Male fetal loss in the U.S. following the terrorist attacks of September 11, 2001

Public Health & Planning, Policy and Design, University of California at Irvine, Irvine, CA, USA.
BMC Public Health (Impact Factor: 2.26). 05/2010; 10(1):273. DOI: 10.1186/1471-2458-10-273
Source: PubMed


The secondary sex ratio (i.e., the odds of a male birth) reportedly declines following natural disasters, pollution events, and economic collapse. It remains unclear whether this decline results from an excess of male fetal loss or reduced male conceptions. The literature also does not converge as to whether the terrorist attacks of September 11, 2001 induced "communal bereavement", or the widespread feeling of distress among persons who never met those directly involved in the attacks. We test the communal bereavement hypothesis among gravid women by examining whether male fetal deaths rose above expected levels in the US following September 11, 2001.
We apply interrupted time-series methods to all fetal deaths at or greater than the 20th week of gestation in the US from 1996 to 2002. Time-series methods control for trends, seasonality, and other forms of autocorrelation that could induce spurious associations.
Results support the hypothesis in that the fetal death sex ratio (i.e., the odds of a male fetal death) increased above its expected value in September 2001. Additional analysis of the secondary sex ratio indirectly supports that the terrorist attacks may have threatened the gestation of male more than female fetuses.
Societal responses to events such as September 11, 2001 do not appear confined only to persons who have ever met the deceased. The fetal death sex ratio in the US population may serve as a sentinel indicator of the degree to which pregnant women react to population stressors.

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Available from: Tim Bruckner, Oct 05, 2015
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    • "More males are born preterm [1] and those that survive, have poorer outcomes [8] [9] [10]. Additionally, several studies demonstrate lower than expected live birth sex ratios (i.e., the ratio of male to female live births) following natural and manmade disasters , such as the terror attacks of September 11, 2001 [11] and periods of economic decline [12]. "
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    ABSTRACT: To test for gender-differences in the relation between mothers' antenatal anxiety and infants' body weight during gestation, at birth, and at 1-month of age. Two hundred and twelve randomly-recruited women were divided into two groups: Controls (n=105) and Anxious Group (n=107) based on a standard cut-off of the Beck Anxiety Inventory. Outcome measures were Fetal Weight derived from biometrics obtained from an ultrasound scan in the 3rd trimester and infants' weight at birth and at 1-month of age, both obtained from medical records. Multivariate analyses showed main effects of Gender on infants' birth weight (P=.001) and on infants' weight at 1-month of age (P=.004), but no main effects of Anxiety Group at any time-point. Gender x Anxiety Group interactions at all three time points (Fetal weight: P=.05; Birth weight: P=.03; 1-month of age: P=.10) reflected gender differences (males>females) among infants in the anxious group, but not among controls. Distinct trends regarding same sex comparisons across groups (Control vs. Anxiety) were in line with predictions (male controls<male anxious; female controls>females anxious). Controlling for Postpartum Anxiety and Antenatal and Postpartum Depression in the models did not affect primary results. Gender differences in fetal and birth weight were more substantial among infants of anxious mothers than among controls due to the seemingly accelerated growth of "anxious" males and the diminution of weight among "anxious" females. Copyright © 2015 Elsevier Inc. All rights reserved.
    Journal of psychosomatic research 07/2015; DOI:10.1016/j.jpsychores.2015.07.006 · 2.74 Impact Factor
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    • "We specified employment with no lag (i.e., employment the same month as CD) as well as in lags of 1 and 2 months (i.e., employment one and two months before CD) to ensure capturing any delayed associations induced near the end stage of gestation. This time lag is consistent with literature reporting male-specific responses to population shocks within a few months [17,20,21]. Fourth, we inspected the residual values of the error term to ensure that they exhibited no temporal patterns. "
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    ABSTRACT: Background In light of the recent Great Recession, increasing attention has focused on the health consequences of economic downturns. The perinatal literature does not converge on whether ambient economic declines threaten the health of cohorts in gestation. We set out to test the economic stress hypothesis that the monthly count of cesarean deliveries (CD), which may gauge the level of fetal distress in a population, rises after the economy declines. We focus on male CD since the literature reports that male more than female fetuses appear sensitive to stressors in utero. Methods We tested our ecological hypothesis in California for 228 months from January 1989 to December 2007, the most recent data available to us at the time of our tests. We used as the independent variable the Bureau of Labor Statistics unadjusted total state employment series. Time-series methods controlled for patterns of male CD over time. We also adjusted for the monthly count of female CD, which controls for well-characterized factors (e.g., medical-legal environment, changing risk profile of births) that affect CD but are shared across infant sex. Results Findings support the economic stress hypothesis in that male CD increases above its expected value one month after employment declines (employment coefficient = -24.09, standard error = 11.88, p = .04). Additional exploratory analyses at the metropolitan level indicate that findings in Los Angeles and Orange Counties appear to drive the State-level relation. Conclusions Contracting economies may perturb the health of male more than female fetuses sufficiently enough to warrant more CD. Male relative to female CD may sensitively gauge the cohort health of gestations.
    BMC Pregnancy and Childbirth 06/2014; 14(1):198. DOI:10.1186/1471-2393-14-198 · 2.19 Impact Factor
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    • "Prenatal exposure to stress from conception onwards has been shown to alter birth outcomes including: increases in the percentage of infants born pre-term (defined as less that 37 weeks gestation) [1], an increase in the percentage of infants born at a low birth-weight (less than 2500 g) [1] and decreases to the secondary sex-ratio (an increase in the number of female infants born compared to male infants born). Although the biological and psychological drivers of these changes are not fully understood at present, stress-related changes to birth outcomes have been observed following exposure to: environmental disasters [2] [3] [4] [5] [6] [7] [8]; terrorist attacks [9] [10] [11]; wars [12] [13]; national economic decline [12] [14] [15]; severe life stress, such as the death of a partner or other child [16]; and racism [17]. Thus, as the intensity and frequency of environmental disasters continues to increase, reductions in gestational length and birthweight may present a significant challenge for public health and disaster policymakers. "
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    ABSTRACT: Previous studies show that shorter gestation, lower birth-weight and fewer male births can result from maternal exposure to environmental disasters. We examined the 2009 Black Saturday fires in Victoria, Australia using a population cohort method. This study principally finds small but significant increases in pre-term birth (p=0.04) and decreases in birth-weight (p=0.001) in infants whose mothers were exposed to the fires late in the second trimester or during the third trimester. Because environmental disasters are an increasing threat and poor birth outcomes can have detrimental effects across the lifespan, understanding the relationship between environmental disasters and birth outcomes is important for future disaster policy.
    International Journal of Disaster Risk Reduction 09/2013; 5:98–106. DOI:10.1016/j.ijdrr.2013.08.002
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