TABLE 4-14 Adverse Reproductive and Perinatal Outcomes

Study

Design

Population

Outcomes

Results

Adjustments

Comments

Birth defects

Araneta et al., 2003 (Vol. 4)

Retrospective cohort, using population-based, birth-defect registries (active surveillance all cases identified from birth to 1 year)

Infants of military personnel born 1/1/1989-12/31/1993 in Arizona, Iowa, Hawaii, and participating counties of Arkansas, California, Georgia to GWV mothers (n = 450) NDV mothers (n = 3966) GWV fathers (n = 11,511) NDV fathers (n = 29,086)

48 birth defects identified by CDC as occurring frequently or of public health importance, excluding pulmonary artery anomalies and adding dextrocardia, chromosomal anomalies (other than trisomies 13, 18, and 21), and Goldenhar syndrome

Postwar conceptions, GWVs vs NDVs (unadjusted RRs): father: tricuspid valve insufficiency, 10/4648 vs 9/11,164 (RR 2.7, 95% CI 1.1-6.6); aortic valve stenosis, 5/4648 vs 2/11,164 (RR 6.0, 95% CI 1.2-31.0); coarctation of aorta, 5/4648 vs 3/11,164 (RR 4.0, 95% CI 0.96-16.8); renal agenesis or hypoplasia, 5/4648 vs 5/11,164 (RR 2.4, 95% CI 0.7-8.3) mother: hypospadias 4/154 vs 4/967 (RR 6.3, 95% CI 1.5-26.3) GWVs postwar vs prewar conceptions (unadjusted RRs): father: aortic valve stenosis 5/4648 vs 0/6863 (RR 16.3, 95% CI 0.9-294); coarctation of aorta, 5/4648 vs 1/6,863 (RR 7.4, 95% CI 0.9-63.3); renal agenesis and hypoplasia, 5/4648 vs 0/6863 (RR 16.3, (95% CI 0.9-294); adjustment did not change results

State, maternal and paternal age, race, marital status, education, plurality, parity, prenatal visits, gestational weight gain, branch of service, military rank, prenatal alcohol exposure, intrauterine growth retardation, low birth weight, small for gestational age, preeclampsia

Limitations: California limited to diagnoses in nonmilitary hospitals; relies on availability of unique personal identifiers in military and birth certificate data, limited power to assess individual defects, multiple comparisons, limited to live births Strengths: population-based, including reservists, National Guard, former military personnel; includes defects diagnosed through first year, medically confirmed as opposed to self-reports, comparisons with prewar experience

Werler et al., 2005 (Vol. 4)

Case-control

HFM cases ≤ 3 years old (born 1996-2002) from craniofacial clinics in 24 US cities (n = 232); controls matched by age and pediatrician (n = 832)

HFM, facial asymmetry, or Goldenhar syndrome and no evidence of Mendelian inherited or chromosomal anomaly

Adjusted ORs: cases vs controls; parental army service, (OR 2.4, 95% CI 1.4-4.2); parental GW army service, (OR 2.8, 95% CI 0.8-9.6); any parental GW service (OR 0.8, 95% CI 0.3-2.3)

Family income, race, BMI in early pregnancy, multiple gestation

Limitations: unmeasured Lifestyle factors Strengths: included cases diagnosed up to of 3 years age



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