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Background: Lack of birth registers hindered knowledge of the frequency of birth defects (BD) in Fallujah, Iraq and comparison of changes in prevalence in time. One study found correlation between BD presentation and teratogenic metal load .
Methods: We obtained reproductive history, kin health, environmental exposure and historical residence of families. Hair was sampled from the nape of the neck from families and analyzed by ICP/MS for metal content.
Findings: BD in newborn in 2010 were about 14.7% . Data of reproductive history from 56 couples with child, overcoming the lack of previous data, shows pattern of increase in BD presentation since 1991. Information on parent's immediate kin in more than 1000 people, supports that BD are sporadic events. High residential stability of families allows to rule out local clusters for BD. Focus on load for ten teratogenic and carcinogenic metals (V, Cr, Co, As, Mo, Cd, W, U, Hg, Pb) in hair of 43 BD children and 103 their parents, and of 11 healthy newborns and 16 their parents, compared with that of 10 children and 8 adults controls outside the war area, shows that metal contamination is diffuse in the whole Fallujah population and is present already in newborn children hair. Absolute levels of major teratogenic and carcinogenic contaminants (V, Co, Mo, U and Pb) were significantly higher in Fallujah people than in controls from other areas, with Pb levels in BD children higher than other newborns in Fallujah.
Interpretation: Unusual high prevalence progressive in time and increased load of teratogenic metals even in new born hair are reported in Fallujah population. The extensive metal contamination persistent in people's hair in post-war environment and the composite metal load might be a major factor in the increase in time of stochastic events that lead to BD presentation.
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