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Agent Orange and Birth DefectsAgent Orange BriefD1
Prepared by the Environmental Agents Service (131)
VA Central Office, Washington, DC 20420
August 2005
Agent Orange and Birth DefectsDoes exposure to Agent Orange or service in Vietnam increase the likelihood of a veteran fathering a child with birth defects? One of the most emotional aspects of the Agent Orange issue is the concern that exposure to herbicides in Vietnam may have caused or contributed to the risks of having children with birth defects. Although thousands of Vietnam veterans have children with abnormalities, some background rate of birth defects must be expected. Considering that approximately 2.6 million veterans served in Vietnam and that 3-6 percent of all children are born with some kind of defect, scientists expect many children with abnormalities among the offspring of Vietnam veterans. Unfortunately, in most cases of all birth defects scientists cannot explain what caused these birth defects. Research has been conducted to determine whether exposure to Agent Orange or military service in Vietnam may have increased the risk of having children with birth defects. Based on the research completed to date, the overall answer seems to be "apparently not." In 1996, the National Academy of Sciences found that there is "limited/suggestive" evidence of an association between herbicide exposure and one rare birth defect, spina bifida. For information about spina bifida, see Agent Orange Brief, D11. The Australian birth defects study, the Centers for Disease Control (CDC) birth defects study, the Air Force Health Study (Ranch Hand), and the CDC Vietnam Experience Study all suggest that Agent Orange is not the most likely cause of the birth defects. These investigations are briefly summarized below. Later in this Brief, see the short discussion of the benefits and services available for Vietnam veterans' children born with spina bifida, and for women Vietnam veterans' children with certain birth defects. Case-Control Study of Congenital Anomalies and Vietnam Service (Birth Defects Study) - Report to the Minister for Veterans' Affairs - January 1983 - Prepared by J. W. Donovan and others. This Australian investigation involved examination of the hospital and laboratory records of infants born with birth defects in three populous areas of Australia between the years 1966 and 1979. In all, 34 hospitals and 4 laboratories cooperated fully with the investigating team. Whenever the birth of an infant with a defect was found, it was matched to a healthy control infant born in the same hospital, to a mother of similar age, and as close as possible in time to the birth of the child with the defect. The fathers of both cases (for this study, a case is a baby with a birth defect) and controls (for this study, a control is a baby without a birth defect) were identified in 8,517 instances and those identified were compared with a list of every man who served in the Australian Army between 1962 and 1972, the period of Australian involvement in Vietnam. Fathers who served in the Army during this period were then classified according to whether they had served in Vietnam. The important finding of the study is that 127 of the fathers of children with birth defects were Vietnam veterans and 123 veterans were among the fathers of healthy children. This indicates that there is no evidence that Army service in Vietnam increased the risk of fathering a child with a birth defect. Vietnam Veterans' Risks for Fathering Babies with Birth Defects - August 1984 - U.S. Department of Health and Human Services, Public Health Service, Centers for Disease Control, Center for Environmental Health. Vietnam veterans' risks for fathering babies with major structural birth defects were assessed using a case-control study. Information regarding military service in Vietnam was obtained from interviews with mothers and fathers of babies in case and control groups and from review of military records. Vietnam veterans did not have an increased risk of fathering babies with defects. Furthermore, Vietnam veterans who had greater estimated opportunities for Agent Orange exposure were not at greater risk for fathering babies with all types of defects combined. Air Force Health Study (Project Ranch Hand II) - An Epidemiologic Investigation of Health Effects in Air Force Personnel Following Exposure to Herbicides Periodic reports on morbidity (health problems). The February 1984 Baseline Morbidity Study Results indicated that there were no significant differences between the Ranch Hand (the military unit that did most of the herbicide spraying in Vietnam) and control groups with regard to severe or moderate birth defects. Based on parental reports, however, Ranch Hand offspring showed significantly more minor birth defects (birth marks, etc.). In 1992, the Air Force study compared blood dioxin levels with reproductive outcomes. All of the 791 Ranch Hands and 942 comparison subjects who have measured levels of dioxin in their blood were included in the study. It analyzed miscarriages, total adverse outcomes, total conceptions, birth weights, birth defects, birth defect severity, specific and multiple birth defects, and infant and neonatal deaths. In addition, the study looked at sperm counts and the percentage of abnormal sperm of study participants. Investigations found no adverse relationship between dioxin and any of these reproductive outcomes, nor between dioxin and sperm count or percentage of abnormal sperm. Health Status of Vietnam Veterans - Reproductive Outcomes and Child Health - The Centers for Disease Control Vietnam Experience Study - May 1988. The Vietnam Experience Study was a multidimensional assessment of the health of Vietnam veterans. From a random sample of enlisted men who entered the U.S. Army from 1965 through 1971, 7,924 Vietnam and 7,364 non-Vietnam veterans participated in a telephone interview; a random subsample of 2,490 Vietnam and 1,972 non-Vietnam veterans also underwent a comprehensive medical examination. Children of Vietnam veterans were not more likely to have birth defects recorded on hospital birth records than were children of non-Vietnam veterans. The rates of total, major, minor, and suspected defects were similar among children of Vietnam and non-Vietnam veterans. What did the National Academy of Sciences conclude about birth defects in its 1993 report, entitled Veterans and Agent Orange - Health Effects of Herbicides Used in Vietnam? The 800+page NAS report included the following statements: There is little evidence of a statistical association between father's occupational exposure to herbicides or dioxin and birth defects among offspring. The available epidemiologic studies have been limited by a number of problems, especially inadequate statistical power for the evaluation of specific birth defects. Studies involving environmental exposure have yielded inconsistent results; furthermore, given the ecologic nature of the studies, the limited sample sizes (for specific defects), and the failure to verify reported birth defects, the evidence can be considered inadequate for an association. The results of available epidemiologic studies of Vietnam veterans are also inconsistent; some studies suggest a potential association with defects of the central nervous system and other systems, although others find no increased risk. As noted for other end points, the veteran studies were generally limited by inadequate size, marginal magnitude of the increased risk, and the failure to exclude bias and chance. Moreover, uncertainty regarding the assessment of exposure among Vietnam veterans and the limited evidence from other cohorts do not permit one to draw a conclusion about an increased risk of birth defects among the offspring of men exposed to herbicides in Vietnam. Future analyses of the Ranch Hand data may contribute important evidence regarding an increased risk of birth defects. What has the NAS concluded about birth defects in its subsequent updates? The 1996 update included the following statements: There is limited/suggestive evidence between exposure to the herbicides considered in this report and spina bifida. There is inadequate or insufficient evidence to determine whether an association exists between exposure to herbicides and all other birth defects. The evidence regarding association is drawn from occupation and other studies in which subjects were exposed to a variety of herbicides and herbicide components. Since the strongest associations are from studies of Vietnam veterans and there are some data suggesting that the highest risks were for those veterans estimated to have had exposure to Agent Orange (e.g., Ranch Hands), it therefore follows that there is limited/suggestive evidence for an increased risk in Vietnam veterans of spina bifida in offspring. In Update 1998, there are no changes from Update 1996. In Update 1996, there was limited/suggestive evidence of an association between exposure to the herbicides considered in this report and spina bifida. There is inadequate or insufficient evidence to determine whether an association exists between exposure to herbicides and other birth defects. Laboratory studies, using adult male animals, of the potential male-mediated developmental toxicity of TCDD or herbicides, specifically with regard to birth defects are too limited to permit conclusions... The 2000 update included the following statement: There is no information reviewed in this report to change the conclusion that there is inadequate or insufficient evidence to determine whether an association exists between exposure to herbicides ... and other birth defects [than spina bifida]. The 2002 update stated that there were no new studies linking exposure to herbicides and birth defects in offspring of those affected. This statement is included in the 2002 update: there remains inadequate or insufficient evidence to determine whether an association exists between chemicals and other (than spina bifida) birth defects. What can a Vietnam veteran now assume about the risks of birth defects? The critical question is "Are Vietnam veterans more likely than other individuals to produce children with birth defects?" Based on all we know from the scientific research described above and studies of dioxin-contaminated areas in Times Beach, Missouri, and Seveso, Italy (where investigators concluded "that the data collected contain no evidence ... that in the population of the Seveso area exposed to dioxin, there was greater risk of producing congenitally malformed offspring."), Vietnam veteran men do not seem to be at increased risk of fathering children with birth defects (with the possible exception of spina bifida, for which there is "limited/suggestive" evidence of an association). What about the recent VA study on Women Vietnam veterans? In a recently completed VA study, women Vietnam veterans reported significantly more babies born with birth defects as compared to non-Vietnam women veterans. In this study, the risk of having children with birth defects was also significantly elevated among women Vietnam veterans after investigators made adjustments for demographic and military characteristics, and smoking and drinking histories of mothers. Similarly, the risk of having children with severe birth defects was significantly elevated among women Vietnam veterans. Over-reporting or selective recalls by women Vietnam veterans are considered unlikely explanations for these findings. A relatively small number of women served in Vietnam. Based on this evidence Secretary West asked Congress for statutory authority to provide certain benefits and service to children with birth defects who were born to women Vietnam veterans. The authority was granted in Public Law 106-419, signed by President Clinton on November 1, 2000. Implementing regulations, published July 31, 2002, December 6, 2002, and January 3, 2003, are retroactive to December 1, 2001. It is important to point out that in this case the association was with service in Vietnam and not specifically exposure to Agent Orange. What benefits/services are the Vietnam veterans children with spina bifida entitled to? What about the children with birth defects born to women Vietnam veterans? Under the provisions of Public Law 104-204 (and implementing regulations issued by VA), Vietnam veterans' children are eligible for monthly monetary allowance, ranging in 2005, from $244 to $1,440, based on the degree of disability; health care services related to spina bifida, and vocational training and rehabilitation (if feasible). For additional information about these benefits and services, see Agent Orange Brief D11. The provisions in the legislation (Public Law 106-419) authorizing benefits and services for the children with certain covered birth defects born to women Vietnam veterans was modeled on the spina bifida provisions in Public Law 104-204. The covered birth defects do not included condition due to familial (inherited) disorders, birth-related injuries, or fetal or neonatal infirmities with well-established causes. Thus, the benefits/services are quite similar for these two groups. Where can concerned veteran get additional information about birth defects? In October 1985, VA published a monograph entitled "Birth Defects and Genetic Counseling." This publication was distributed to all VA medical center libraries in 1985. The March of Dimes Birth Defects Foundation, the Easter Seal Society, and the Spina Bifida Association of America are good sources of information on this subject. Where can a veteran obtain additional information about Agent Orange-related issues? The Agent Orange Brief fact sheets (including the one you are reading) are on the World Wide Web at www.va.gov/AgentOrange. They also can be obtained from local VA medical centers or from the VA Central Office at the Environmental Agents Service (131) Department of Veterans Affairs, 810 Vermont Avenue, N.W., Washington, DC 20420. The following Briefs are available: A1.Agent Orange - General Information; A2.Agent Orange Class Action Lawsuit; B1.Agent Orange Registry Program; B2.Agent Orange - Health Care Eligibility; B3.Agent Orange and VA Disability Compensation; B4.VA Information Resources on Agent Orange and Related Matters; C1.Agent Orange - The Problem Encountered in Research; C2.Agent Orange and Vietnam Related Research - VA Projects; C3.Agent Orange and Vietnam Related Research - Non-VA Projects; D1.Agent Orange and Birth Defects; D2.Agent Orange and Chloracne; D3.Agent Orange and Non-Hodgkin's Lymphoma; D4.Agent Orange and Soft Tissue Sarcomas; D5.Agent Orange and Peripheral Neuropathy; D6.Agent Orange and Hodgkin's Disease; D7.Agent Orange and Porphyria Cutanea Tarda; D8.Agent Orange and Multiple Myeloma; D9.Agent Orange and Respiratory Cancers; D10.Agent Orange and Prostate Cancer; D11.Agent Orange and Spina Bifida; D12.Agent Orange and Diabetes; and D13.Agent Orange and Chronic Lymphocytic Leukemia. At the same site you will find copies of past and current issues of the "Agent Orange Review" newsletter and other items of interest. This fact sheet was prepared in August 2005 and does not include subsequent developments. Birth defects are abnormalities present at birth that result in mental or physical disabilities. VA recognizes a wide range of birth defects as associated with women Veterans' service in Vietnam. These diseases are not tied to herbicides, including Agent Orange, or dioxin exposure, but rather to the birth mother's service in Vietnam. Covered birth defects include, but are not limited to, the following conditions: Agent Orange: Birth Defects in Children of Women Vietnam Veterans http://www1.va.gov/agentorange/docs/D1AOBRIEF82005.doc "Don't worry, it only hurts plants."
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