Post-war environmental pollution as a risk factor of congenital disorders in Iraq: A study review Post-war environmental pollution as a risk factor of congenital disorders in Iraq: A study review
Main Article Content
Keywords
pollution, post-war,environmental, review article, congenital anomalies
Abstract
Background: Several years of war with the recent terrorist conflicts have cumulatively affected Iraq’s land, air, water, and health infrastructure, and a substantial rise in the incidence of congenital defects has been reported in the period following the Gulf War in 1991, which was principally accredited to the environmental contamination by depleted uranium.
Aim: The aim is to review some published works of literature that are specifically concerned with environmental pollution after the war in Iraq as a possible risk factor for developmental disorders.
Patients and Methods: In addition to the published articles, this review includes direct descriptive data of congenital anomalies, which was obtained from Al-Khansaa, Al-Salaam, Al-Batool Teaching Hospitals of Obstetrics and Gynecology, and General Mosul Hospital in Mosul city over a period of 12 months, starting from October 2017 to October 2018.
Results: All of the research related to this topic was discussed, and most of them revealed that a higher incidence of congenital disorders was detected among people exposed directly or indirectly to post-war environmental pollution by depleted uranium (DU) and other chemical constituents. From the analysis of the scientific publications, we observed that Basrah, Baghdad, Falluja, Mosul, and Al-Anbar are predominantly affected by war contamination. The study revealed that there were 317 cases of birth defects out of the 44,372 newborns delivered over a period of one year after the war in Mosul; thus, the overall percentage of congenital disorders was 0.71%, and defects of the nervous system were the most prominent, among which anencephaly was the predominant condition. The highest percentage of anomalies was detected in the maternal age of 21–26 and more in female newborns.
Conclusion: We must decrease parental exposure to the possible teratogens through prenatal counseling and public education about the penalties of environmental pollution in order to arrange practical guidelines for public health and to alleviate the outcome of pregnancy.
References
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46. Heintze E. Toxicity of depleted uranium complexes is independent of p53 activity. Inorganic Biochemistry. 2010;105:142–148.
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55. Al-Mendalawi M, Mahmoud I, Obed A, Al-Ameri L. Neural tube defects in Iraq. KCMJ. 2013;9(2):3–5.
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57. Al-Ani Z, Al-Hiali S, Al-Mehimdi S, et al. Neural tube defects among neonates delivered in Al-Ramadi Maternity and Children’s Hospital, western Iraq. SMJ. 2010;31(2):163–169.
58. Al-Azzawi SA. Depleted uranium and radioactive contamination in Iraq: an overview. Global Research.2015;(1):1–10.
59. Busby C, Hamdan M, Ariabi E. Cancer, infant mortality and birth sex-ratio in Fallujah, Iraq 2005–2009. Int J Environ Res Public Health. 2010;7(7):2828–2837.
60. Ghabili K, Agutter P, Ghanei M. Sulfur mustard toxicity: history, chemistry, pharmacokinetics, and pharmacodynamics. Critical Reviews in Toxicology. 2011;41(5):384–403.
61. Goverman J, Montecino R, Ibrahim A, Sarhane K, Tompkins R, Fagan S. Sulfur mustard gas exposure: case report and review of the literature. Ann Burns Fire Disasters. 2014;27(3):146-150.
62. Belal M. Effects of chemical weapons on cancer development in human. Kurdistan J of Applied Research. 2016;1(1):50–56.
63. Apostoli P, Catalani S. Metal ions affecting reproduction and development. Met Ions Life Sci. 2011;8:263–303.
64. Al-Hamawandi A, Della Ali F, Al-Diwan J, Al-Hadithi T, Al-Baldawi K, Diyaiy MA. Blood lead level among children in Al-Anbar governorate, Iraq. Al-Anbar Medical J. 2004;5(1):10–13.
65. Macdonell JE, Campbell H, Stone DH. Lead level in domestic water supplies
66. and neural tube defects in Glasgow. Arch Dis Child. 2000;82(1):50–53.
67. Chen E, Navier D, Padilla C, Deguen S. Effects of air pollution on the risk of congenital anomalies: a systematic review and meta-analysis. Int J Environ Res Public Health. 2014;11:7642–7668.
68. Atheer Q, Hiba M. Determination of uranium concentration in soil of Baghdad governorate and its effect on mitotic index assay. Iraqi J Sci. 2015;56(1):140–146.
69. Rhind S, Evans N, Bellingham M, Sharpe R, Cotinot C, Mandon-Pepin B, et al. Effects of environmental pollutants on the reproduction and welfare of ruminants. Animal. 2010;4(7):1227–1239.
70. Al-Sabbak M, Ali S, Savabi O, Savabi G, Dastgiri S, Savabieasfahani M. Metal contamination and the epidemic of congenital birth defects in Iraqi cities. Bull Environ Contam Toxicol. 2012;89(5):937–944.
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72. Al-Ansari N, Knutsson S, Almuqdadi K. Engineering solution for radioactive waste in Iraq. J Advanced Science and Engineering Research. 2014;4(1):18–36.
2. Mattison DR. Environmental exposures and development. Curr Opin Pediatr. 2010;22(2):208–218.
3. Gandhi MK, Chaudhi UR, Thakor N. A study on incidence of congenital anomalies in new borns and their association with fetal factors: a prospective study. Int J Res Med Sci. 2016;4(4):1200–1203.
4. Prajkta B, Gund P, Kar A. Prevalence of congenital anomalies in an Indian maternal cohort: healthcare, prevention, and surveillance implications. PLoS One. 2016;11(11):66–40.
5. Egbe AC. Birth defects in the newborn population: Race and ethnicity. Pediatrics & Neonatology. 2014;56(3):183–188.
6. Ritz B. Air pollution and congenital anomalies. Occup Environ Med. 2010;67(4):221–222.
7. Tripathy K, Nanda T, Sudharani OV. The influence of environmental and genetic factors on various disorders and diseases. Journal of Genetic Syndromes & Gene Therapy. 2011;15(1):15–20.
8. Vargesson N. Thalidomide-induced teratogenesis: history and mechanisms birth defects. Res C Embryo Today. 2015;105(2):140–156.
9. Al-Shammari AM. Environmental pollutions associated to conflicts in Iraq and related health problems. Rev Environ Health. 2016;31(2):245–250.
10. Marshall AC. Gulf war depleted uranium risks. J Expo Sci Environ Epidemiol. 2008;18(1):95–108.
11. Al-Sadoon I, Hassan GG, Yacoub A. Depleted uranium and health of people in Basrah: epidemiological evidence. Medical Journal of Basrah University. 1999;17:27–33.
12. Al-Alwani M, Alnuaimi AS. Prevalence of major fetal defects in Fallujah, Iraq. Open Journal of Obstetrics and Gynecology. 2014;4:569–577.
13. Alaani S, Savabieasfahani M, Tafash M, Manduca P, et al. Four polygamous families with congenital birth defects from Fallujah, Iraq. Int J Environ Res Publ Health. 2011;8(1):89–96.
14. Fathi RA, Matti L, Al-Salih H, Godbold D. Environmental pollution by depleted uranium in Iraq with special reference to Mosul and possible effects on cancer and birth defect rates. Med Confl Surviv. 2013;29(1):7–25.
15. Ansari TM, Marr IL, Tariq N. Heavy metals in marine pollution perspective – a mini review. J. of Applied Sciences. 2004;4(1):1–20.
16. Sadek ME, Seheimy AE, El-Tokhy TT, MA Allah. Management process of oil spill in water plants. J Pollut Eff Cont. 2017;5(4):205.
17. AbdolRazak T, Abdul Hameed M, Hisham M.Cobalt-60 and cesium-137 soil contamination in Al Tuwaitha nuclear site, using GIS technique. Engineering Technol J. 2014;32(13):3209–3215.
18. Al-Ansari N, Knutsson P, Almuqdadi S. Isolation of radioactive military wastes in Iraq. J Earth Sciences and Geotechnical Engineering. 2013;3(3):1–10.
19. Habib SA. The incidence of congenital malformation and associated risk factors in Basrah city. Fellowship of Iraqi Commission of Medical Specializations (ICMS) dissertation. ICMS Scientific Council of Pediatrics, Iraq; 1994.
20. Hameed NN. Analytic study of congenital malformations in four hospitals in Baghdad, Iraq. J Fac Med Baghdad. 2007;49:32–36.
21. Al Hosani HA, Czeizel AE. Congenital abnormalities in the United Arab Emirates. Teratology 2018;61(3):161–2.
22. Dastgiri S, Imani S, Kalankesh L, Barzegar M, Heidarzadeh M. Congenital anomalies in Iran: a cross-sectional study on 1574 cases in the north-west of country. Child Care Health Dev. 2007;33(3):257–261.
23. Al-Rabbaty A. Birth defects among neonates admitted to neonatal intensive care unit – Erbil Children and Maternity Hospital. Zanko Med J. 2001;5:66–78.
24. Feldkamp ML, Carey JC, Byrne JL, Krikov S, Botto LD. Etiology and clinical presentation of birth defects: population based study. BMJ. 2017;35(7):22–49.
25. Mohammed B, Mohammed A. congenital malformation pattern in Duhok city. J of Biology. 2015;5(8):120.
26. Abdurrahman KN. The prevalence of neural tube defects among newborns delivered in Azadi hospital in Duhok city, Kurdistan region, Iraq. Duhok Med J. 2007;1(1):42–48.
27. Al-Shammosy MM. Neural tube defects in Diwaniah: increasing incidence. In proceedings of the conference on the Effects of the Use of DU Weaponry on Human and Environment in Iraq: 26–27 March. Baghdad; 2002.
28. Al-Hadithi T, Al-Diwan J, Saleh A, Shabila N. Birth defects in Iraq and the plausibility of environmental exposure: a review. Confl Health. 2012;6:3.
29. Moorthie S, Blencowe H, Darlison M, Lawn J, Morris J, Modell B, et al. Estimating the birth prevalence and pregnancy outcomes of congenital malformations worldwide. J Phanum Fury Community Genet 2018;9(4):387–396.
30. Alaani S, Tafash M, Busby C, Hamdan M, Blaurock E. Uranium and other contaminants in hair from the parents of children with congenital anomalies in Fallujah, Iraq. Confl Health. 2011;5:15.
31. Feldkamp M, Carey J, Byrne J, Krikov S, Botto L. Etiology and clinical presentation of birth defects: population based study. BMJ. 2017;357:22–49.
32. Devi K, Devi R, Priya J, Sanaton A, Singh L, Murray L. Study of congenital anomalies in a tertiary care hospital in north east region, India. Int J Reprod Contracept Obstet Gynecol. 2018;7(7):2899–2903.
33. Ahmed M, Redondo S, Hamdan M. Nondisjunction and chromosomal anomalies. Salud Uninorte Barranquilla. 2010;26(1):117–133.
34. Taboo AZ. Prevalence and risk factors for congenital anomalies in Mosul city. The Iraqi Postgraduate Medical J. 2012;11(4):458–470.
35. Eke CB, Uche EO, Chinawa JM, Obi IE, Obu HA, Ibekwe RC. Epidemiology of congenital anomalies of the central nervous system in children in Enugu, Nigeria: a retrospective study. AnnAfr Med. 2016;15(3):126–132.
36. Sallout S, Al Reham A, Abdelmane A, Al Sulemat. Antenatal diagnosis, prevalence and outcome of major congenital anomalies in Saudi Arabia: a hospital-based study. Ann Saudi Med. 2010;28:272–76.
37. Tain YL, Luh H, Lin CY, Hsu CN. Incidence and risks of congenital anomalies of kidney and urinary tract in newborns: a population-based case-control study in Taiwan. Medicine. 2016;95(5):e2659.
38. Anwar WA, Khyatti M, Hemminki K. Consanguinity and genetic diseases in North Africa and immigrants to Europe. European J Public Health. 2014;24(1):57–63.
39. Arfsten DP, Still KR, Ritchie GD. A review of the effects of uranium and depleted uranium exposure on reproduction and fetal development. Toxicology and Industrial Health. 2001;17(10):180–191.
40. Caporali P, Cutuli D, Gelfo F, Laricchiuta D, Foti F, De Bartolo P. Pre-reproductive maternal enrichment influences offspring developmental trajectories: motor behavior and neurotrophin expression. Front Behav Neurosci. 2014;8(1):195.
41. Hon Z, Osterreicher J, Navratil L. Review depleted uranium and its effects on humans. Sustainability. 2015;7(1):4063–4077.
42. Edmands J, Brabander D, Coleman D. Uptake and mobility of uranium in black oaks: implications for biomonitoring depleted uranium-contaminated groundwater. Chemosphere. 2001;44(4):789–795.
43. Danesi E. Kinetic energy penetrator long term strategy study. US Army Armament, Munitions, and Chemical Command. 1990;5(1):20-25.
44. Bem H, Bou-Rabee F. Environmental and health consequences of depleted uranium use in the 1991 Gulf War. Environ Int. 2004;30(1):123–34.
45. Zwijnenburg W. Laid to waste: depleted uranium contaminated military scrap in Iraq. PAX. 2014;6(1):12–20.
46. Heintze E. Toxicity of depleted uranium complexes is independent of p53 activity. Inorganic Biochemistry. 2010;105:142–148.
47. Briner W. The toxicity of depleted uranium. Int J Environ Res Public Health. 2010;7(1):303–313.
48. McDiarmid M, et al., Measures of genotoxicity in Gulf War I veterans exposed to depleted uranium. Environmental and Molecular Mutagenisis. 2011;52(7):569–581
49. Thiebault C, Carriere M, Milgram S, Simon A, Avoscan L, Gouget B. Uranium induces apoptosis and is genotoxic to normal rat kidney proximal cells. Toxicological Sciences. 2007;98(2):479–487.
50. Milacic S, Petrovic D, Jovicic D, Kovacevic R, Simic J. Examination of the health status of populations from depleted uranium contaminated regions. Environmental Research. 2004;75: 2–10.
51. LaCerte C, Xie H, Aboueissa A, Wise J. Particulate depleted uranium is cytotoxic and clastogenic to human lung epithelial cells. Mutation Research. 2010;697:31–37
52. Hindin R, Brugge D, Panikkar B. Teratogencity of depleted uranium aerosols: a review from an epidemiological perspective. Environ Health. 2005;4:17.
53. Webster P. Questions raised over Iraq congenital birth defects study. The Lancet. 2013;382:1156–1166.
54. Weir D. Civilian protection, environmental pollution and conflict – a role for the public health community. Medicine, Conflict and Survival. 2015;31(1):4–12.
55. Al-Mendalawi M, Mahmoud I, Obed A, Al-Ameri L. Neural tube defects in Iraq. KCMJ. 2013;9(2):3–5.
56. AL-Barazanjy JS. Epidemiological study of congenital malformations in Baghdad. MSc thesis. Iraq: Al-Mustansiryah University, College of Medicine; 1989.
57. Al-Ani Z, Al-Hiali S, Al-Mehimdi S, et al. Neural tube defects among neonates delivered in Al-Ramadi Maternity and Children’s Hospital, western Iraq. SMJ. 2010;31(2):163–169.
58. Al-Azzawi SA. Depleted uranium and radioactive contamination in Iraq: an overview. Global Research.2015;(1):1–10.
59. Busby C, Hamdan M, Ariabi E. Cancer, infant mortality and birth sex-ratio in Fallujah, Iraq 2005–2009. Int J Environ Res Public Health. 2010;7(7):2828–2837.
60. Ghabili K, Agutter P, Ghanei M. Sulfur mustard toxicity: history, chemistry, pharmacokinetics, and pharmacodynamics. Critical Reviews in Toxicology. 2011;41(5):384–403.
61. Goverman J, Montecino R, Ibrahim A, Sarhane K, Tompkins R, Fagan S. Sulfur mustard gas exposure: case report and review of the literature. Ann Burns Fire Disasters. 2014;27(3):146-150.
62. Belal M. Effects of chemical weapons on cancer development in human. Kurdistan J of Applied Research. 2016;1(1):50–56.
63. Apostoli P, Catalani S. Metal ions affecting reproduction and development. Met Ions Life Sci. 2011;8:263–303.
64. Al-Hamawandi A, Della Ali F, Al-Diwan J, Al-Hadithi T, Al-Baldawi K, Diyaiy MA. Blood lead level among children in Al-Anbar governorate, Iraq. Al-Anbar Medical J. 2004;5(1):10–13.
65. Macdonell JE, Campbell H, Stone DH. Lead level in domestic water supplies
66. and neural tube defects in Glasgow. Arch Dis Child. 2000;82(1):50–53.
67. Chen E, Navier D, Padilla C, Deguen S. Effects of air pollution on the risk of congenital anomalies: a systematic review and meta-analysis. Int J Environ Res Public Health. 2014;11:7642–7668.
68. Atheer Q, Hiba M. Determination of uranium concentration in soil of Baghdad governorate and its effect on mitotic index assay. Iraqi J Sci. 2015;56(1):140–146.
69. Rhind S, Evans N, Bellingham M, Sharpe R, Cotinot C, Mandon-Pepin B, et al. Effects of environmental pollutants on the reproduction and welfare of ruminants. Animal. 2010;4(7):1227–1239.
70. Al-Sabbak M, Ali S, Savabi O, Savabi G, Dastgiri S, Savabieasfahani M. Metal contamination and the epidemic of congenital birth defects in Iraqi cities. Bull Environ Contam Toxicol. 2012;89(5):937–944.
71. Glenn C. Timeline: the rise, spread, and fall of the Islamic state. Wilson Center. 2016;6(1)1–5.
72. Al-Ansari N, Knutsson S, Almuqdadi K. Engineering solution for radioactive waste in Iraq. J Advanced Science and Engineering Research. 2014;4(1):18–36.
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Post-war environmental pollution as a risk factor of congenital disorders in Iraq: A study review: Post-war environmental pollution as a risk factor of congenital disorders in Iraq: A study review. Iraqi Natl J Med [Internet]. 2020 Jan. 15 [cited 2024 Nov. 14];2(1):1-12. Available from: https://iqnjm.com/index.php/homepage/article/view/14
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