Birth Outcomes Among Offspring of Women Exposed to the September 11, 2001, Terrorist Attacks

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OBJECTIVE:To evaluate the effects of the September 11, 2001, World Trade Center attacks on birth outcomes.METHODS:Live singleton births between September 11, 2001, and October 31, 2002, to women enrolled in a World Trade Center Health Registry (the Registry, n=446) were compared with births to women residing more than 5 miles from the World Trade Center (n=49,616). Birth weight, gestational age, low birth weight, and preterm delivery were evaluated using linear and logistic regression. Births before September 11, 2001, were analyzed to assess possible seasonal biases of associations with pregnancy trimester on September 11. Associations of birth outcomes with September 11–related psychologic stress and physical exposures were assessed among births to women within the Registry (n=499).RESULTS:Birth weight and gestational age distributions were similar for births to women enrolled in the Registry and comparison births. Although mean gestational age and birth weight varied with trimester on September 11, a similar association was found among births in previous years, consistent with a seasonal effect not related to exposure. Registry-linked births to mothers with probable posttraumatic stress disorder (n=61) had a higher odds of low birth weight (adjusted odds ratio [OR] 2.49, 95% confidence interval [CI] 1.02–6.08) and preterm delivery (adjusted OR 2.48, 95% CI 1.05–5.84) compared with births to women without posttraumatic stress disorder.CONCLUSION:Women who lived, worked, or were near the World Trade Center on or soon after September 11 had pregnancy outcomes similar to women residing more than 5 miles away. However, among exposed women, probable posttraumatic stress disorder was associated with low birth weight and preterm delivery.LEVEL OF EVIDENCE:II

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