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

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

Mar 20, 2023 227 likes •491 views

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

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SLIDE 1
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SLIDE 2

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
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SLIDE 3

Teratogens Identified by Alert Practitioners

  • Thalidomide
  • Rubella
  • Dilantin
  • DES
  • Alcohol
  • Methyl Mercury
  • Radiation
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SLIDE 4

Scientific Advisory Board

  • Peter Kahn, Ph.D.

Rutgers University

  • James Murphy, Ph.D.

University of Colorado

  • Theo Colborn, Ph.D.

World Wildlife Fund

  • Stuart Newman, Ph.D.

New York Medical College

  • Shanna Swan, Ph.D.

California Department of Health Services

  • Maureen Paul, M.D.

University of Massachusetts

  • Wayland Swain, Ph.D.

Eco Logic Company

  • Janette Sherman, M.D.

Wayne State University

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SLIDE 5

Registry Projects

  • Bendectin
  • Agent Orange
  • Gulf War
  • Community based
  • Dickson, TN - oral cleft cluster
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SLIDE 6

Gulf War Exposures

  • DEET
  • Permethrin
  • Pyridostigmine
  • Pentachlorophenol
  • Benzocaine sulfur
  • Aluminum phospide
  • Baygon
  • Boric Acid
  • Sevin
  • Amidinohydrazone
  • Diazinon
  • Dursban
  • Dichlorvos
  • Ficam
  • Carbaryl
  • Lindane
  • Malathion
  • Oil Well Fires
  • Leaded fuels
  • Depleted

Uranium

  • Solvents
  • Decontam agent
  • Malaria Pills
  • Campfires
  • Leishmaniasis
  • Chemical warfare

agents

  • CARC
  • Vaccinations
  • D-phenothrin
  • Allethrin
  • Paint
  • Others
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SLIDE 7

Disability Frequency

  • Resp. Infect.

117

  • Ear Infect.

92

  • Motor Delay

86

  • Colic as Baby

62

  • Speech

62

  • Allergies 57
  • Jaundice

56

  • Reflux

52

  • Heart Murmur

51

  • High Fevers

46

  • Ext. Ears

40

  • Asthma

38

  • Food Sens.

38

  • Eczema

35

  • VSD

35

  • Drug Reaction

34

  • Hypotonia

34

  • Seizures

33

  • Acne-like Rash

33

  • Thrush

32

  • Mood Swings

32

  • Pneumonia 29
  • Birth Mark

28

  • Stomach problems

28

  • Sleep disorder 26
  • Walks on tiptoes

26

  • Goldenhar

26

  • Up. Limb Reduction 25
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SLIDE 8

Male-Mediated Birth Defects

Evidence from Experimental and Epidemiological Studies

  • Toluene
  • Benzene
  • Lead/mercury
  • Trichloroethane
  • Solvents
  • Dyes
  • Cigarette smoke/alcohol
  • Drugs

Possible Outcomes

  • Congenital malformations
  • Spontaneous abortions
  • Low birth weight
  • Childhood cancers
  • Developmental,

neurobehavioral, neuroendocrine, neurochemical abnormalities

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SLIDE 9

2.44 1.46 1.21 0.99 0.5 1 1.5 2 2.5 3

Anencephaly Cortical Blindness

Gulf War Veteran Non-GW Veteran 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

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SLIDE 10

6.1 5.12 9.76 3.7 2.97 5.02

2 4 6 8 10 12

AB/Undeveloped Lung Intern Ears Ex Ear Defects

Gulf War Veteran Non-GW Veteran 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

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SLIDE 11

1.95 1.95 8.54 6.1 0.95 0.92 4.03 3.04

1 2 3 4 5 6 7 8 9

Trans Gr Vessels Tetra of Fallot VSD ASD

Gulf War Veteran Non-GW Veteran 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

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SLIDE 12

0.73 3.41 0.73 2.44 0.15 1.5 0.37 1.14

0.5 1 1.5 2 2.5 3 3.5 4

Endo Cushion Def Pulm Valve Sten Tricus Valve Sten Cardiomegaly

Gulf War Veteran Non-GW Veteran 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

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SLIDE 13

2.44 3.41 3.17 2.2 0.81 2.05 0.99 0.62

0.5 1 1.5 2 2.5 3 3.5 4

Hypo Left Heart Patent Ductus Coart Aorta Pulm Atresia

Gulf War Veteran Non-GW Veteran 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

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SLIDE 14

1.46 6.59 0.73 0.7 2.71 0.11

1 2 3 4 5 6 7

Trisomy Goldenhar Turners

Gulf War Veteran Non-GW Veteran 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

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SLIDE 15

0.49 0.24 0.49 0.29 0.07 0.11

0.1 0.2 0.3 0.4 0.5 0.6

TAR Cri Du Chat DiGeorge

Gulf War Veteran Non-GW Veteran 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

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SLIDE 16

28.78 22.44 4.39 7.8 11.22 7.74 3.08 2.68 19.51 24.46

5 10 15 20 25 30 35

Up Res Infect Ear Infections Immune Def Thrush Unexplained Fevers

Gulf War Veteran Non-GW Veteran N=3137 GW VETERAN: 410 NON-GW VET: 2727 – Immune Comp Cases per 100

Birth Defect Research for Children, Inc.

National Birth Defect Registry – Children of GW Vets/ Non-GW Vets

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SLIDE 17

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

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SLIDE 18

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
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SLIDE 19

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

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SLIDE 20

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.

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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
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SLIDE 22

Goldenhar Case Study

DOB Distribution

2 4 6 8 10 12 1991 1992 1993 1994 1995 1996 1997 1998 1999 2001 Goldenhar cases

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SLIDE 23

All GW Birth Defects

DOB Distribution

20 40 60 80 100 120 1990 1992 1994 1996 1998 2000 2003 All BDs

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SLIDE 24

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

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SLIDE 25

National Birth Defect Registry

Now available on-line 24 hours a day…..

www.birthdefects.org

sponsored by Birth Defect Research for Children