Self-Reported Reproductive Outcomes Among Male and Female 1991 Gulf War era US Military Veterans

  • Timothy S. Wells
  • Linda Z. Wang
  • Christina N. Spooner
  • Tyler C. Smith
  • Katia M. Hiliopoulos
  • Deborah R. Kamens
  • Gregory C. Gray
  • Paul A. Sato
Original Paper


Background: Following the 1991 Gulf War, some veterans expressed concerns regarding their reproductive health. Our objective was to assess whether an association exists between deployment to the 1991 Gulf War and self-reported adverse pregnancy outcomes. Methods: Using a modified Dillman technique with telephone follow-up, we conducted a survey via a postal questionnaire from February 1996–August 1997 to compare selected reproductive outcomes among 10,000 US veterans deployed to the 1991 Gulf War with those of 10,000 nondeployed Gulf War era veterans. Results: A total of 8742 individuals responded to the survey, a response rate of 51 percent. Using multivariable analyses, results showed no differences in number of reported pregnancies between Gulf War veterans and nondeployed veterans. Among 2233 female and 2159 male participants, there were no differences in birth weight of infants born to Gulf War veterans compared with nondeployed Gulf War era veterans. In multivariable models, male and female Gulf War veterans did not significantly differ in risk for ectopic pregnancies, stillbirths, or miscarriages when compared with nondeployed veterans of the same era. Conclusions: These results do not suggest an association between service in the 1991 Gulf War and adverse reproductive outcomes for both male and female veterans during the 4 years after the war.


Gulf War Reproductive outcomes Birth weight Military 



The authors gratefully acknowledge the support of the following professionals: Dr. Gary Gackstetter, Dr. Tomoko Hooper, Dr. Karl Friedl, Robert J. Reed, Andrew Zau, Dr. Rebecca Calderon, Michael A. Dove from the Defense Manpower Data Center, and the Henry M. Jackson Foundation for the Advancement of Military Medicine. This represents report 05-15, supported by the Department of Defense, under work unit no. 60002. The views expressed in this article are those of the authors and do not reflect the official policy or position of the Department of the Navy, Department of the Air Force, Department of Defense, or the US Government. Approved for public release; distribution is unlimited. This research has been conducted in compliance with all applicable Federal Regulations governing the protection of human subjects in research (Protocol # 30276).


  1. 1.
    Committee to Review the Health consequences During the Persian Gulf War, Institute of Medicine. Health consequences of service during the Persian Gulf War: initial findings and recommendations for immediate action. Washington, DC: National Academy Press; 1995.Google Scholar
  2. 2.
    Fukuda K, Nisenbaum R, Stewart G, Thompson WW, Robin L, Washko RM, Noah DL, Barrett DH, Randall B, Herwaldt BL. Chronic multisymptom illness affecting Air Force veterans of the Gulf War. JAMA 1998;280(11):981–8.CrossRefPubMedGoogle Scholar
  3. 3.
    Centers for Disease Control and Prevention. Unexplained illness among Persian Gulf War veterans in an Air Force National Guard unit: August 1990–March 1995. MMWR 1995;44:443–7.Google Scholar
  4. 4.
    Briggs J, Miller K, Hudson D. The tiny victims of Desert Storm: Has our country abandoned them? Life 1995:45–61.Google Scholar
  5. 5.
    The Iowa Persian Gulf Study Group. Self-reported illness and health status among Persian Gulf War veterans: a population-based study. JAMA 1997;277(3):238–45.CrossRefGoogle Scholar
  6. 6.
    Gray GC, Reed RJ, Kaiser KS, Smith TC, Gastanaga VM. The Seabee Health Study: self-reported multi-symptom conditions are common and strongly associated among Gulf War veterans. Am J Epidemiol 2002;155:1033–44.CrossRefPubMedGoogle Scholar
  7. 7.
    Kang HK, Mahan CM, Lee KY, Magee CA, Murphy FM. Illnesses among United States veterans of the Gulf War: a population-based survey of 30,000 veterans. J Occup Environ Med 2000;42(5):491–501.PubMedGoogle Scholar
  8. 8.
    Zwerling C, Torner JC, Clarke WR, Voelker MD, Doebbeling BN, Barrett DH, Merchant JA, Woolson RF, Schwartz DA. Self-reported postwar injuries among Gulf War veterans. Public Health Rep 2000;115(4):346–9.CrossRefPubMedGoogle Scholar
  9. 9.
    Unwin C, Blatchley N, Coker W, Ferry S, Hotopf M, Hull L, Ismail K, Palmer I, David A, Wessely S. The health of United Kingdom servicemen who served in the Persian Gulf War. Lancet 1999;353:169–78.CrossRefPubMedGoogle Scholar
  10. 10.
    Steele L. Prevalence and patterns of Gulf War illness in Kansas veterans: association of symptoms with characteristics of person, place, and time of military service. Am J Epidemiol 2000;152(10):992–1002.CrossRefPubMedGoogle Scholar
  11. 11.
    Ismail K, Everitt B, Blatchley N, Hull L, Unwin C, David A, Wessely S. Is there a Gulf War syndrome? Lancet 1999;353(9148):179–82.CrossRefPubMedGoogle Scholar
  12. 12.
    Barrett DH, Gray GC, Doebbeling BN, Clauw DJ, Reeves WC. Prevalence of symptoms and symptom-based conditions among Gulf War veterans: current status of research findings. Epidemiol Rev 2002;24(2):218–27.CrossRefPubMedGoogle Scholar
  13. 13.
    Gray GC, Coate BD, Anderson CM, Kang HK, Berg SW, Wignall FS, Knoke JD, Barrett-Connor E. The postwar hospitalization experience of US veterans of the Persian Gulf War. N Engl J Med 1996;335(20):1505–13.CrossRefPubMedGoogle Scholar
  14. 14.
    Gray GC, Smith TC, Kang HK, Knoke JD. Are Gulf War veterans suffering war-related illnesses? Federal and civilian hospitalizations examined, June 1991 to December 1994. Am J Epidemiol 2000;151(1):63–71.PubMedGoogle Scholar
  15. 15.
    Knoke JD, Gray GC. Hospitalizations for unexplained illnesses among U.S. veterans of the Persian Gulf War. Emerg Infect Dis 1998;4(2):211–9.PubMedCrossRefGoogle Scholar
  16. 16.
    Smith TC, Gray GC, Knoke JD. Is systemic lupus erythematosus, amyotrophic lateral sclerosis, or fibromyalgia associated with Persian Gulf War service? An examination of Department of Defense hospitalization data. Am J Epidemiol 2000;151(11):1053–9.PubMedGoogle Scholar
  17. 17.
    Smith TC, Jimenez DL, Smith B, Gray GC, Hooper TI, Gackstetter GD, Heller JM, Dalager NA, Kang HK, Hyams KC. The postwar hospitalization experience of Gulf War veterans participating in US health registries. J Occup Environ Med 2004;46(4):386–97.PubMedGoogle Scholar
  18. 18.
    Smith TC, Corbeil TE, Ryan MA, Heller JM, Gray GC. In-theater hospitalizations of US and allied personnel during the 1991 Gulf War. Am J Epidemiol 2004;159(11):1064–76.CrossRefPubMedGoogle Scholar
  19. 19.
    Kang H, Bullman T. Mortality among US veterans of the Persian Gulf War. N Engl J Med 1996;355:1498–504.CrossRefGoogle Scholar
  20. 20.
    Writer JV, DeFraites RF, Brundage JF. Comparative mortality among US military personnel in the Persian Gulf region and worldwide during Operations Desert Shield and Desert Storm. JAMA 1996;275(2):118–21.CrossRefPubMedGoogle Scholar
  21. 21.
    Kang HK, Bullman TA, Macfarlane GJ, Gray GC. Mortality among US and UK veterans of the Persian Gulf War: a review. J Occup Environ Med 2002;59(12):794–9.CrossRefGoogle Scholar
  22. 22.
    Jones E, Vermaas RH, Beech C, Palmer I, Hyams K, Wessely S. Mortality and postcombat disorders: UK veterans of the Boer War and World War I. Military Medicine 2003;168(5):414–8.PubMedGoogle Scholar
  23. 23.
    Gray GC, Smith TC, Knoke JD, Heller JM. The postwar hospitalization experience of Gulf War Veterans possibly exposed to chemical munitions destruction at Khamisiyah, Iraq. Am J Epidemiol 1999;150(5):532–40.PubMedGoogle Scholar
  24. 24.
    Kaiser KS, Hawksworth AW, Gray GC. Pyridostigmine bromide intake during the Persian Gulf War not associated with postwar handgrip strength. Mil Med 2000;165:165–8.PubMedGoogle Scholar
  25. 25.
    Smith TC, Heller JM, Hooper TI, Gackstetter GD, Gray GC. Are veterans of the Gulf War experiencing illness from exposure to Kuwaiti oil well fire smoke? Department of Defense hospitalization data examined. Am J Epidemiol 2002;155(10):908–17.CrossRefPubMedGoogle Scholar
  26. 26.
    Smith TC, Gray GC, Weir JC, Heller JM, Ryan MAK. Gulf War veterans and Iraqi nerve agents at Khamisiyah. Postwar hospitalization data revisited. Am J Epidemiol 2003;158:456–67.Google Scholar
  27. 27.
    US General Accounting Office. Operation desert storm: Potential for reproductive dysfunction is not being adequately monitored. Washington, DC: US GAO; 1994.Google Scholar
  28. 28.
    Sylvester R, Chambers D. New theory on “Gulf War syndrome”. Washington Times 1995 Oct 1;Sect D:8.Google Scholar
  29. 29.
    Stellman SD, Stellman JM, Sommer JF. Health and reproductive outcomes among American Legionnaires in relation to combat and herbicide exposure in Vietnam. Environ Res 1988;47(2):150–74.CrossRefPubMedGoogle Scholar
  30. 30.
    Penman AD, Tarver RS, Currier MM. No evidence of increase in birth defects and health problems among children born to Persian Gulf War veterans in Mississippi. Mil Med 1996;161(1):1–6.PubMedGoogle Scholar
  31. 31.
    Araneta MR, Schlangen KM, Edmonds LD, Destiche DA, Merz RD, Hobbs CA, Flood TJ, Harris JA, Krishnamurti D, Gray GC. Prevalence of birth defects among infants of Gulf War veterans in Arkansas, Arizona, California, Georgia, Hawaii, and Iowa, 1989–1993. Birth Defects Res Part A Clin Mol Teratol 2003;67(4):246–60.CrossRefPubMedGoogle Scholar
  32. 32.
    Araneta MR, Destiche DA, Schlangen KM, Merz RD, Forrester MB, Gray GC. Birth defects prevalence among infants of Persian Gulf War veterans born in Hawaii, 1989–1993. Teratology 2000;62(4):195–204.CrossRefPubMedGoogle Scholar
  33. 33.
    Araneta MR, Moore CA, Olney RS, Edmonds LD, Karcher JA, McDonough C, Hiliopoulos KM, Schlangen KM, Gray GC. Goldenhar syndrome among infants born in military hospitals to Gulf War veterans. Teratology 1997;56(4):244–51.CrossRefPubMedGoogle Scholar
  34. 34.
    Cowan DN, DeFraites RF, Gray GC, Goldenbaum MB, Wishik SM. The risk of birth defects among children of Persian Gulf War veterans. N Engl J Med 1997;336(23):1650–6.CrossRefPubMedGoogle Scholar
  35. 35.
    Maconochie N, Doyle P, Carson C. Infertility among male UK veterans of the 1990-1 Gulf War: reproductive cohort study. BMJ 2004;329(7459):196–201.CrossRefPubMedGoogle Scholar
  36. 36.
    Ishoy T, Andersson AM, Suadicani P, Guldager B, Appleyard M, Gyntelberg F, Skakkebaek NE. Major reproductive health characteristics in male Gulf War Veterans. The Danish Gulf War Study. Dan Med Bull 2001;48(1):29–32.PubMedGoogle Scholar
  37. 37.
    Sim M, Abramson M, Forbes A, Glass D, Ikin J, Ittak P, Kelsall H, Leder K, McKenzie D, McNeil J, Creamer M, Fritschi L. Australian Gulf Veterans’ Health Study 2003, Volume 2. Australia Commonwealth Department of Veterans’ Affairs; 2003.Google Scholar
  38. 38.
    Kang H, Magee C, Mahan C, Lee K, Murphy F, Jackson L, Matanoski G. Pregnancy outcomes among U.S. Gulf War veterans: a population-based survey of 30,000 veterans. Ann Epidemiol 2001;11:504–11.CrossRefPubMedGoogle Scholar
  39. 39.
    Araneta MR, Kamens D, Zau A, Gastanaga VM, Schlangen KM, Hiliopoulos K. Conception and pregnancy during the Persian Gulf War: the risk to women veterans. Ann Epidemiol 2004;14(2):109–16.CrossRefPubMedGoogle Scholar
  40. 40.
    Maconochie N, Doyle P, Davies G, Lewis S, Pelerin M, Prior S, Sampson P. The study of reproductive outcome and the health of offspring of UK veterans of the Gulf War: methods and description of the study population. BMC Public Health 2003;3(1):4.CrossRefPubMedGoogle Scholar
  41. 41.
    Executive order 12744: Designation of Arabian Peninsula areas, airspace and adjacent waters as a combat zone. Fed Regist 1991;56(15):2663.Google Scholar
  42. 42.
    Sever JL, Brenner AI, Gale AD, Lyle JM, Moulton LH, Ward BJ, West DJ. Safety of anthrax vaccine: an expanded review and evaluation of adverse events reported to the Vaccine Adverse Event Reporting System (VAERS). Pharmacoepidemiol Drug Saf 2004;13:825–40.CrossRefPubMedGoogle Scholar
  43. 43.
    Hotopf M, David AA, Hull L, Khalida I, Unwin C, Wessely S. Role of vaccinations as risk factors for ill health in veterans of the Gulf War: cross sectional study. BMJ 2000;320:1363–7.CrossRefPubMedGoogle Scholar
  44. 44.
    Dillman DA. Mail and internet surveys, the tailored design method. 2nd ed. New York, NY: John Wiley & Sons; 2000.Google Scholar
  45. 45.
    Knoke JD, Gray GC, Garland FC. Testicular cancer and Persian Gulf War service. Epidemiology 1998;9(6):648–53.CrossRefPubMedGoogle Scholar
  46. 46.
    Zeger SL, Liang KY. Longitudinal data analysis using generalized linear models. Biometrica 1986;73:13–22.CrossRefGoogle Scholar
  47. 47.
    SAS/STAT® Software. Version 9.0. Cary, NC: SAS Institute, Inc.; 2002.Google Scholar
  48. 48.
    Doyle P, Maconochie N, Davies G, Maconochie I, Pelerin M, Prior S, Lewis S. Miscarriage, stillbirth and congenital malformation in the offspring of UK veterans of the first Gulf War. Int J Epidemiol 2004;33(1):74–86.CrossRefPubMedGoogle Scholar
  49. 49.
    Centers for Disease Control and Prevention. Health status of Vietnam veterans. JAMA 1988;259(18):2715–19.Google Scholar
  50. 50.
    Hemminki E, Forssas E. Epidemiology of miscarriage and its relation to other reproductive events in Finland. Am J Obstet Gynecol 1999;181(2):396–401.CrossRefPubMedGoogle Scholar
  51. 51.
    Eisner V, Brazie JV, Pratt MW, Hexter AC. The risk of low birthweight. Am J Public Health 1979;69(9):887–93.PubMedGoogle Scholar
  52. 52.
    Healy AJ, Malone FD, Sullivan LM, Porter TF, Luthy DA, Comstock CH, Saade G, Berkowitz R, Klugman S, Dugoff L, Craigo SD, Timor-Tritsch I, Carr SR, Wolfe HM, Bianchi DW, D’Alton ME. Early access to prenatal care: Implications for racial disparity in perinatal mortality. Obstet Gynecol 2006;107(3):625–31.PubMedGoogle Scholar
  53. 53.
    Laditka SB, Laditka NB, Probst JC. Racial and Ethnic Disparities in Potentially Avoidable Delivery Complications Among Pregnant Medicaid Beneficiaries in South Carolina. Matern Child Health J 2006 [Epub ahead of print].Google Scholar
  54. 54.
    Rosenberg TJ, Garbers S, Lipkind H, Chiasson MA. Maternal obesity and diabetes as risk factors for adverse pregnancy outcomes: differences among 4 racial/ethnic groups. Am J Public Health 2005;95(9):1545–51.CrossRefPubMedGoogle Scholar
  55. 55.
    Rosenberg TJ, Garbers S, Chavkin W, Chiasson MA. Prepregnancy weight and adverse perinatal outcomes in an ethnically diverse population. Obstet Gynecol 2003;102(5 Pt 1):1022–7.CrossRefPubMedGoogle Scholar
  56. 56.
    Haas M. Hypertension, race, and glomeruli: more than simply a numbers game. Kidney Int 2006;69(4)640–2.CrossRefPubMedGoogle Scholar
  57. 57.
    Ehrenberg HM, Dierker L, Milluzzi C, Mercer BM. Prevalence of maternal obesity in an urban center. Am J Obstet Gynecol 2002;187(5):1189–93.CrossRefPubMedGoogle Scholar
  58. 58.
    Alexander GR, Baruffi G, Mor JM, Kieffer EC, Hulsey TC. Multiethnic variations in the pregnancy outcomes of military dependents. Am J Public Health 1993;83(12):1721–5.PubMedCrossRefGoogle Scholar
  59. 59.
    Gray GC, Chesbrough KB, Ryan MA, Amoroso P, Boyko EJ, Gackstetter GD, Hooper TI, Riddle JR. Millennium Cohort Study Group. The Millennium Cohort Study: A 21-year prospective cohort study of 140,000 military personnel. Mil Med 2002;167(6):483–8.PubMedGoogle Scholar
  60. 60.
    Ryan MA, Pershyn-Kisor MA, Honner WK, Smith TC, Reed RJ, Gray GC. The Department of Defense Birth Defects Registry: overview of a new surveillance system. Teratology 2001;64(S1):S26–29.CrossRefPubMedGoogle Scholar
  61. 61.
    Kang HK, Mahan CM, Lee KY, Magee CA, Mather SH, Matanoski G. Pregnancy outcomes among U.S. women Vietnam veterans. Am J Ind Med 2000;38(4):447–54.CrossRefPubMedGoogle Scholar
  62. 62.
    Centers for Disease Control and Prevention. Infant mortality and low birth weight among black and white infants—United States, 1980–2000. MMWR 2002;51(27):589–92.Google Scholar
  63. 63.
    US Department of Health and Human Services. Chapter 16: Maternal, Infant, and Child Health. In: Healthy People 2010. Available at:
  64. 64.
    Martin JA, Park MM. Trends in twin and triplet births: 1980–1997. National vital statistics reports; Vol 47, No. 24. Hyattsville, MD: National Center for Health Statistics; 1999.Google Scholar

Copyright information

© Springer Science+Business Media, Inc. 2006

Authors and Affiliations

  • Timothy S. Wells
    • 1
    • 2
  • Linda Z. Wang
    • 1
  • Christina N. Spooner
    • 1
  • Tyler C. Smith
    • 1
  • Katia M. Hiliopoulos
    • 3
  • Deborah R. Kamens
    • 1
  • Gregory C. Gray
    • 4
  • Paul A. Sato
    • 5
  1. 1.Department of Defense Center for Deployment Health Research, Naval Health Research CenterSan DiegoUSA
  2. 2.Air Force Research LaboratoryWright-Patterson Air Force BaseDaytonUSA
  3. 3.PRA International, Inc.San DiegoUSA
  4. 4.University of IowaCollege of Public HealthIowa CityUSA
  5. 5.National Institutes of HealthBethesdaUSA

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