National Birth Defect Registry Based on concept of alert - PowerPoint PPT Presentation

National Birth Defect Registry • Based on concept of “alert practitioner” • Identifies patterns of birth defects with the same or similar exposures • Collects data on maternal/paternal pre- conceptual and prenatal exposures • Cases dually identified by individual symptoms and overall syndrome or category name • Designed to raise hypotheses

Teratogens Identified by Alert Practitioners • Thalidomide • Rubella • Dilantin • DES • Alcohol • Methyl Mercury • Radiation

Scientific Advisory Board • Peter Kahn, Ph.D. • Shanna Swan, Ph.D. Rutgers University California Department of Health Services • James Murphy, Ph.D. • Maureen Paul, M.D. University of Colorado University of Massachusetts • Theo Colborn, Ph.D. • Wayland Swain, Ph.D. World Wildlife Fund Eco Logic Company • Stuart Newman, Ph.D. • Janette Sherman, M.D. New York Medical College Wayne State University

Registry Projects • Bendectin • Agent Orange • Gulf War • Community based - Dickson, TN - oral cleft cluster

Gulf War Exposures • DEET • Dursban • Malaria Pills • Permethrin • Dichlorvos • Campfires • Pyridostigmine • Ficam • Leishmaniasis • Pentachlorophenol • Carbaryl • Chemical warfare • Benzocaine sulfur • Lindane agents • Aluminum phospide • Malathion • CARC • Baygon • Oil Well Fires • Vaccinations • Boric Acid • Leaded fuels • D-phenothrin • Sevin • Depleted • Allethrin Uranium • Amidinohydrazone • Paint • Solvents • Diazinon • Others • Decontam agent

Disability Frequency • Resp. Infect. 117 • VSD 35 • Ear Infect. 92 • Drug Reaction 34 • Motor Delay 86 • Hypotonia 34 • Colic as Baby 62 • Seizures 33 • Speech 62 • Acne-like Rash 33 • Allergies 57 • Thrush 32 • Jaundice 56 • Mood Swings 32 • Reflux 52 • Pneumonia 29 • Heart Murmur 51 • Birth Mark 28 • High Fevers 46 • Stomach problems 28 • Ext. Ears 40 • Sleep disorder 26 • Asthma 38 • Walks on tiptoes 26 • Food Sens. 38 • Goldenhar 26 • Eczema 35 • Up. Limb Reduction 25

Male-Mediated Birth Defects Evidence from Experimental Possible Outcomes and Epidemiological Studies • Congenital malformations • Toluene • Spontaneous abortions • Benzene • Low birth weight • Lead/mercury • Childhood cancers • Trichloroethane • Developmental, neurobehavioral, • Solvents neuroendocrine, • Dyes neurochemical abnormalities • Cigarette smoke/alcohol • Drugs

Birth Defect Research for Children, Inc. National Birth Defect Registry – Children of GW Vets/ Non-GW Vets 3 2.44 2.5 2 1.46 Gulf War 1.5 Veteran 1.21 Non-GW 0.99 Veteran 1 0.5 0 Anencephaly Cortical Blindness N=3137 GW VETERAN: 410 NON-GW VET: 2727 – CNS Comp Cases per 100

Birth Defect Research for Children, Inc. National Birth Defect Registry – Children of GW Vets/ Non-GW Vets 12 9.76 10 8 6.1 Gulf War 6 5.12 Veteran 5.02 Non-GW 3.7 Veteran 4 2.97 2 0 AB/Undeveloped Intern Ears Ex Ear Defects Lung N=3137 GW VETERAN: 410 NON-GW VET: 2727 – Lung/Ear Comp Cases per 100

Birth Defect Research for Children, Inc. National Birth Defect Registry – Children of GW Vets/ Non-GW Vets 9 8.54 8 7 6.1 6 Gulf War 5 Veteran 4.03 4 Non-GW Veteran 3.04 3 1.95 1.95 2 0.95 0.92 1 0 Trans Gr Tetra of Fallot VSD ASD Vessels N=3137 GW VETERAN: 410 NON-GW VET: 2727 – Heart Defects Comp Cases per 100

Birth Defect Research for Children, Inc. National Birth Defect Registry – Children of GW Vets/ Non-GW Vets 4 3.41 3.5 3 2.44 2.5 Gulf War 2 Veteran 1.5 Non-GW 1.5 Veteran 1.14 1 0.73 0.73 0.37 0.5 0.15 0 Endo Cushion Pulm Valve Sten Tricus Valve Cardiomegaly Def Sten N=3137 GW VETERAN: 410 NON-GW VET: 2727 – Heart Defects Comp Cases per 100

Birth Defect Research for Children, Inc. National Birth Defect Registry – Children of GW Vets/ Non-GW Vets 4 3.41 3.5 3.17 3 2.44 2.5 2.2 2.05 Gulf War 2 Veteran Non-GW 1.5 Veteran 0.99 1 0.81 0.62 0.5 0 Hypo Left Heart Patent Ductus Coart Aorta Pulm Atresia N=3137 GW VETERAN: 410 NON-GW VET: 2727 – Heart Defects Comp Cases per 100

Birth Defect Research for Children, Inc. National Birth Defect Registry – Children of GW Vets/ Non-GW Vets 7 6.59 6 5 4 Gulf War Veteran Non-GW 3 2.71 Veteran 2 1.46 1 0.73 0.7 0.11 0 Trisomy Goldenhar Turners N=3137 GW VETERAN: 410 NON-GW VET: 2727 – Syndromes Comp Cases per 100

Birth Defect Research for Children, Inc. National Birth Defect Registry – Children of GW Vets/ Non-GW Vets 0.6 0.49 0.49 0.5 0.4 Gulf War 0.29 0.3 Veteran 0.24 Non-GW Veteran 0.2 0.11 0.1 0.07 0 TAR Cri Du Chat DiGeorge N=3137 GW VETERAN: 410 NON-GW VET: 2727 – Syndromes Comp Cases per 100

Birth Defect Research for Children, Inc. National Birth Defect Registry – Children of GW Vets/ Non-GW Vets 35 30 28.78 24.46 25 22.44 19.51 20 15 11.22 Gulf War 10 Veteran 7.8 7.74 Non-GW 4.39 5 Veteran 2.68 3.08 0 Up Res Infect Ear Infections Immune Def Thrush Unexplained Fevers N=3137 GW VETERAN: 410 NON-GW VET: 2727 – Immune Comp Cases per 100

Goldenhar Syndrome • Incidence ranges from 1/14,699 to 1/45,000 births • Associated with teratogens - Thalidomide - Primidone - Accutane • Some cases familial • Others “phenocopies” • Aranetta study found tripling of Goldenhar in GW children born in military hospitals

Goldenhar Case Study • 24 Goldenhar – fathers deployed • 7 Goldenhar critera fathers deployed • 2 Goldenhar fathers in Gulf after war • 33 Goldenhar associated with Gulf service

Goldenhar Case Study 7 Goldenhar fathers non-deployed 23344 Steel worker 22970 Shots/solvents 26815 Cont gear 26896 Shots/Naptha 30868 Shots/lead fuel 45947 mechanic 48695 Cont gear

Goldenhar Case Rates • 16 D Goldenhar DOB prior 10/1/93 • 3 ND Goldenhar DOB prior 10/1/93 • 56,782 births to deployed vets* • 68,908 births to non-deployed vets* Crude rates for Goldenhar: Deployed – 28 per 100,000 Non-deployed – 4 per 100,000 *Araneta, Teratology, 1997.

Goldenhar Details • Medical records confirmation 14/19 • 9/16 healthy children before GW • 2/16 healthy children after birth of child with Goldenhar Syndrome • 16/16 Goldenhar first born after GW

Goldenhar Case Study DOB Distribution 12 10 8 6 Goldenhar cases 4 2 0 1991 1992 1993 1994 1995 1996 1997 1998 1999 2001

All GW Birth Defects DOB Distribution 120 100 80 60 All BDs 40 20 0 1990 1992 1994 1996 1998 2000 2003

Pubished Studies • 1997 Teratology – Aranetta - tripling of Goldenhar Syndrome in GWV infants born in military hospitals • 2001 Ann of Epidemiology – Kang – increased reporting of birth defects significantly associated with military service in the Gulf War • 2003 Birth Defects Research – Aranetta – higher prevalence of tricuspid valve insufficiency, aortic valve stenosis and renal agenesis in infants conceived postwar by GWV fathers; hypospadias in boys born to GWV mothers • 2004 Internat. J. of Epidemiology – Doyle – increased risk of miscarriage, malformations of genital system, urinary system, digestive system, musculo-skeletal system and non-chromosome anomalies in children of GWV fathers

National Birth Defect Registry Now available on- line 24 hours a day….. www.birthdefects.org sponsored by Birth Defect Research for Children