(OR 2.4, 95% CI 1.4-4.2), but the risk associated with having served in the Gulf War was not (OR 0.8, 95% CI 0.3-2.3).

Secondary Studies

Four secondary studies, one of Vietnam veterans and three of Gulf War veterans, were identified that assessed birth defects or miscarriages.

Kang et al. (2000a) compared the self-reported pregnancy outcome of 3392 female Vietnam-theater veterans and 3038 female veterans not deployed to Vietnam. A structured health questionnaire was administered by telephone interview in 1992, and hospital records were obtained to verify reports of moderate to severe birth defects in 13 children. Although there were no significant differences between groups in rates of miscarriage or stillbirth, low birth weight, preterm delivery, or infant death, reports of “moderate to severe” birth defects were significantly higher in female Vietnam veterans (OR 1.46, 95% CI 1.06-2.02), after adjustment for demographic and military characteristics and a number of factors associated with pregnancy.

Researchers obtained information on a cohort of 52,811 Gulf War veterans from the United Kingdom and a randomly selected comparison group of 52,924 nondeployed veterans regarding adverse reproductive outcomes (Doyle et al. 2004; Maconochie et al. 2003). Data were collected with a validated mailed questionnaire in 1998-2001, and 25,084 Gulf War veterans and 19,003 nondeployed veterans responded. There were 27,959 pregnancies reported by male veterans and 861 by female veterans. Miscarriages were reported more frequently by male Gulf War-deployed veterans than nondeployed veterans (OR 1.4, 95% CI 1.3-1.5). Malformations in infants were also more frequently reported among male Gulf War veterans than among nondeployed veterans (OR 1.5, 95% CI 1.3-1.7). No association between Gulf War service and miscarriage was found among women; when restricted to cases that had been clinically confirmed, the maternal results were too few to analyze for malformations and stillbirths.

Kelsall et al. (2007) obtained information on reproductive function from 1424 Australian Gulf War-deployed veterans and 1548 nondeployed veterans with a mail questionnaire in 2000-2002. There was no increased risk in veterans of miscarriage, stillbirth, or terminations. Children of male Gulf War veterans born after the Gulf War were not at greater risk of being born prematurely, having a low birth weight, or having a birth defect or chromosomal abnormality (OR 1.0, 95% CI 0.6-1.6).

A mail survey with telephone followup of 10,000 married U.S. veterans deployed to the Gulf War and 10,000 married U.S. veterans not deployed to the Gulf War was conducted in 1996-1997 (Wells et al. 2006). The response rate in both groups was 51%. Among the subset of 2233 female deployed and nondeployed veterans and 2159 male deployed and nondeployed veterans who had reported one or more pregnancies, no significant differences were found between deployed men and women and nondeployed men and women in reported pregnancies, birth weight, ectopic pregnancies, stillbirths, or miscarriages.

Fertility Difficulties

Primary Studies

The VES examined fertility (CDC 1988b) in theater and era veterans. During the 1985-1986 physical-examination phase, fertility difficulties were reported in 21.0% and 14.5% of the 2490 Vietnam-theater and 1972 Vietnam-era veterans, respectively, for an OR of 1.5 (p < 0.05). Because of concerns about fertility, the 705 veterans without vasectomies who had physical

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