Wayne State University

WSU study examines relationship between '91 Gulf War exposure, birth outcomes

Bengt Arnetz
Hikmet Jamil
Robert Sokol

DETROIT - Data collected and analyzed at the Wayne State University School of Medicine in Detroit has resulted in what could be the first published work to examine the relationship between wartime environmental exposures and birth outcomes for children of men and women living in Iraq before and after the 1991 Gulf War.

“The key finding is that exposures to that war seem to be associated with an increase in adverse pregnancy outcomes,” said reproductive health expert Robert Sokol, M.D., the WSU distinguished professor of Obstetrics and Gynecology and the John M. Malone Jr., M.D., Endowed chair and director of the C.S. Mott Center for Human Growth and Development in Detroit.

The study also revealed a dose-response relationship between war-related environmental exposures and total number of adverse birth outcomes, especially for certain chemical exposures, and suggests primary care doctors in particular consider reproductive risks in pregnant mothers with a history of exposure to war.

“There’s very little data like this in the whole world. Most of the work involves veterans, not civilian populations,” Sokol added.

Adverse birth outcomes were defined as congenital anomalies, stillbirth, low birth weight and preterm delivery.

The study stresses the need to design better studies of reproductive health risks from war and conflicts, including those that consider the interaction between chemical and psychosocial stressors.

“You’ll collect, hopefully, better data the next time,” Sokol said. “It will be very helpful to know these kinds of things.”

Using data from interviews with 307 Iraqi families who immigrated to the United States, the WSU team compared mothers giving birth in Iraq before and after being exposed to the Gulf War, to those giving birth in the U.S. before or after the first Gulf War.

“1991 Gulf War Exposures and Adverse Birth Outcomes” is published in the April-June issue of the United States Army Medical Department Journal. While previous studies about the 1991 Gulf War implied potential exposure to psychological trauma and environmental stressors such as smoke from oil-burning fires, diesel or gas fumes and skin contact, burning trash, burning feces, nerve gas, mustard gas, contaminated water, depleted uranium and pesticides on clothing or bedding, little was known about how the war might affect an unborn child.

“There is generally a lack of good studies of the reproductive hazards of war in which there are both data on exposures as well as outcomes,” said Bengt Arnetz, M.D., Ph.D., WSU professor of Family Medicine and Public Health Sciences and the study’s principal investigator.

After adjusting for other risk factors, psychosocial stress/trauma did not relate significantly to adverse birth outcomes, Arnetz said.

Co-author Hikmet Jamil, M.D., Ph.D., WSU professor of Occupational and Environmental Health, lived in Iraq from 1991 to 1997, and in 1998 began voluntarily collecting the self-reported data from Iraqi immigrants living in Michigan. The Detroit area’s Iraqi population is estimated at more than 46,000, per the U.S. Census, making it the largest concentration in the country.

“In the literature review, we don’t see, until now, such type of impact of the environment on health,” Jamil said.

“We were surprised to see the high levels of adverse birth outcomes following the Gulf War. However, there are independent and smaller local studies in Iraq, and a few from Kuwait, suggesting adverse effects on the fetus from the war,” Arnetz said.

The study does not lend support to the popular, but so far unproved notion, that psychosocial stress per se induces adverse birth outcomes, he added.

Study participants lived both in and away from the war zone, and were also asked about socioeconomics and lifestyle. “We found that the mean number of adverse birth outcome per women increased from a pre-Gulf War prevalence of 3.43 to 4.63 in those that had experienced the Gulf War. There were no differences before the Gulf War in adverse birth outcome whether the birth had occurred in Iraq or the United States. This supports the notion that something associated with the Gulf War contributed to the findings,” Arnetz said.

The mean stress exposure increased by 2,300 percent from before to after the Gulf War, on the study scale. The mean environmental exposure increased by 1,900 percent.

“It might be that there are residual effects from the Gulf War exposures that affect reproductive health many years later. A weakness in our study is that we do not know the timing of birth, only whether they gave birth before or after the 1991 Gulf War,” Dr. Arnetz said. “We also need to develop better exposure measures of civilians’ exposures during war and conflict and how it might affect reproductive health.”

Study co-authors include statistician Michael Kruger and School of Medicine graduate Alexis Drutchas, M.D., Class of 2012.

Drs. Arnetz and Jamil’s work was funded by R01MH085793 from the National Institute of Mental Health, National Institutes of Health. The study was also funded by an unrestricted grant from Pfizer Inc.


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