Do health odds favor adoption?
September 9, 2010 11:37 AM   Subscribe

My partner and I would like to raise a child. We both have hereditary illnesses in our families (diabetes, cancer, heart disease), and this is one reason we lean towards adoption. But it recently occurred to me (duh) adopted kids can have hereditary illnesses too. So is adoption really better odds in the disease gene pool? Ignoring other factors for a moment, if our only consideration for deciding to adopt or not was the likelihood of our child having (or less significantly, carrying genes for) hereditary illnesses, how bad would our genes need to be before adoption is clearly the better option? Are there specific types of adoption (e.g. international vs. American) that greatly improve the odds?
posted by anonymous to Health & Fitness (21 answers total) 2 users marked this as a favorite
Do you actually know that you have some sort of genetic disorder? Many, many, many people are genetically predisposed to diabetes, cancer, and heart disease, but in most cases, these are complex diseases that emerge due to interaction between genome, physiology, and environment. Unless you know that you, for instance, carry a mutant BRCA1 gene, it's kind of ridiculous to base this decision on the familial disease history.
posted by mr_roboto at 11:42 AM on September 9, 2010

Go to a genetic counselor. These are people whose jobs it is to answer these questions -- usually specifically related to possible outcomes for children. As Mr. Roboto says, family history is not necessarily indicative of whether you are a carrier for an illness, and a genetic counselor can help you figure out what is testable and what the actual odds are.
posted by brainmouse at 11:44 AM on September 9, 2010 [6 favorites]

In terms of genetic planning, the most usual risk is that if two parents both have similar genetic defects, those will reinforce each other. Whereas, if your genetic defects are different from those of your partner, your chances of having a non-defective child are much improved. As for the risk of adopting a defective child, you should be able to see the child you are thinking of adopting before making a decision. See if you can discern any defects. Of course, there could be problems that are not obvious and may only show up years later. One never knows.

There are no perfect solutions to this concern, as you note. Either biological children or adopted children can turn out to have genetic defects. In the future children will be genetically engineered to have exactly the genetics that their parents want. Exactly how long it will take us to perfect the technology, I can't predict. Until then, we muddle through.
posted by grizzled at 11:45 AM on September 9, 2010 [1 favorite]

Can we not refer to children (or people in general) as defective? OK, thank you.

Moving on.

I would be more concerned about non-genetic health issues when adopting. For example, one common issue in international adoption is attachment disorder. The mother could have smoked, drank alcohol, or used drugs while pregnant. With international adoptions especially, I doubt you will be able to know the genetic background of both parents.

I'd see a genetic counselor so you can properly assess the genetic risks of a biological child.
posted by desjardins at 11:53 AM on September 9, 2010 [9 favorites]

Ignoring other factors for a moment, if our only consideration for deciding to adopt or not was the likelihood of our child having (or less significantly, carrying genes for) hereditary illnesses, how bad would our genes need to be before adoption is clearly the better option? Are there specific types of adoption (e.g. international vs. American) that greatly improve the odds?

This is kind of a weird calculation you are trying to do here, I'm not sure what you are getting at. You and your partner may or may not be more predisposed to produce biological children that have genes related to serious hereditary diseases than any other random couple. But that doesn't really have anything to do with the percentage of adopted children that have similar negative hereditary traits. The children you would be adopting are going to be raised by someone regardless of what you decide to do, so deciding to adopt them is not like deciding to give birth to a biological child.

If you knew for example that an adopted child would have on average a 5% chance of developing a certain kind of cancer in their lifetime, whereas your biological child would have a 15% chance, that doesn't mean it makes more sense to adopt. The decision you should probably make is if the risk of genetic problems is enough that you don't want to create a child with that genetic makeup, rather than by comparing your potential biological children's risk to the risk of other possible children that you could raise.
posted by burnmp3s at 11:58 AM on September 9, 2010 [1 favorite]

grizzled: As for the risk of adopting a defective child, you should be able to see the child you are thinking of adopting before making a decision. See if you can discern any defects.

Pardon me, that is not how adoption works. It's not like picking a pumpkin. You don't just stroll down the aisle until you find a kid that looks like a good one.
posted by DarlingBri at 11:59 AM on September 9, 2010 [16 favorites]

This is how I see it:

When you make a baby yourselves, you're creating new life including whatever bad genes you might pass on. As a fellow carrier (and sometime sufferer) of congenital diseases, this seems irresponsible to me. However, if you adopt, that child will have been born with those genes regardless of your actions.
posted by wayland at 12:12 PM on September 9, 2010 [1 favorite]

We both have hereditary illnesses in our families (diabetes, cancer, heart disease)

I just wanted to echo what mr_roboto said. The diseases you listed, while they may have genetic components, are not considered hereditary diseases in the sense that, say, Tay-Sachs disease is considered a genetic disorder. The premise of your question is seriously flawed, which makes it very difficult to answer definitively. In addition, while adoption is wonderful and works well in many cases, adoption itself is a risk factor for all kinds of complications (usually psychological) that affect children.
posted by OmieWise at 12:18 PM on September 9, 2010 [1 favorite]

No adoption agency is going to give you genetic info on a prospective child, and grizzled's idea of being able to spot problems is both offensive and ludicrous, so you basically assume the chances of that child developing any particular problem are the same as the base rate of that problem in the whole population. The only case in which adoption seems like an obvious win is when you know you or your husband are carriers for something like Huntingtons, so your own child would have a 50% chance while the adopted child would have the same chance as any person chosen at random. Even then you could conceive through in vitro with zygotes prescreened to be sure they did not end up with the gene you're worried about, but this will not give you a super designer baby with only the best combination possible from you and your husbands genes.

If your concern is that your child might have milder problems that are less than 100% heritable, like heart disease, that's not really reason enough to adopt. Most traits do not work on principles of simple Mendellian genetics so you could end up with a biological child free of heart disease even if you and your husband both have it because a remixing of your gene pools plus good environment could equal no heart disease. Most importantly, if you are not
prepared to have a child with any serious, partly heritable medical condition, you need to rethink your readiness to be parents through any means.
On preview: what Omni said.
posted by slow graffiti at 12:43 PM on September 9, 2010

Unless you both have had specific genetic testing for specific genetic markers that indicate a huge percentage that you will pass it along, you have more control over the heath and development of the child that you're making a part of your life if you do it naturally. In addition to "going light on" genetic history, nutrition, drug/alcohol use, mental disorders and general health, you really have no control or guarantees.

Good thing, too, because the scrapes, bruises, accidents, scares and randomness of being a parent is so vastly out of your control at times, this is a fantastic chance to get used to that.

Seconding (or thirding) the "get ye to a genetic counselor" because that's what those folks are for -- and it's fun to talk for an hour to someone who knows statistics and probability better than almost anyone else you'll meet in life. It's cheaper than the application for adoption -- possibly covered by insurance if your PCP refers you (which he/she will at the drop of a hat, they hate talking genetics for the most part).
posted by Gucky at 12:54 PM on September 9, 2010

A child would probably be far more comfortable growing up with diabetes than with overprotective, neurotic parents who are going to treat any disease the child might get as their own personal failure -- or worse, the child's 'defectiveness'. See a genetic councellor if you are really at high risk for a dangerous illness that will truly affect the child's quality of life, or something more serious (Huntington's or something).

Adopting can take thousands and thousands of dollars, and the rigorous process can take years. If you and your partner are both healthy, having a baby the ol' fashioned way might be the best option for you despite the odds. I suppose it's fine and all to want your baby to have the best life possible. But if you are considering adopting because you are not 100% sure you will be able to love and support a child should they be stricken with illness, perhaps having a child isn't the best idea for you. Besides -- part of having children is the element of chance -- you coul wind up with a healthy baby, or a diabetic, or hell, a Republican. You sort of have to agree to love it no matter what before it comes out.

My advice, go home, watch Gattaca, take a chill pill, and make a baby the traditional way.
posted by custard heart at 1:15 PM on September 9, 2010 [4 favorites]

There is no person alive on this earth that is not "carrying genes for hereditary illnesses"
posted by sero_venientibus_ossa at 1:19 PM on September 9, 2010 [6 favorites]

The diseases you mention have huge environmental components. Diabetes, for example, is on the rise in North America due to childhood obesity. Keep your child away from Slurpees and you may well avoid diabetes even if it was common in your family; and it may have been common in your family because of bad eating habits, not genes. Likewise, you may have had cancer in your family because of smoking or breathing second hand smoke or air pollution. Heart disease has a huge environmental component -- exercise and eating habits.

Also, beware anecdotal data. In the absence of actual genetic information, you might be looking at a statistical cluster in your family -- a random accumulation of one kind of disease over another.

Bear in mind also that by the time your kid is 20, who knows what medicine is going to look like. Diabetes might be something we shrug off with an injection. Heart disease may just be something you get a shot of artery-clearing nanobots for.

So I wouldn't adopt a kid because you had these diseases in your family. If you were talking schizophrenia or autism, you might be wise to get tested for genetic markers. But not heart disease and diabetes.
posted by musofire at 2:16 PM on September 9, 2010

We both have hereditary illnesses in our families (diabetes, cancer, heart disease)

I'm a little confused -- there isn't a single person out there who doesn't have at least cancer and heart disease somewhere in their family. Everyone dies of something, and cancer and heart disease are right up there on the list (with complications from diabetes being common as well). Are you saying that you have family history of extremely early on-set of all these diseases -- as in, your parents both died of cancer before the age of 40 or something?

how bad would our genes need to be before adoption is clearly the better option?

The diseases you've listed are so common that I think you would need some sort of drastic family tragedy in terms of early deaths from these things. Do people in your family tend to die before the age of 40? 50? 60? What do you think is an acceptable lifespan for your potential child?
posted by frobozz at 2:21 PM on September 9, 2010 [1 favorite]

What is your goal?

If your goal is to not bring a child into the world who carries some disease alleles, then your only choice is not to have a biological child. I guarantee that both your genomes are chock full of deleterious recessives; but the likelihood that you have defects in the same gene -- even if it's for the same disease -- is pretty low (unless you have other information, such as that you both have immediate family members with Type I diabetes, AND are both of recent Scandinavian extraction.)

If your goal is to not bring a child into the world who will die of heart disease, cancer or diabetes, you're already kind of SOL. These are major killers in the developed world . . . because the first two are diseases of old age, and Type II diabetes is a disease of age (or it used to be) and diet.

If your goal is to bias the odds as much as possible towards parenting a healthy child, unless there's something more specific in your familial history, then your best choice is to try and make one yourselves. I don't want to open a big can of worms on the realities of adoption, but healthy infants born to healthy & demonstrably uncoerced mothers are rather thin on the ground.
posted by endless_forms at 2:22 PM on September 9, 2010 [1 favorite]

If you want to adopt a child for humanitarian reasons--ie, there are unwanted children in the world and we are not attached to our genes-- go for it, you're doing a mitzvah and the world needs more people like you.

However, do not do it because the child's genes will be "better." Consider which children are likely to be up for adoption: most will be accidental pregnancies (so there could be a tendency towards impulsivity on the part of one or both parents which could be genetic and is involved in predisposition for things like ADHD), some could be the result of rape (the father could have genes involved in antisocial personality disorder), or pregnancies by people who cannot care for their children (mentally ill, cognitively disabled, etc).

Please note: in the vast majority of these cases, the kids will be absolutely 100% fine-- but if your concern is genetics, they aren't going to be "better" than nonadopted kids on average, in terms of mental health predispositions anyway.

Best case scenario is simple poverty which isn't genetic of course-- but then they may have spent their early lives in an orphanage which can be damaging to about 1/3 of kids who are there for their first 2 or more years. Alternatively, the children will have been taken away from abusive parents-- so, um, they will have been abused and the abusive parents are likely to have problems like addictions, ADHD, antisocial personality disorder, etc., which can have a genetic component.

So adopt if you want to help, if you want not to add to overpopulation. But if you have a real genetic issue (as said above, heart disease is the number 1 killer so you are really going to have difficulties if you want to try to select against it, diabetes is also really common as is cancer), you might want to consider genetic testing and then, if something is found that you both have like Tay-Sachs, IVF with pre-implantation genetic diagnosis (this is insanely expensive -- about $17000 a pop) but for common diseases, there's not much to be done.
posted by Maias at 3:16 PM on September 9, 2010

Just a personal note: my dad's adopted (closed adoption). As he gets older, there's this big question mark hanging over him because he has no clue as to his genetic makeup. Did every man in his family die before the age of 60? That'd be good to know, since he's there now. He's got diabetes and heart problems and we can't really know if they could have been avoided. And for us kids, we're getting these same mystery genes. Life is a bit of a crapshoot. (And that's not even thinking about all the really bad stuff I might be carrying!)

As said above, if you're truly worried about it, get genetic counseling so you can make an informed decision.
posted by wallaby at 3:35 PM on September 9, 2010 [2 favorites]

There are no guarantees with any child. You can have every possible prenatal test and still have a child who is born with or later develops a disease, a disability or some other sort of issue. If you want to have a kid, either through adoption or with a biological child, you have to be prepared to love the child you get. We are all human and we are all both gifted and flawed in our own unique ways. Why do you want to be a parent? If you love children and want to share your life with one, then either adopt or conceive and take your chances. If you are looking for some sort of genetic guarantee, well, good luck with that.
posted by Kangaroo at 5:29 PM on September 9, 2010 [2 favorites]

To answer "So is adoption really better odds in the disease gene pool?". As desjardins stated "The mother could have smoked, drank alcohol, or used drugs while pregnant. " This is actually very likely with adoption: no one gives up their child without good reason.
In the case of multiple kids the mother might give away the "worst" one, possibly an example of Gresham's law.

So you question focus lies on Nature (might be better genes), while the Nurture part is much more likely to be compensating in the other direction. Data point: I know an adoption child from Colombia, mother used drugs during the pregnancy. Kid has a very good build, natural sportsman, but total mess in organisation and dyslexic to boot. See here the conflict between Nature and Nurture. Getting a kid (from whatever source) is to participate in a lottery.
posted by Eltulipan at 5:09 AM on September 10, 2010

Yes, go see a genetic counselor. I had no idea these people even existed before I got pregnant, but I had to see one recently (I have a pre-existing condition which in no way affects my developing baby and, as I thought, my family history doesn't place me at risk - but hey! Good to know.) and she was very kind and very knowledgeable about what in your family history does and doesn't have a chance of affecting the baby.

Diabetes, cancer, and heart disease aren't reasons not to have a baby. They can affect anyone. Those things are very common and while they can show up later in life, your child would most likely be perfectly healthy. From an adoption standpoint: you're taking on a wildcard and won't know if those factors are a risk for your child or not. Things you should actually worry about: mental retardation and other severe birth defects, heart abnormalities, and genetic conditions such as cystic fibrosis.

If you want to adopt and are looking to rationalize the decision, just go for it and adopt because you want to. If you're looking for a healthy baby, the factors you mention aren't a concern at all in pregnancy and your best chance in later life is just to know that these could be issues and try to have a healthy family by being aware and living a reasonable lifestyle.

TL;DR - Talk to a genetic counselor, but the factors that you mention won't affect you in pregnancy and won't directly affect the health of a baby/child.
posted by sonika at 10:32 AM on September 10, 2010

Looks like I'm the only adoptee piping in here? As an adoptee I have to say .... in the nicest way possible....

please don't adopt for any of the reasons you mentioned.

Please. Spare a child a life of trying to be as genetically good as you hoped for when they can never achieve that.
posted by xarnop at 7:04 PM on February 17, 2011

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