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Veterans and Agent Orange: Update 2002
terms often used interchangeably with birth defects are congenital anomalies and congenital malformations. Major birth defects are usually defined as abnormalities that are present at birth and are severe enough to interfere with viability or physical well-being. Major birth defects are seen in about 2– 3% of live births. Birth defects can be detected in an additional 5% of babies with follow-up through the first year of life. The causes of most birth defects are unknown. In addition to genetic factors, a number of exposures—including medications and environmental, occupational, and lifestyle factors—have long been implicated in the etiology of birth defects (Kalter and Warkany, 1983). Historically, most etiologic research focused on the effect of maternal and fetal exposures, but some work has addressed paternal exposures. Paternally mediated exposures could occur via several routes, and therefore exert an effect in various ways. One is through direct genetic damage to the male germ cell that is transmitted to the offspring and expressed as a birth defect. A second is through transfer of chemicals from the work, home, or general environment via seminal fluid with subsequent fetal exposure during gestation. A third route is via indirect exposure from household contamination by take-home exposures.
The committee responsible for VAO found that there was inadequate or insufficient information to determine whether an association exists between exposure to the chemicals of interest (2,4-D, 2,4,5-T or its contaminant TCDD, picloram, or cacodylic acid) and birth defects among offspring. Additional information available to the committee responsible for Update 1996 led it to conclude that there was limited or suggestive evidence of an association between at least one of the chemicals of interest (2,4-D, 2,4,5-T or its contaminant TCDD, picloram, or cacodylic acid) and spina bifida in the children of veterans; there was no change in the conclusions regarding other birth defects. There was no change in those findings in Update 1998 or Update 2000. Reviews of the studies underlying the findings may be found in the earlier reports (see Tables 7-1 and 7-2).
Update of the Scientific Literature
No relevant occupational studies have been published since Update 2000 (IOM, 2001).
In a pilot study of 30 Vietnamese women who were known or whose spouses were known to be exposed to Agent Orange, Le and Johansson (2001) reported