood in the countryside; 
they are almost eighteen times more likely than their ur-
ban counterparts. [Yet women in] northwestern Mo-
rocco, [who reside in] rural [areas] before marriage have 
a highly significant effect on the choice of consanguine-
ous marriage” (El Goundali et al., 2022). Lastly, while 
many MENA countries have made significant economic 
gains in recent years, economic status is the last piece 
of the consanguinity puzzle, allowing us to completely 
understand all the components behind consanguineous 



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marriages throughout Middle Eastern and North Af-
rican countries. 

 

2 PREVENTATIVE MEASURES IN THE 

GULF REGION OF THE MIDDLE 

EAST 
Due to proactively countering consanguine-

ous marriages and the detrimental effects on unborn 
children, countries such as Saudi Arabia (KSA), Bah-
rain, Iraq, Qatar, and The United Arab Emirates have 
mandated a premarital screening for hemoglobinop-
athies. The increased prevalence in the region has re-
sulted in screenings for thalassemia and sickle cell 
anemia. This change has decreased the number of 
sickle cell anemia cases in just Bahrain alone (Abou 
Tayoun et al. 2021). However, the medical accessibil-
ity and acceptance has caused a stalemate in medical 
screenings for MENA residents. According to the Ge-
nomic Medicine in the Middle East study, researchers 
state that “population genetic screening, in the form 
of limited or expanded gene panels, is still lacking in 
the Middle East. Cytogenetic services, mostly based 
on traditional karyotyping and FISH, have become 
widely available in major hospitals within the region. 
The most prominent gap in the region is the lack of 
adequate clinical genomic-sequencing facilities”, 
which highlights the growing need for resources 
based on medical necessities due to high levels of 
consanguinity (Abou Tayoun et al. 2021). 

 

3 DISORDERS OF GENETIC VARIA-

TION 
To further understand the severity of these 

genetic mutations, one must understand the cause 
and symptoms associated with genetically variated 
disorders like with sickle cell anemia.  According to 
the Mayo Clinic, those who inherit this disease have 
red blood cells shaped like crescent moons or sick-
les. This particular shape causes these cells to be 
rigid and sticky, slowing or blocking blood flow. On 
the other hand, regular red blood cells that are typi-
cally round and flexible while moving throughout the 
bloodstream. The onset of sickle cell anemia symp-
toms can begin around the age of six months, with 
many patients experiencing episodes of pain, 

swelling of the hands and feet, anemia, habitual infec-
tions, vision problems, delayed growth or even puberty 
(Mayo Clinic 2022). Common complications associated 
with this disease include, but are not limited to, organ 
damage, pulmonary hypertension, leg ulcers, blind-
ness, and pregnancy complications. As recommended 
by medical professionals, the easiest way to prevent this 
genetic abnormality and reduce the risk of passing such 
mutations is through genetic testing. Figure 2 below 
shows the breakdown of sickle cell anemia and the dif-
ference in blood cells passing through the bloodstream 
between regular (left) and crescent-shaped cells (right) 
(“Sickle Cell Disease” 2021).  

 
Moreover, one of the more prevalent genetic 

abnormalities when examining descendants from the 
MENA region is β-thalassemia. This specific demo-
graphic is genetically predisposed to an increased 
probability of inheriting this blood disorder. This issue 
arises once the body does not make enough beta glo-
bin as it should. Beta globin and alpha globin are build-
ing blocks of hemoglobin, which is a part of the red 
blood cell (RBC). The red blood cell is a carrier of 



ARESTY RUTGERS UNDERGRADUATE RESEARCH JOURNAL, VOLUME I, ISSUE VI 
 

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oxygen across the body and decreases in beta-glo-
bin can cause anemia (Schultz 2022). One of the main 
problems with this blood disorder is primarily due to 
the lack of hemoglobin. According to the American 
Family Physician Journal, beta globin chain produc-
tion can range from near normal to completely ab-
sent. This leads to varying degrees of excess alpha 
globin to beta globin chain production, where the 
beta thalassemia trait (minor) is asymptomatic and 
results in microcytosis and mild anemia. While many 
do not experience iron deficiency, the typical path to 
treatment is contingent on low iron levels, resulting 
in blood transfusions, chelation, and even bone mar-
row transplants for severe cases (Muncie & Campbell 
2009). Given by the previous research conducted by 
the Mayo Clinic and the National Library of Medicine, 
it is critical to understand how consanguinity affects 
the DNA's makeup. Through genetic testing and 
medical advancements, these congenital abnormali-
ties become more transparent and manageable for 
medical professionals and researchers to prevent 
such mutations from arising. Figure 3 above shows a 
side-by-side comparison of normal red blood cells to 
that of malformed red blood cells in a person with 
beta thalassemia (MedlinePlus 2020). 

 

4 MEDICAL TESTING IN THE UNITED 

STATES 
To effectively combat this issue head-on, im-

plementing a program which focuses on the current 
issue in Saudi Arabia and Bahrain will create an equal 
opportunity for Arab Americans to receive access to 
healthcare. In addition, this program will also allow 
medical practitioners to promote the educational as-
pect to Arab Americans in order to stay informed 
about the risks. Through the use of testing in CLIA-
certified testing laboratories and in conjunction with 
prenatal screening and gene carrier testing, the 
United States healthcare system will better accom-
modate the relevant healthcare solutions most suita-
ble to the needs of the growing population of Arab 
Americans.   

 
 
 

 
CARRIER TESTING 

To counteract, the specific disorders of genetic 
variations disproportionately affect the Arab Americans. 
Carrier testing can be utilized if one parent has a “family 
history of congenital abnormalities or mutations that are 
passed on in an autosomal recessive way,” according to 
the Cleveland Clinic. According to ORM Genomics, 30-
50% of all patients screened at ORM using carrier test-
ing are found to be carriers of at least one genetic con-
dition (“Genetic Carrier Screening”). However, carrier 
testing can range anywhere from $100-2,000, depend-
ing on the types of testing being performed and may be 
covered by insurance if recommended by a specialist 
(Mannarino & Ghazal 2023). Figure 4 above shows how 
carrier testing is conducted, what is evaluated, and 
when it is used for predictive prenatal testing (“Genetic 
Carrier Screening”).  
 

PREIMPLANTATION TESTING 
Another way to mitigate the growing number of 

genetic abnormalities present in MENA descendants is 
preimplantation screening. This medical technique is 
one of many ways used to detect and determine the 
possibility of passing disorders with genetic variation to 
future generations. Figure 5 below shows the process of 
preimplantation screening to evaluate genetic risks 
from beginning to end (“The PGD Process Step by Step” 
2020). This test is conducted by specialists who “search 
for genetic mutations in the [female’s] embryos that 
were made using assisted reproductive techniques 
(ART), [such as] in-vitro fertilization (IVF), [where] a small 
number of cells are taken from your embryos and tested 
for [specific] mutations. [Once completed], only [the] 
embryos without these mutations are implanted in your 
uterus [attempting] to start a pregnancy” (Cleveland 



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Clinic 2022). Those who are “over age 37, couples 
who are at risk of having a child affected with an in-
herited genetic disease [and those who have a] his-
tory of recurrent miscarriages due to chromosomal 
abnormalities” qualify for this type of genetic screen-
ing (PFCLA 2022). However as per the Pacific Fertility 
Center in Los Angeles, this procedure can vary any-
where from $4,000-10,000 for PGT-A/PGS and is not 
covered by most private or public health insurance 
within the United States (Drazba et al. 2014). 

 

5 CONCLUSION 

This paper highlights the stark differences be-
tween preventative and curative practices currently 
available in the Unites States compared to those of 
Middle Eastern and North African countries. Consider-
ing that there are over 3.7 million Arab Americans 
(Arab American Institute 2023) currently living in the 
U.S., this research identifies the flaw in American 
healthcare for MENA descendants. Receiving proper 
medical resources can determine if genetic variation 
disorders are prevalent and can also offer preventative 
care to MENA descendants. Medicare, which currently 
provides medical coverage to roughly 65 million 
Americans, offers little to no coverage for genetic test-
ing or inherited genetic disorders (“Medicare & Medi-
caid Coverage of Genetic Services”). According to the 
U.S. Department of Health & Human Services for the 
Office of the Inspector General, genetic testing under 
Medicare Part B will not be covered for predictive pur-
poses as it is considered a screening exam (Washmuth 
2023). 
 
 

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Ms. Guennouni is a rising senior in the School of Arts and Sci-
ences at Rutgers University New Brunswick, where she is pursu-
ing her B.A. in Political Science with minors in Spanish, Business 
& Technical Writing. The inspiration for this research paper came 
from the personal experiences of being an Arab American, 
where she has seen such practices take place. Yet, the develop-
ment of her research began in her Writing in the Business and 
Professions class with Professor Rasheeda Young, where she was 
tasked with formulating a research topic for a business proposal, 
accompanied by a presentation and examination of preliminary 
findings in detail. Throughout her extensive research and guid-
ance under Dr. Amrik Sahota from the Department of Genetics, 
she gained a more profound understanding of the cultural and 
historical factors that come into play when looking at the for-
mation of different disorders of genetic variation. This included a 
high percentage of consanguineous marriages that date back 
several centuries, through which practices have served as a com-
mon practice. Since the paper’s original formulation, she has 
presented her findings as a panelist at the 13th Annual Under-
graduate Research Writing Conference (URWC) in April 2025. 
She was published in the Spring 2024 issue of the Rutgers Uni-
versity Undergraduate Law Review for her paper on “MENA-Re-
lated Genetic Abnormalities & Insurance Fraud”. 

 
Maya can be contacted at mpg128@rutgers.edu. 

 

mailto:mpg128@rutgers.edu.

