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Symptoms in Gulf War Veterans
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Birth Defects

Penman, A.D et al. No Evidence of Increase in Birth Defects and Health Problems Among Children to Persian Gulf War Veterans in Mississippi. Military Medicine 1996; 161: 1-6. This is a study of children born to veterans from two Mississippi National Guard units which had deployed to the Gulf War. In 1993 a Jackson newspaper reported an apparent cluster of birth defects and other health problems among children of unit members. The state and the CDC launched this study in response to the media reports. 254 of the 282 veterans were contacted. 55 children had been conceived and born to 52 veterans after the deployment. Three different major birth defects and two different minor birth defects were found. Using U.S. rates for birth defects, one would expect to see one to four major birth defects and three to six minor birth defects among this group of children. The types of defects seen are not known to have any common links to genetic, chromosomal, or teratogenic causes. Four cases of low birth weight would be expected and five occurred. The average number of medical visits for respiratory infections and otitis media did not appear to be excessive. Limitations of the study are its small size, the lack of information about 28 unit members, and the uncertainties of applying U.S. rates to this group of veterans.

Cowan, D.N. et al. The Risk of Birth Defects Among Children of Persian Gulf War Veterans. New Eng J Med 1997; 336 1650-1656. This study evaluated live births at 135 military hospitals in 1991-1993. 33,998 infants were born to GW veterans and 41,463 were born to a random sample of 700,000 servicemembers who did not deploy. The overall risk of any birth defect was 7.45 % and the risk of severe birth defects was 1.85 %. These rates are similar to those reported in civilian populations. In the multivariate analysis, there was no significant association for either men or women between service in the GW and the risk of any birth defect or of severe birth defects in their children. Although the risk of any birth defect was slightly higher among the children of female GW veterans, this appears to be the result of confounding by race or ethnicity, marital status, and branch of service. There was no association between risk and duration of service in the Gulf. There was no evidence of reduced fertility and no significant differences in the sex ratios of the babies. Limitations of the study: only children born in military hospitals were included (68% of all births); excluded were children born after their mother or father left active duty and children born to the more than 110,000 reserve component personnel; the study was limited to live births; and, diagnoses made during subsequent hospitalizations, in outpatient settings, or in non-military hospitals were not identified. The authors recommend a conservative approach in interpreting the data, given the potential for late recognition of birth defects and the limitations of the ICD-9 system for defining some patterns of congenital malformations occurring as syndromes.

Araneta, Maria Rosario G. et al. Goldenhar Syndrome Among Infants Born in Military Hospitals to Gulf War Veterans. Teratology 1997; 56: 244-251. Because press reports in 1995 suggested an excess of a congenital malformation called Goldenhar syndrome among the children of Gulf War veterans (GWV), the authors searched for cases of this syndrome among infants conceived after the Gulf War and born to active duty military personnel in DoD hospitals. The offspring of all GWV were compared to those of a 50% sample of veterans who had not deployed to the Gulf (NDV). Seven children fulfilled the criteria for Goldenhar syndrome. Five were born to GWVs and 2 to NDVs. The prevalence was higher among GWVs’ infants, but the difference was not statistically significant. The observed prevalence was compared to the rates in Hawaii, Atlanta, and California and variations in these rates was discussed. Limitations of this study are: only births in military hospitals were studied, so the children of veterans who had left the military, of members of the reserve component, and of some active duty personnel were not counted; potential errors in classification of birth defects may have occurred; and, the small number of affected births resulted in very wide confidence intervals around the relative risk.