April is the Month of the Military Child in recognition of the important role of children in military families and communities. What better way to celebrate military children than by protecting their health?

The Department of Defense (DoD) Birth and Infant Health Registry was established in 1998 by the Assistant Secretary of Defense for Health Affairs to do just that. At the time, the growing number of women on active duty, along with diverse occupational exposures associated with military service, prompted the establishment of the Registry, which is managed by the Deployment Health Research Department at the Naval Health Research Center (NHRC) in San Diego.

Around the time the Registry was established, military service members, veterans, and DoD officials began to raise questions about potential exposures experienced during Operation Desert Storm and their possible effects on reproductive health. The Registry quickly became a valuable tool for monitoring the health of both service members and of the youngest members of the DoD family-military children.

The Registry's goal is to explore possible relationships between military service and reproductive health. It does this by regularly gathering information about births among DoD service members or their spouses, applying scientific methods, and objectively researching infant health outcomes up to their first birthday. Registry researchers have access to large, DoD medical databases that capture all birth and health outcomes for infants born to military families.

Scientific Rigor

The databases used by Registry researchers include administrative and medical data such as diagnoses and procedures from health care providers in both inpatient and outpatient settings at military hospitals and clinics. When an infant is born or later receives care at a civilian hospital or clinic, as long as a TRICARE plan was used, researchers have access to their medical information as well.

NHRC researchers develop scientifically sound methods to evaluate epidemiologic associations between several birth outcomes and specific exposures of concern. The birth and infant health outcomes routinely examined include:

* Preterm birth
* Infant sex ratio (ratio of male infants to female infants)
* Birth weight
* Growth problems in utero and in infancy
* Birth defects

Parental exposures of concern include:

* Military occupation
* Geographical location
* Military-unique exposures such as deployments or specific vaccinations received during pregnancy

The Registry recently expanded to include pregnancies among DoD beneficiaries that may not have resulted in a live birth, such as miscarriages and stillbirths, as well as health outcomes among military children who remain part of the DoD family through early childhood. This will allow researchers to study childhood health outcomes that may not be diagnosed until after the first year of life, such as developmental delays.

Robust Research

Each year, approximately 90,000-120,000 infants are born to military families. Currently, the Registry includes infants born from 1998 through 2014, bringing the total number of infants whose health information has been captured by the Registry to over 1.6 million!

Using this information, researchers have made several important findings:

* Within the DoD, approximately 3-4 percent of infants born to service members or their spouses are diagnosed with a birth defect-this rate is similar to rates seen in civilian populations.
* Rates of preterm birth and growth problems are comparable to or lower than those in non-military populations.

Recent studies by NHRC on anthrax vaccination during pregnancy, H1N1 influenza vaccination during pregnancy, exposure to open-air burn pits while deployed, Operation TOMODACHI participation, and Gulf War deployment have also shown reassuring results, meaning rates of adverse outcomes of interest were not elevated.

In addition to the core work of the Registry, staff also manage two active enrollment pregnancy registries: the BioThrax® (Anthrax) Vaccine in Pregnancy Registry (BAVPR) and the National Smallpox Vaccine in Pregnancy Registry (NSVIPR). These registries enroll women who may have received the anthrax or smallpox vaccine during pregnancy or, in the case of smallpox vaccine, shortly before pregnancy.

Women who were vaccinated are contacted throughout their pregnancy and after the birth of their infant to complete periodic surveys. Both registries have provided reassuring results thus far, but enrollment efforts continue. Service women who are interested in learning more about BAVPR and/or NSVIPR enrollment may contact Registry staff at NHRC-VaccineRegistry@mail.mil or 619-553-9255/DSN 553-9255.

Protecting the Health of Military Families

NHRC's researchers-through the work of the Registry, BAVPR, and NSVIPR-are focused on monitoring and protecting the health of military families. They continue to address the unique reproductive health concerns of military families and contribute to the prevention of birth defects and other infant health challenges. Through these ongoing research and surveillance efforts, the Registry team adds to the medical community's understanding of associated risk factors and causes. All of this undoubtedly contributes to the health and well-being of DoD's most valuable resource: our service members and military children.


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