An increased prevalence of birth defects was allegedly reported in Iraq in the post-1991 Gulf War period, which was largely attributed to exposure to depleted uranium used in the war. This has encouraged further research on this particular topic. This paper reviews the published literature and provides evidence concerning birth defects in Iraq to elucidate possible environmental exposure. In addition to published research, this review used some direct observation of birth defect data from Al-Ramadi Maternity and Paediatric Hospital in Al-Anbar Governorate in Iraq from 1st July 2000 through 30th June 2002.
Introduction
Birth defects are still the leading cause of perinatal mortality and childhood disability in developed countries. In contrast, in some developing countries where infant mortality remains very high, the leading causes of death are related to malnutrition and infection. However, birth defects in the developing world are largely underreported due to deficiencies in diagnostic capabilities and the lack of reliability in medical records and health statistics. Thus, an increase in birth defect rates should be handled with caution, as this could only be attributed to the use of more reliable diagnostic facilities or improvements in medical records.
The causes of most birth defects remain unknown, but the growing literature indicates that environmental factors may cause genetic mutations and interact with genetic factors predisposing to birth defects. Most birth defects can be considered to be of multifactorial causation due to a combination of environmental and genetic factors. Prevalence studies of birth defects are useful to establish baseline rates, document changes over time, and identify clues to etiology. They are also important for planning and evaluating antenatal screening for birth defects, particularly for high-risk populations.
Environmental Exposure and Birth Defects
Workers allegedly reported a high prevalence of birth defects in Basrah (south of Iraq) in the post-1991 Gulf War period, which was attributed to exposure to depleted uranium (DU) used in the war. This provided impetus for further research in this particular field in Iraq. This paper reviews the published literature and provides evidence concerning birth defects in Iraq to elucidate possible environmental exposure. The review also used some directly collected data on birth defects from Al-Ramadi Maternity and Paediatric Hospital in Al-Anbar Governorate. The data covered 12,831 live births and stillbirths from 1st July 2000 through 30th June 2002. All live-born neonates were physically examined by a pediatrician during the first three days of delivery, and birth defects were reported. Stillborn fetuses were only physically examined without autopsy.
Despite the significant environmental challenges faced by Iraq since 1980, the reviewed studies and available research evidence do not provide clear evidence of a significant increase in birth defects nor a clear indication of possible environmental exposure, including DU.
The Al-Anbar Study
The Al-Anbar study refers to the data collected from Al-Ramadi Maternity and Paediatric Hospital in Al-Anbar Governorate from 1st July 2000 to 30th June 2002. The study included 12,831 live births and stillbirths, and all live-born neonates were physically examined by a pediatrician during the first three days after delivery. The examination focused on the detection of birth defects, which were then documented. Stillborn fetuses were also physically examined but not subjected to autopsy.
While birth defects were observed during this study, no significant trends were found that could conclusively link them to environmental exposure, including depleted uranium. The review highlights the challenges in drawing definitive conclusions due to issues with health infrastructure, data collection, and diagnostic limitations.
Conclusion
The increase in birth defects reported in Iraq, particularly following the Gulf War, remains a source of concern. However, the available research does not provide definitive evidence linking environmental exposure, such as DU, to an increase in birth defects. As Iraq continues to face environmental and health challenges, further research is needed to fully understand the potential environmental causes of birth defects and improve healthcare delivery in the region.
In conclusion, while environmental exposure, including DU, may contribute to the reported increase in birth defects in Iraq, it is not possible to conclusively identify this as the primary cause. The complexities surrounding the issue require a more comprehensive approach to research, taking into account various environmental, social, and medical factors.
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