31, 2004, using a Cox proportional hazard model. Based on death certificates, among the 43,719 female Gulf War veterans, there was one death from ALS and none in the nondeployed female veterans; deployed male veterans also showed no increased risk for ALS. Ten female Gulf War veterans had died from brain cancer compared with 17 among the 99,027 nondeployed female veterans (rate ratio 1.50, 95% CI 0.68-3.30; adjusted for race, branch of service, type of unit, age, and marital status at entry to follow-up); men showed no increased risk for death from brain cancer. Being deployed did not increase the risk for MS or Parkinson’s disease for deployed women compared with nondeployed women or men (deployed or nondeployed).

Being a woman slightly increased the likelihood of being diagnosed with chronic multisymptom illness 10 years after the Gulf War regardless of whether the female veteran was deployed (OR 1.41, 95% CI 0.94-2.13) or nondeployed (OR 1.29, 95% CI 0.81-2.04) although the increase was not significant (Blanchard et al., 2005).

Several studies have assessed the risk of adverse reproductive outcomes in female veterans who were deployed to the Gulf War. Kang et al. (2001) used data from the 1996 National Health Survey of Gulf War Era Veterans and Their Families of 30,000 veterans to estimate rates of spontaneous abortions, stillbirths, preterm births, birth defects, and infant mortality between deployed and era veterans, both men and women. There were 632 deployed female veterans compared with 691 female nondeployed veterans. Female veterans who were deployed reported more miscarriages and stillbirths compared with female nondeployed veterans but the differences were not different and there were no significant differences for preterm births or infant death. Deployed women also were more likely than nondeployed women to report giving birth to a child with a likely birth defect (OR 2.97, 95% CI 1.47-5.99), particularly one with a moderate to severe birth defect (OR 2.80, 95% CI 1.26-6.25). Deployed men also reported having more children with a likely birth defect (OR 1.94, 95% CI 1.37-2.74) and that the birth defect was moderate to severe (OR 1.78, 95% CI 1.19-2.66). Reported birth defects were categorized by study pediatricians as likely or unlikely based on the participants’ descriptions of the infants’ birth defect. In a 2005 follow-up study of the same Gulf War veterans, Kang et al. (2009) asked female veterans (1225 deployed and 851 nondeployed) about gynecological and reproductive outcomes. Compared with nondeployed veterans, the deployed female veterans reported more serious problems with premenstrual moods (OR 1.28, 95% CI 1.13-1.45) and more difficulty getting pregnant (OR 2.20, 95% CI 1.50-3.22). However, more deployed women had given birth in the 6 months prior to the survey (OR 2.11, 95% CI 0.89-5.04) and had experienced fewer miscarriages in the past 6 months (OR 0.42, 95% CI 0.15-1.17).

In a study of reproductive outcomes in Gulf War veterans conducted in 1996, Wells et al. (2006) found that female veterans were not at increased risk of reporting an adverse pregnancy outcome (OR 1.16, 95% CI 0.91-1.48), whether miscarriage, stillbirth, or ectopic pregnancy, compared with nondeployed female veterans. There was also no difference in the likelihood of having a low, normal, or high birth weight infant between deployed female veterans and nondeployed female veterans.

Mental Health Effects

Pierce (1997) found that 24% of 160 women deployed to the Gulf War theater met the criteria for PTSD based on the Mississippi scale for combat-related PTSD compared with 15% of the female veterans deployed elsewhere.

In a study of the prevalence and course of PTSD in a cohort of 2949 Gulf War veterans from Fort Devens, Massachusetts, that included 240 women, Wolfe et al. (1999a) found that

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