Prevalence of birth defects among infants of Gulf War veterans in Arkansas, Arizona, California, Georgia, Hawaii, and Iowa, 1989-1993

BACKGROUND Epidemiologic studies of birth defects among infants of Gulf War veterans (GWV) have been limited to military hospitals, anomalies diagnosed among newborns, or self‐reported data. This study was conducted to measure the prevalence of birth defects among infants of GWVs and nondeployed veterans (NDV) in states that conducted active case ascertainment of birth defects between 1989–93. METHODS Military records of 684,645 GWVs and 1,587,102 NDVs were electronically linked with 2,314,908 birth certificates from Arizona, Hawaii, Iowa, and selected counties of Arkansas, California, and Georgia; 11,961 GWV infants and 33,052 NDV infants were identified. Of these, 450 infants had mothers who served in the Gulf War, and 3966 had NDV mothers. RESULTS Infants conceived postwar to male GWVs had significantly higher prevalence of tricuspid valve insufficiency (relative risk [RR], 2.7; 95% confidence interval [CI], 1.1–6.6; p = 0.039) and aortic valve stenosis (RR, 6.0; 95% CI, 1.2–31.0; p = 0.026) compared to infants conceived postwar to NDV males. Among infants of male GWVs, aortic valve stenosis (RR, 16.3; 95% CI, 0.09–294; p = 0.011) and renal agenesis or hypoplasia (RR, 16.3; 95% CI, 0.09–294; p = 0.011) were significantly higher among infants conceived postwar than prewar. Hypospadias was significantly higher among infant sons conceived postwar to GWV women compared to NDV women (RR, 6.3; 95% CI, 1.5–26.3; p = 0.015). CONCLUSION We observed a higher prevalence of tricuspid valve insufficiency, aortic valve stenosis, and renal agenesis or hypoplasia among infants conceived postwar to GWV men, and a higher prevalence of hypospadias among infants conceived postwar to female GWVs. We did not have the ability to determine if the excess was caused by inherited or environmental factors, or was due to chance because of myriad reasons, including multiple comparisons. Although the statistical power was sufficient to compare the combined birth defects prevalence, larger sample sizes were needed for less frequent individual component defects. Birth Defects Research (Part A) 67:246–260, 2003. Published 2003 Wiley‐Liss, Inc.