Several studies of deployed veterans have indicated that veterans express concerns about the effects of deployment on child-bearing—both their ability to conceive children and the health of those children. This section reviews studies on three subjects related to reproductive health: birth defects and miscarriage, fertility, and sexual function.

To determine the association between deployment-related stress and adverse reproductive effects, the committee identified six primary studies and nine secondary studies. Primary studies obtained information from both deployed and nondeployed veterans and assessed relevant outcomes with methods beyond self-reporting, such as review of hospital or public-health records. Secondary studies obtained information relevant to the effects in question but had methodologic limitations, such as reliance on self-reports of symptoms or effects, or the examination of small or potentially biased samples of veterans. The primary studies of reproductive effects are summarized in Table 6-12.

Birth Defects and Miscarriage

Primary Studies

The committee identified five citations of four studies that examined the prevalence of birth defects or miscarriage in veterans. One study was on veterans of the Vietnam War and four of the citations were to three studies of offspring of Gulf War veterans.

The VES was a cross-sectional retrospective cohort study of all U.S. Army veterans conducted 17 years after the Vietnam War (CDC 1988b). It surveyed a random sample of the 5 million Army veterans who served during the Vietnam era. In the 1985-1986 phase 1 telephone survey, 7924 theater veterans and 7364 era veterans were asked about various reproductive outcomes in their offspring: live births, pregnancies that ended early (including miscarriages, induced abortions, and tubal pregnancies), stillbirths, major health problems in the first five years of life, low birth weight, leukemia or other cancer, birth defects, infant and child mortality, and cerebrospinal malformations (CDC 1988c). In a substudy, hospital birth records of the children of a random subsample of 1237 theater veterans and 1045 era veterans, selected without regard to phone interview results, were sought. Records were obtained for 1791 children of theater veterans and 1575 children of era veterans.

During the interview phase, Vietnam-theater veterans reported more pregnancies that ended in miscarriage (OR 1.3, 95% CI 1.2-1.4) and more birth defects in their children (OR 1.3, 95% CI 1.2-1.4) than did era veterans, but there was no significant difference between the veteran groups in the other reproductive outcomes examined—pregnancies ending in induced abortions, tubal pregnancies, stillbirths, and infant mortality (CDC 1988c). However, in the birth-defects substudy, the rates for all birth defects as documented by hospital birth records were similar for theater veterans and era veterans (72.6 and 71.1 per 1000 total births, respectively) for an OR of 1.0 (95% CI 0.8-1.4), adjusted for veteran’s age at the time of the child’s birth, race, year of entry into Army, enlistment status, general technical test score, primary military occupational specialty, years between entry and birth, maternal age, and gravidity. Cerebrospinal malformations, including anencephaly, spina bifida, and hydrocephalus, were observed in 26 children of theater veterans (expected number 18.3-32.4, based on rates from the nationwide Birth Defects Monitoring Program) and in 12 children of era veterans

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