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ABSTRACT: To evaluate three modes of questionnaire completion (online, mail, and telephone) and a choice group for a questionnaire survey with a sensitive topic.
A randomized trial of alternative completion methods (online, paper [mail], telephonic interview, and a choice of the three modes) for a survey about fertility problems embedded within a population-based cross-sectional survey of reproduction among women living in England and Wales.
From an initial cohort of 21,036 women who were sent a screening questionnaire, 4,559 responded. A total of 699 women reported fertility problems, of whom 593 (85%) agreed to participate. A total of 521 (75%) of the 699 women then completed the survey. Compared with the "mail" arm, those allocated to telephonic interview were less likely to agree to participate initially (odds ratio [OR], 0.41; 95% confidence interval [CI]: 0.22, 0.74) but were ultimately more likely to complete the questionnaire (OR, 2.20; 95% CI: 1.01, 4.80). Overall, those allocated to the choice arm were most likely to go through to completion (80% vs. 77% mail, 72% telephone, and 68% online groups). In the choice arm, women showed a clear preference for mail (59% vs. 37% choosing online and 3% telephonic response).
Online surveys are a viable alternative to mailed questionnaires but were not as popular as mail in this study population. Response can possibly be increased by offering women a choice of response modes.
Journal of clinical epidemiology 02/2013; 66(2):226-35. · 2.96 Impact Factor
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ABSTRACT: BACKGROUND: Motor neuron disease (MND) is a severe neurodegenerative disease with largely unknown etiology. Most epidemiological studies are hampered by small sample sizes and/or the retrospective collection of information on behavioural and lifestyle factors. METHODS: 1.3 million women from the UK Million Women Study, aged 56 years on average at recruitment, were followed up for incident and/or fatal MND using NHS hospital admission and mortality data. Adjusted relative risks were calculated using Cox regression models. FINDINGS: During follow-up for an average of 9.2 years, 752 women had a new diagnosis of MND. Age-specific rates increased with age, from 1.9 (95% CI 1.3 - 2.7) to 12.5 (95% CI 10.2 - 15.3) per 100,000 women aged 50-54 to 70-74, respectively, giving a cumulative risk of diagnosis with the disease of 1. 74 per 1000 women between the ages of 50 and 75 years. There was no significant variation in risk of MND with region of residence, socio-economic status, education, height, alcohol use, parity, use of oral contraceptives or hormone replacement therapy. Ever-smokers had about a 20% greater risk than never smokers (RR 1.19 95% CI 1.02 to 1.38, p=0.03). There was a statistically significant reduction in risk of MND with increasing body mass index (pfor trend=0.009): obese women (body mass index, 30 kg/m2 or more) had a 20% lower risk than women of normal body mass index (20 to <25 Kg/m2)(RR 0.78 95% CI 0.65-0.94; p=0.03). This effect persisted after exclusion of the first three years of follow-up. Interpretation. MND incidence in UK women rises rapidly with age, and an estimated 1 in 575 women are likely to be affected between the ages of 50 and 75 years. Smoking slightly increases the risk of MND, and adiposity in middle age is associated with a lower risk of the disease.
BMC Neurology 05/2012; 12(1):25. · 2.17 Impact Factor
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ABSTRACT: Although infertility is an important public health problem, treatment can be expensive and resources are increasingly scarce. This study investigates possible inequalities in the use of medical services for fertility problems. We analysed data from a population-based survey for associations between socio-economic characteristics and help-seeking or use of services, to establish whether inequalities existed. More women of higher social status and education reported fertility problems, but there was no clear trend in help-seeking, investigations or treatments for infertility by social status and education level. New work is planned to investigate these issues more fully, particularly the role of family income.
Human Fertility 12/2010; 14(1):16-22. · 1.38 Impact Factor
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ABSTRACT: Cadmium is known to be a significant health hazard, but most information comes from studies of adults. The effects of exposure to cadmium during fetal life on early growth and development remain uncertain. In this study we investigated the placental transport of cadmium and the effects of prenatal cadmium exposure on fetal and child growth in Taiwan.
The data in this study were from a birth cohort study in Taiwan which started in 2004. Pregnant women were recruited from four hospitals and interviewed after delivery to collect information on themselves and their infants. Children were followed up to obtain information on growth up to 3years of age. Whole blood cadmium concentrations in maternal and cord blood samples were measured and the relationship with birth size and growth assessed using linear regression and mixed models.
321 maternal blood samples and 402 cord blood samples were eligible for analysis. Among 289 pairs with maternal and cord blood suitable for measurement, the median cadmium concentration in cord blood (0.31μg/l) was less than that in maternal blood (1.05μg/l), with low correlation between the two (r=0.04). An increase in cord blood cadmium was found to be associated with newborn decreased head circumference and to be significantly and consistently associated with a decrease in height, weight and head circumference up to 3 years of age.
Placental transport of cadmium is limited. However, prenatal cadmium exposure may have a detrimental effect on head circumference at birth and child growth in the first 3years of life.
Occupational and environmental medicine 12/2010; 68(9):641-6. · 3.64 Impact Factor
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ABSTRACT: Epidemiological studies have found adverse birth and child health outcomes from prenatal lead exposure, but little is known about factors influencing placental transfer. In this study we describe the placental transfer of lead in a Taiwanese population, and investigate whether three essential metals - zinc, manganese, or selenium - influence transfer. Maternal and cord blood samples (308 pairs) from a birth cohort study were analyzed using multiple linear regression. There was a clear correlation between mother and child lead concentration (r=0.48, p<0.001), although lead concentration in cord blood (mean=1.29, SD=0.72 microg/dL) was lower than that for mothers (mean=1.58, SD=1.11 microg/dL). Cord blood lead was lower where the mother had a higher blood concentration of zinc (p<0.001) or manganese (p=0.02). Thus maternal blood zinc and manganese, but not selenium, appeared to decrease the placental transfer of lead. These findings raise the possibility of reducing placental transfer of lead by increasing zinc levels via nutritional supplementation during pregnancy.
Reproductive Toxicology 03/2010; 29(4):443-6. · 3.23 Impact Factor
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Pharmacoepidemiology and Drug Safety 11/2009; 18(11):1119-20. · 2.53 Impact Factor
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ABSTRACT: Radiation-induced cytogenetic damage in somatic cells has raised concern that low-dose ionising radiation can also damage germ cells and influence gamete production and/or function, resulting in decreased fertility. Time to pregnancy (TTP) was used to investigate whether exposure to gamma-radiation affected fertility among the residents of cobalt-60-contaminated buildings in Taiwan.
This was a retrospective pregnancy-based study of 357 pregnancies born to 124 exposed couples. Both the cumulative dose and the dose rate for each pregnancy was estimated based on a physical dose reconstruction programme. The comparison population consisted of 612 pregnancies born to 225 couples randomly sampled from the Taiwan general population. Information on TTP was collected by personal interviews. Fecundability ratios (FRs) were calculated with a discrete proportional hazards model.
For exposed mothers, fertility decreased significantly when unprotected intercourse began during the period of living in the radiation-contaminated buildings (FR 0.75, 95% CI 0.61 to 0.92). The effect was borderline significant for fathers (FR 0.83, 95% CI 0.68 to 1.02). There was evidence that prolonged TTP was associated with the rate of exposure for both mothers and fathers (tests for trend: female, p=0.0006; male, p=0.03), especially evident for dose rates > or =10 mSv/year (female, FR 0.60, 95% CI 0.43 to 0.84; male, FR 0.68, 95% CI 0.49 to 0.96).
Our findings suggest that exposure to low-dose ionising radiation of cobalt-60-contaminated buildings may decrease fertility, especially in females. Fertility declined with increasing concurrent dose but not with cumulative dose.
Occupational and environmental medicine 09/2009; 67(3):187-95. · 3.64 Impact Factor
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ABSTRACT: Current health inequality targets include the goal of reducing the differential in infant mortality between social groups. This article reports on a multivariate analysis of risk factors for infant mortality, with specific focus on deprivation and socio-economic status. Data on all singleton live births in England and Wales in 2005-06 were used and deprivation quintile (Carstairs index) was assigned to each birth using postcode at birth registration. Deprivation had a strong independent effect on infant mortality, risk of death tending to increase with increasing levels of deprivation. The strength of this relationship depended, however, on whether the babies were low birthweight, preterm or small-for-gestational-age. Trends of increasing mortality risk with increasing deprivation were strongest in the postneonatal period. Uniquely, this article reports the number and proportion of all infant deaths which would potentially be avoided if all levels of deprivation were reduced to that of the least deprived group. It estimates that one quarter of all infant deaths would potentially be avoided if deprivation levels were reduced in this way.
Health statistics quarterly / Office for National Statistics 01/2009; 42(1):22-39.
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ABSTRACT: This study used the data from a retrospective cross-sectional survey to describe the prevalence of smoking in pregnancy in a large UK sample, over more than 20 years of pregnancies. The main objective was to determine whether women in their second or subsequent pregnancy are more or less likely than primigravidae to change their smoking behaviour. The participants were 7506 ever-pregnant women, from 7702 who answered the second stage of a survey of reproductive history in 2001-02, sent to 10 828 women, aged 18-55 years on the UK electoral register. These women gave detailed information on their last pregnancy. The main outcome measure was self-reported cigarette consumption in the first trimester of pregnancy. Nineteen per cent (1417/7506) of women in this sample smoked in the first trimester of the reported pregnancy. The data showed that there had been a decrease over the last 20 years in smoking prevalence, but this trend was not statistically significant after adjustment for confounding (P(trend) = 0.07). There was evidence that multigravidae were more likely to smoke in their pregnancies than were primigravidae (adjusted OR = 1.24, [95% CI 1.01, 1.53]), with a highly significant trend with increasing pregnancy order (P(trend) < 0.0001). Over time, women who reported smoking before pregnancy (n = 1926), showed a decreasing trend in continuing to smoke the same amount after recognising their pregnancies (P(trend) < 0.0001). After adjustment, multigravid smokers were almost 75% more likely than primigravid smokers to continue to smoke with no change in consumption (adjusted OR = 1.74, [95% CI 1.32, 2.28]), with a clear trend found with increasing pregnancy order (P(trend) = 0.001). In this UK population-based study, multigravidae were more likely to smoke in pregnancy than women pregnant for the first time. If already a smoker, they were much less likely to cut down their smoking once they found out they were pregnant, regardless of age. This suggests that a great deal of the burden of morbidity associated with smoking in pregnancy is in the multigravid group.
Paediatric and Perinatal Epidemiology 06/2007; 21(3):201-9. · 2.31 Impact Factor
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Oona Campbell,
Michel Coleman,
Simon Cousens, Pat Doyle,
Diana Elbourne,
Stephen Evans,
Suzanne Filteau,
Paul E M Fine,
Judith R Glynn,
Emily Grundy, [......],
Laura C Rodrigues,
Isabel dos Santos Silva,
Liam Smeeth,
Egbert Sondorp,
Bianca De Stavola,
Ian M Timaeus,
Gill Walt,
John Whittaker,
Paul Wilkinson,
Basia Zaba
The Lancet 04/2007; 369(9566):987. · 38.28 Impact Factor
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ABSTRACT: The objective of the study was to examine pregnancy outcomes in women with systemic lupus erythematosus (SLE) and population controls in Trinidad. We performed a cross-sectional analysis of adverse outcomes in pregnancies of Afro-Caribbean women with SLE and without SLE. One hundred and twenty-two female adult cases of SLE and 203 neighbourhood age-matched women without SLE were interviewed concerning details of their reproductive history, and the anticardiolipin antibody (ACL) status was established for women with SLE. A total of 1,029 pregnancies were reported (356 by women with SLE, 673 by women without SLE). In women with > or = 1 pregnancy the total number of pregnancies was similar in women with a diagnosis of SLE and women without; however, a lower proportion of women with SLE had ever been pregnant compared with women without SLE (80% versus 91%, P = 0.002). In multivariate logistic regression analyses adjusted for maternal age, district of residence, pregnancy order and smoking, SLE pregnancies were more than twice as likely to end in foetal death than non-SLE pregnancies (odds ratio (OR), 2.4; 95% confidence interval (CI), 1.2-4.7). This effect was driven by a large increase in the odds of stillbirth (OR, 8.5; 95% CI, 2.5-28.8). The odds of early miscarriage (OR, 1.4; 95% CI, 0.6-3.1) and of mid-trimester miscarriage (OR, 1.9; 95% CI, 0.4-9.5) were higher, but were not statistically significantly different, in SLE pregnancies than in non-SLE pregnancies. The odds of ectopic pregnancy (OR, 7.5; 95% CI, 0.9-62.5) and of preterm birth (OR, 3.4; 95% CI, 1.2-10.0) were higher in SLE pregnancies conceived after diagnosis than in non-SLE pregnancies. There was no evidence of raised levels of IgG or IgM ACL among the majority (93/97 women, 96%) of SLE cases who reported sporadic mid-trimester miscarriage or stillbirth, although there was evidence of high levels of IgM and IgG ACL among women reporting three or more miscarriages and three consecutive miscarriages, and of raised IgG ACL among those experiencing ectopic pregnancy. In conclusion, we found evidence for a large increase in risk of stillbirth in the pregnancies of Afro-Caribbean Trinidadian women with SLE (not accounted for by high ACL status). There was some evidence of an increased risk of preterm delivery and ectopic pregnancy in pregnancies conceived after a diagnosis of maternal SLE.
Arthritis research & therapy 02/2007; 9(6):R124. · 4.27 Impact Factor
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ABSTRACT: Miscarriage is the most common adverse outcome in pregnancy. For many women it is a traumatic experience. Previous research has identified shortcomings in the emotional and social support provided for miscarriage sufferers but personal accounts of pregnancy loss remain relatively under-explored. The UK National Women's Health Study (NWHS) is a nationally representative survey of women's reproductive histories. It provided an opportunity to study accounts of miscarriage written in response to an invitation for further comments on the survey questionnaire. In conjunction with quantitative findings from the NWHS, we thematically analysed 172 detailed narratives that facilitated qualitative exploration of a characteristically private event. Analysis of the narratives suggested that few women who had planned their pregnancy were satisfied with fatalistic explanations of miscarriage. Those who were not given medical explanations for their loss engaged in complex searches for meaning, often linked to accounts of their moral deservedness as mothers. The narratives highlighted tensions between biomedical and lay understandings of pregnancy loss. There were reports of inappropriate medicalisation and a perceived lack of emotional support, but also a desire for medical validation of the reality of miscarriage and investigations to identify medical causes. Professionals' reported behaviour played a key role in women's accounts. These findings remind providers that: women do not experience miscarriage as a routine complication; medicalisation is both resisted and desired; and, for some women, more support and information is needed to assist their search for meaning.
Social Science [?] Medicine 11/2006; 63(7):1934-46. · 2.70 Impact Factor
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ABSTRACT: The United Kingdom Childhood Cancer Study (UKCCS) is a national multi-centre case-control study that was designed to evaluate the potential aetiological role of prenatal events in childhood cancer. The obstetric records of 2692 mothers of children diagnosed with cancer and 4864 mothers of children without cancer were available for analysis. Overall, 1754 (65%) case mothers and 3220 (66%) control mothers had at least one prior pregnancy before the birth of the index child. Of these, 12 (0.68%) of the former and 9 (0.28%) of the latter had a prior molar pregnancy (odds ratio 2.5, 95% confidence interval 1.1 - 6.1). Both childhood cancer and molar pregnancy are rare neoplastic events, and the numbers are small. Nonetheless, whilst the associations were strongest for common precursor B-cell acute lymphoblastic leukaemia (OR 5.2, 95% CI 1.9 - 14.7) and sarcoma (OR 6.2, 95% CI 1.3 - 30.3), the spread across the remaining diagnostic groups suggests that the relationship, if confirmed, may be of a generalized, rather than specific, type. This is the first time that an association between childhood cancer and hydatidiform mole has been reported. The UKCCS's systematic use of clinical records permitted a more precise characterization of reproductive events than is possible in investigations that rely on individuals own accounts, and we are confident that our findings cannot be explained by recall bias or other methodological limitations. Accordingly, we suggest that there may be an aetiologic connection between molar pregnancy and childhood cancer, and speculate here on the various genetic/epigenetic mechanisms that could be involved.
Human Fertility 10/2006; 9(3):171-4. · 1.38 Impact Factor
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ABSTRACT: There has been a Human Volunteer Programme at the British chemical weapons research facility at Porton Down since the First World War, in which some of the participants were exposed to chemical warfare agents.
To identify any striking specific morbidity patterns in members of the Porton Down Veterans Support Group (PDVSG).
A self-completed postal questionnaire was prepared including health immediately after the visits to Porton Down, subsequent diagnoses and hospital admissions, symptoms in, and after, the first 5 years after the visits, fatigue symptoms and current quality of life, measured using the SF-36.
Responses were received from 289 of 436 (66%). Results reported here relate to 269 male respondents of mean age 66.8 years. Sixty-six per cent reported their first visit to Porton Down in the 1950s. The most common diagnoses or hospital admissions reported were diseases of the circulatory system. In the first 5 years after their visits the most common symptoms were headache, irritability or outbursts of anger and feeling un-refreshed after sleep. In the later period, most common symptoms were fatigue, feeling un-refreshed after sleep and sleeping difficulties. Sixty-five per cent met the definition for a case of 'fatigue'. Current quality of life dimensions were consistently lower than age-specific estimates from general population samples.
Members of the PDVSG responding to this survey reported poorer quality of life than the general population. Despite there being no clear pattern of specific morbidities, we cannot rule out ill-health being potentially associated with past experience at Porton Down.
Occupational Medicine 09/2006; 56(5):329-37. · 1.14 Impact Factor
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ABSTRACT: Major congenital malformations place a considerable burden on the affected child, the family and society. Any kind of medicine used during pregnancy might have a harmful impact; therefore, such practice has raised concerns. The objective of the current study was to explore the relationship between the use of herbal medicines by pregnant women during the first trimester of pregnancy and the risk of major congenital malformation in their live born infants.
This was a cross-sectional analysis of data from a prospective pregnancy cohort, which was established between 1984 and 1987. To assemble the cohort, pregnant women of >or=26 weeks of gestation who came to the Taipei Municipal Maternal and Child Hospital in Taiwan for prenatal care were enrolled in the study and interviewed using a structured questionnaire. Detailed information, including herbal medicine use during different periods of pregnancy, was obtained during the interview. Past medical history, current obstetric data and details on conventional medicines used during pregnancy were abstracted from medical records. Data on birth weight, gestational duration and characteristics of live born infants were gathered from the Taiwan national birth register. Congenital malformation information was obtained from multiple sources: the newborn examination record (1984-7); the national death register (1984-2003); and Taiwan National Health Insurance data (1996-2000). Multiple logistic regression was used to estimate the odds ratio [OR] of major congenital malformation by herbal medicines used during the first trimester.
A total of 14,551 live births were analysed. After adjustment for confounding factors, taking huanglian during the first trimester of pregnancy was found to be associated with increased risk of congenital malformations of the nervous system (adjusted OR 8.62, 95% CI 2.54, 29.24). An-Tai-Yin was associated with an increased risk of congenital malformations of the musculoskeletal and connective tissues (adjusted OR 1.61, 95% CI 1.10, 2.36) and the eye (adjusted OR 7.30, 95% CI 1.47, 36.18).
We found evidence for a possible link between the use of specific herbal medicines during the first trimester of pregnancy and increased risks of specific groups of congenital malformations. We could not investigate whether the adverse effects were related to direct toxicity from the herbal medicines, or were from misuse, contamination or uncontrolled confounding. Nonetheless, we would advise caution regarding use of herbal medicines during pregnancy, and we suggest that further investigation of these findings is warranted.
Drug Safety 01/2006; 29(6):537-48. · 3.63 Impact Factor
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ABSTRACT: Miscarriage is a common event but is remarkably difficult to measure in epidemiological studies. Few large-scale population-based studies have been conducted in the UK.
This was a population-based two-stage postal survey of reproductive histories of adult women living in the United Kingdom in 2001, sampled from the electronic electoral roll. In Stage 1 a short "screening" questionnaire was sent to over 60,000 randomly selected women in order to identify those aged 55 and under who had ever been pregnant or ever attempted to achieve a pregnancy, from whom a brief reproductive history was requested. Stage 2 involved a more lengthy questionnaire requesting detailed information on every pregnancy (and fertility problems), and questions relating to socio-demographic, behavioural and other factors for the most recent pregnancy in order to examine risk factors for miscarriage. Data on stillbirth, multiple birth and maternal age are compared to national data in order to assess response bias.
The response rate was 49% for Stage 1 and 73% for the more targeted Stage 2. A total of 26,050 questionnaires were returned in Stage 1. Of the 17,748 women who were eligible on the grounds of age, 27% reported that they had never been pregnant and had never attempted to conceive a child. The remaining 13,035 women reported a total of 30,661 pregnancies. Comparison of key reproductive indicators (stillbirth and multiple birth rates and maternal age at first birth) with national statistics showed that the data look remarkably similar to the general population.
This study has enabled the assembly of a large population-based dataset of women's reproductive histories which appears unbiased compared to the general UK population and which will enable investigation of hard-to-measure outcomes such as miscarriage and infertility.
BMC Public Health 09/2004; 4:35. · 2.00 Impact Factor
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ABSTRACT: The proportion of multiple births has increased markedly since 1980 in England and Wales. A major contribution to this trend is thought to be the widespread introduction of assisted reproductive technologies. Despite a continuing (but slower) upward trend in twin maternities, analysis of recent data shows that the rate of triplet and higher order births in England and Wales has declined by one-quarter since 1998. This probably reflects both voluntary and statutory regulation of treatment regimes. This downward trend will help alleviate the high burden of perinatal morbidity and mortality associated with multiple births.
BJOG An International Journal of Obstetrics & Gynaecology 09/2004; 111(8):856-8. · 3.41 Impact Factor
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ABSTRACT: Forces deployed to the first Gulf War report more ill health than veterans who did not serve there. Many studies of post-Gulf morbidity are based on relatively small sample sizes and selection bias is often a concern. In a setting where selection bias relating to the ill health of veterans may be reduced, we: i) examined self-reported adult ill health in a large sample of male UK Gulf War veterans and a demographically similar non-deployed comparison group; and ii) explored self-reported ill health among veterans who believed that they had Gulf War syndrome.
This study uses data from a retrospective cohort study of reproduction and child health in which a validated postal questionnaire was sent to all UK Gulf War veterans (GWV) and a comparison cohort of Armed Service personnel who were not deployed to the Gulf (NGWV). The cohort for analysis comprises 42,818 males who responded to the questionnaire.
We confirmed that GWV report higher rates of general ill health. GWV were significantly more likely to have reported at least one new medical symptom or disease since 1990 than NGWV (61% versus 37%, OR 2.7, 95% CI 2.5-2.8). They were also more likely to report higher numbers of symptoms. The strongest associations were for mood swings (OR 20.9, 95%CI 16.2-27.0), memory loss/lack of concentration (OR 19.6, 95% CI 15.5-24.8), night sweats (OR 9.9, 95% CI 6.5-15.2), general fatigue (OR 9.6, 95% CI 8.3-11.1) and sexual dysfunction (OR 4.6, 95%CI 3.2-6.6). 6% of GWV believed they had Gulf War syndrome (GWS), and this was associated with the highest symptom reporting.
Increased levels of reported ill health among GWV were confirmed. This study was the first to use a questionnaire which did not focus specifically on the veterans' symptoms themselves. Nevertheless, the results are consistent with those of other studies of post-Gulf war illness and thus strengthen overall findings in this area of research. Further examination of the mechanisms underlying the reporting of ill health is required.
BMC Public Health 08/2004; 4:27. · 2.00 Impact Factor
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ABSTRACT: To examine the hypothesis that, theoretically at least, exposure to toxicants of the type present in the Gulf war could affect spermatogenesis, which might be observed as increased levels of infertility.
Retrospective reproductive cohort analysis.
Male UK Gulf war veterans and matched comparison group of non-deployed servicemen, surveyed by postal questionnaire.
42,818 completed questionnaires were returned, representing response rates of 53% for Gulf veterans and 42% for non-Gulf veterans; 10,465 Gulf veterans and 7376 non-Gulf veterans reported fathering or trying to father pregnancies after the Gulf war.
Failure to achieve conceptions (type I infertility) or live births (type II infertility) after the Gulf war, having tried for at least a year and consulted a doctor; time to conception among pregnancies fathered by men not reporting fertility problems.
Risk of reported infertility was higher among Gulf war veterans than among non-Gulf veterans (odds ratio for type I infertility 1.41, 95% confidence interval 1.05 to 1.89; type II 1.50, 1.18 to 1.89). This small effect was constant over time since the war and was observed whether or not the men had fathered pregnancies before the war. Results were similar when analyses were restricted to clinically confirmed diagnoses. Pregnancies fathered by Gulf veterans not reporting fertility problems also took longer to conceive (odds ratio for > 1 year 1.18, 1.04 to 1.34).
We found some evidence of an association between Gulf war service and reported infertility. Pregnancies fathered by Gulf veterans with no fertility problems also reportedly took longer to conceive.
BMJ (Clinical research ed.). 07/2004; 329(7459):196-201.
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ABSTRACT: To assess whether the offspring of UK veterans of the first Gulf war are at increased risk of fetal death or congenital malformation.
This was a retrospective reproductive cohort study of UK Gulf war veterans and a demographically similar comparison group who were in service at the time but were not deployed to the Gulf. Reproductive history was collected by means of a validated postal questionnaire between 1998 and 2001.
In all, 27 959 pregnancies reported by men and 861 pregnancies reported by women were conceived after the first Gulf war and before November 1997. The risk of reported miscarriage was higher among pregnancies fathered by Gulf war veterans than by non-Gulf war veterans (OR = 1.4, 95% CI: 1.3, 1.5). Stillbirth risk was similar in both groups. Male Gulf war veterans reported a higher proportion of offspring with any type of malformation than the comparison cohort (OR = 1.5, 95% CI: 1.3, 1.7). Examination by type of malformation revealed some evidence for increased risk of malformations of the genital system, urinary system (renal and urinary tract), and 'other' defects of the digestive system, musculo-skeletal system, and non-chromosomal (non-syndrome) anomalies. These associations were weakened when analyses were restricted to clinically confirmed conditions. There was little or no evidence of increased risk for other structural malformations, specific syndromes, and chromosomal anomalies. Among female veterans, no effect of Gulf war service was found on the risk of miscarriage. The numbers of stillbirths and malformations reported by women were too small to allow meaningful analyses.
We found no evidence for a link between paternal deployment to the Gulf war and increased risk of stillbirth, chromosomal malformations, or congenital syndromes. Associations were found between fathers' service in the Gulf war and increased risk of miscarriage and less well-defined malformations, but these findings need to be interpreted with caution as such outcomes are susceptible to recall bias. The finding of a possible relationship with renal anomalies requires further investigation. There was no evidence of an association between risk of miscarriage and mothers' service in the gulf.
International Journal of Epidemiology 03/2004; 33(1):74-86. · 6.41 Impact Factor
