(80.5% response) and 1548 nondeployed military personnel (56.8% response). Among the male participants of this survey conducted between August 2000 and April 2002, deployment was not associated with miscarriages/stillbirths, pregnancy terminations, low birth weight, or preterm birth.

In a cross-sectional survey on the reproductive health of French Gulf War veterans (Verret et al., 2008), a nondeployed comparison group was not included in the study population. Thus, the effects of deployment on reproductive outcomes were not assessed in this population. According to the authors, the frequencies of reproductive characteristics, which included postdeployment miscarriage and stillbirth, were similar to frequencies in the general French population. Statistical comparisons, however, were not provided.

After conducting a 2000 follow-up survey to the 1995 National Health Survey of Gulf War Era Veterans and Their Families, Kang et al. (2009) reported the prevalence of selected self-reported reproductive characteristics among female Gulf War and Gulf War era veterans. Gulf War veterans reported an excess prevalence of “serious problems with mood before period” (OR 1.28, 95% CI 1.13-1.45) but no difference in having given birth within the last 6 months (OR 2.11, 95% CI 0.89-5.04) or having had a miscarriage in the last 6 months (OR 0.42, 95% CI 0.15-1.17). Comparison of births and miscarriages, however, were based on small numbers.

Summary and Conclusions

Although the results from the Araneta et al. (2004) study, which had hospital discharge data available, are suggestive of an increased risk of spontaneous abortions and ectopic pregnancies, the results may not be generalizable to deployed women who left the service or to pregnancy-related admissions to nonmilitary hospitals. These findings for spontaneous abortion were not replicated in the four secondary studies of female veterans, which used self-reported outcome data. Similarly, only one secondary study assessed ectopic pregnancies and observed no differences by deployment status among male or female veterans. Among males, no consistent associations with Gulf War deployment were observed for spontaneous abortion, preterm birth or low birth weight, although three studies reported modest increases in self-reported miscarriages among deployed males.

The committee concludes there is inadequate/insufficient evidence to determine whether an association exists between deployment to the Gulf War and adverse pregnancy outcomes such as miscarriage, stillbirth, preterm birth, and low birth weight.

Fertility

Studies of fertility problems have assessed semen parameters, hospitalization for infertility or genitourinary system diseases, self-reported difficulties achieving a pregnancy, and serum concentrations of reproductive hormones in males. Infertility is typically defined as trying to conceive unsuccessfully for 12 months or more after discontinuing contraception, although the quality of the outcome measurement has varied across studies and has included inference from self-reported disorders of infertility or sperm abnormalities, reports of “having difficulty getting pregnant,” reports of consulting a doctor after trying unsuccessfully for more than 1 year, and seeking treatment for childlessness.



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