Gulf War veterans and their children: Understanding Gulf War Illness

“I would do anything for them,” “I work hard so they can have a good life,” and “I want a better life for them,” are just some of the common phrases uttered and felt deeply by many parents about their children. But what happens if your job puts your children at increased risk of disease? More specifically, what happens if the environmental exposures you experienced while on the job put them at increased risk? How about if your children were at increased risk of disease as a result of a disease you have as a result of your job? These are all questions our Gulf War veterans have been asking themselves, asking researchers, and asking politicians for years following the discovery of Gulf War Illness.

What is Gulf War Illness?

Gulf War Illness is a multi-symptom disorder associated with veterans who served in the 1990-1991 Gulf War. Researchers are currently working to learn more about it, but there is still a lot to be understood. This includes its impact on the families of those who served.

The Research Advisory Committee on Gulf War Veterans’ Illness (RAC) identified a compelling need to determine if veterans who developed Gulf War Illness were also at increased risk for adverse birth outcomes, health problems affecting their offspring, and poorer reproductive health overall. The Committee also noted the lack of research evaluating these outcomes in relation to toxicant exposures during Gulf War deployment, several of which have been consistently linked to significantly increased risk for Gulf War Illness.

Limited work has been done to examine the reproductive health of Gulf War veterans and even less around examining the health of their children. One completed study suggests Gulf War Illness poses an increased risk for adverse pregnancy outcomes in both male and female veterans, including miscarriages.^6,7

The most extensive work thus far examined birth defects in children of Gulf War veterans. These studies have provided evidence of an increased rate of all birth defects in relation to Gulf War deployment^1,3,5, with additional studies identifying excess rates of specific birth defects that include a number of serious problems. These early indications of excess birth defects and reproductive anomalies in families of Gulf War veterans^1-3 have led to veterans expressing concern about the health of their family members, specifically their children. Panels of health experts are also pushing for studies to evaluate adverse health outcomes in relation to Gulf War service, Gulf War Illness, and Gulf War exposures due to these indications.⁴

The Department of Veterans Affairs established a family registry to evaluate spouses and children of Gulf War veterans enrolled in VA’s Gulf War Registry. Although these children of Gulf War veterans received detailed medical evaluations, no results have ever been reported.

Only one published study has examined the overall health of the children of Gulf War veterans with in-person physical examinations and parental ratings of behavioral and emotional problems in their children. This study examined children ages 2-18, grouped by age, and found that children of Gulf War veterans experienced worse dentition, greater obesity, and more behavioral problems compared to non-deployed veterans’ children, suggesting adverse health effects in children are associated with parental deployment to the Gulf War.⁸

In preliminary data from our group using the Northeastern and Southern Gulf War Women’s Cohort (Gulf War WC) Study data, the prevalence of Attention Deficit Hyperactive Disorder (ADHD) in children of veterans who were deployed to the Gulf War (31%) was nearly three times higher than that in the general population (9.4%). A similar pattern was seen with frequent behavioral problems where the rate in the children of Gulf War veterans (14.9%) was nearly double the prevalence reported in the U.S. (7.4%).

When evaluating rates in only those deployed to Gulf War veterans to examine the difference between those with and without Gulf War Illness, Gulf War veterans with Gulf War Illness had double the rate of ADHD in the children (31.4%) compared to the children of Gulf War veterans without Gulf War Illness (15.4%). Similarly, the rate of frequent behavioral problems was higher in the children of Gulf War veterans with Gulf War Illness (14.9%) compared to the children of Gulf War veterans without Gulf War Illness (7.7%).

Where do we go from here in our quest of better understanding the effects of Gulf War Illness?

Our research group has been recommended for funding to directly address these important questions. We plan to systematically assess birth, reproductive, and children’s health outcomes in a large cohort of well-characterized Gulf War veterans, comparing these measures in Gulf War Illness cases vs. Gulf War veteran controls in relation to deployment exposures of potential concern. Overall findings will be evaluated in the context of published rates in other military cohorts and the general population.

Until then, these questions remain unanswered.

Dr. Patricia Janulewicz is an Assistant Professor at the Boston University School of Public Health department of Environmental Health. She combines her expertise in environmental health, neurotoxicology, and teratology to examine how environmental exposures impact the nervous system. Her work spans the life-course and examines prenatal, early postnatal, childhood and adult exposures with a focus on Gulf War veterans.

Thank you to my research collaborators, including Kimberly Sullivan, Maxine Krengel, Timothy Heeren, Rosemary Toomey, and Alexa Friedman.

References

1. Doyle, P. et al. Miscarriage, stillbirth and congenital malformation in the offspring of UK veterans of the first Gulf war. Int J Epidemiol 33, 74–86 (2004).
2. Araneta, M. R. G. et al. Goldenhar syndrome among infants born in military hospitals to Gulf War veterans. Teratology 56, 244–251 (1997).
3. Araneta, M. R. G. et al. Prevalence of birth defects among infants of Gulf War veterans in Arkansas, Arizona, California, Georgia, Hawaii, and Iowa, 1989–1993. Birth Defects Research Part A: Clinical and Molecular Teratology 67, 246–260 (2003).
4. Veterans’ Illnesses, G. W. Research Advisory Committee on Gulf War Veterans’ Illnesses. (2004).
5. Kang, H. et al. Pregnancy Outcomes Among U.S. Gulf War Veterans: A Population-Based Survey of 30,000 Veterans. Annals of Epidemiology 11, 504–511 (2001).
6. Abu-Musa, A. A., Kobeissi, L., Hannoun, A. B. & Inhorn, M. C. Effect of war on fertility: a review of the literature. Reproductive BioMedicine Online 17, 43–53 (2008).
7. Kang, H. K., Li, B., Mahan, C. M., Eisen, S. A. & Engel, C. C. Health of US Veterans of 1991 Gulf War: A Follow-Up Survey in 10 Years. Journal of Occupational & Environmental Medicine 51, 401–410 (2009).
8. GULF WAR: WHAT KIND OF CARE ARE VETERANS RECEIVING 20 YEARS LATER? 79–944 (U.S. Government Publishing Office, 2013).
9. Toomey, R. et al. Physical Health, Behavioral and Emotional Functioning in Children of Gulf War Veterans. (2021).