A study of the reproductive health of UK Gulf War veterans and the health of their children

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A study of the reproductive health of UK Gulf War
veterans and the health of their children
Funded by Ministry of Defence Administered by
Medical Research Council
Pat Doyle and Noreen Maconochie Dept
Epidemiology and Population Health London School
of Hygiene and Tropical Medicine
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Study design Retrospective occupational cohort
study with internal control group Study
cohort All UK armed forces personnel who served
in Gulf War Comparison cohort (ERA) A sample
of armed forces personnel who were in service at
the time of the Gulf War but who did not serve
there. Matched to study cohort by service, age,
sex, rank, fitness Data collection instruments
Postal forms sent to unit and home addresses
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• Outcome measures
• Miscarriage
• Stillbirth
• Congenital malformation
• Infertility

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RESPONSE RATES MEN
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RESPONSE RATES WOMEN
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PREGNANCIES CONCEIVED SINCE THE GULF WAR
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Fetal Death
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FETAL DEATH
In pregnancies reported by men
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FETAL DEATH
In pregnancies reported by women
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Congenital Malformation
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CONGENITAL MALFORMATION
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Congenital malformations reported by men Gulf
compared to ERA
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Congenital malformations reported by men
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Infertility
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Infertility reported by men
Indication that higher proportion of Gulf men
with infertility had teratospermia (abnormal
sperm structure) but numbers extremely small
Pregnancies fathered by Gulf veterans (with no
reported infertility) took longer to conceive
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CONCLUSIONS
WOMEN

• No evidence of an increased risk of miscarriage

• Too few stillbirths or malformations reported
  to analyse

• Too few pregnancies to permit meaningful
  analyses of infertility

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CONCLUSIONS
MEN

• No strong evidence for a link between paternal
  Gulf war service and increased risk of
  stillbirth or most structural
• malformations, chromosomal malformations, or
  syndromes in offspring

• Weak evidence for increased risk of
  malformations of
• the urinary system and musculoskeletal system

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CONCLUSIONS
MEN -continued

• The risk of reported miscarriage was higher in
  pregnancies fathered by Gulf war veterans

• The risk of reported infertility was higher for
  Gulf
• veterans

• Pregnancies fathered by Gulf veterans took
  longer to conceive than pregnancies fathered by
  ERA veterans

• No associations were found between risk of
  miscarriage and infertility in the Gulf group
  and reported exposures during the conflict

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CONCLUSIONS
MEN -continued

• In the interpretation of these findings we
  must consider
• the role of bias

• We cannot conclude at this stage that the
  associations
• we have found are causal

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RECOMMENDATIONS

• Further analysis of the data we have and
  systematic comparisons with other reported
  studies

• Prospective investigation of the reproductive
  health of veterans of the current conflict