of Gulf War service and congenital malformations have been limited because specific birth defects are relatively rare, multiple comparisons were performed, and sample sizes were small when divided by timing of exposure (before or after conception) and whether the mother or the father was exposed. Thus, overall there is no consistent pattern of higher prevalence of birth defects among offspring of male or female Gulf War veterans, and no single defect, except urinary tract abnormalities, has been found in more than one well-designed study.

The committee concludes there is inadequate/insufficient evidence to determine whether an association exists between deployment to the Gulf War and specific birth defects.

Adverse Pregnancy Outcomes

Studies of adverse pregnancy outcomes have evaluated the prevalence of spontaneous abortions, stillbirths, ectopic pregnancies, preterm births, low birth weight and macrosomia in the pregnancies of Gulf War deployed and nondeployed men and women.

Summary of Volume 4
Primary Studies

Only one study of adverse pregnancy outcomes used hospital-discharge records, rather than relying exclusively on self-reported outcomes. Araneta and colleagues (2004) recruited women admitted to military hospitals for pregnancy-related diagnoses (including livebirths, stillbirths, spontaneous and induced abortions, ectopic pregnancies, and pregnancy-related complications) from August 2, 1990, to May 31, 1992. Reproductive outcomes were collected from surveys administered in 1997 and 1998 to the 3825 US women with pregnancy-related hospital admissions. Of the 1110 respondents with complete data, there were 415 predeployment and in-theater conceptions among Gulf War veterans (referred to as “Gulf War-exposed pregnancies”), 298 postwar conceptions among Gulf War veterans, and 427 conceptions among nondeployed women from deployed units. Self-reported outcomes were confirmed by hospital discharge data. The odds of spontaneous abortions (OR 2.9, 95% CI 1.9-4.6) and ectopic pregnancies (OR 7.7, 95% CI 3.0-19.8) were higher among Gulf War veterans’ postwar conceptions compared to conceptions among nondeployed women. The frequency of these outcomes among so called Gulf War-exposed conceptions was also increased compared to pregnancies among nondeployed veterans, but not in a significant way. Because only military hospitals were included, only information on active-duty personnel was available. The authors also acknowledge that deployment status, which was based on deployment dates for each military unit, may have been misclassified for pregnant women whose deployment orders were cancelled or delayed due to pregnancy. Furthermore, spontaneous abortions were not completely ascertained, given a substantial proportion of losses occur before pregnancies are clinically recognized (Wilcox et al., 1988).

Secondary Studies

Doyle and colleagues (2004) also studied self-reported miscarriages and stillbirths among Gulf War deployed fathers and mothers. The authors assessed clinically confirmed reports of congenital malformations. However, similar efforts to evaluate clinically confirmed reports of miscarriages and stillbirths were not described, and the outcomes assessed were limited to self-reports. Thus, when considering the analysis of other adverse pregnancy outcomes, the study is

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