Pregnant women exposed to chemical weapons during an August 2013 attack in Syria were much more likely to miscarry, deliver prematurely or have stillbirths, a study published in the Lancet Global Health has found.
On August 21, 2013, the Syrian government launched a sarin gas attack on opposition-held territory outside Damascus that killed more than 1,600 people.
The researchers, who reviewed medical records from the last months of 2014, also noted higher than normal numbers of birth defects among children born to women who had past exposure to the chemicals used in the attack.
While acute exposure resulted in death, Dr. Sawsan Jabri, one of the study’s authors, said the long-term consequences are still unfolding.
Dr. Jabri spoke to Syria Deeply about the adverse effects of chemical weapons on pregnant women and their offspring.
Syria Deeply: How did you conduct your research?
Dr. Jabri: The research was done in the city of Moadamyah, Syria, one of the areas affected by a chemical attack on August 21, 2013. Sarin was used in the attack, which is not the same chemical used in more recent attacks, like the one most recently reported on March 16 in Idlib. Sarin has a much higher toxic effect and is completely prohibited by international law. We reviewed medical records for 211 pregnant women who visited the hospital in Moadamyah, including 110 who said they’d been exposed to the chemical attack; 101 were not exposed. Moadamyah was hit by three missiles that day – however, only one part of the city was hit, so it was easy to determine who was exposed to the chemical attack.
Syria Deeply: Can you describe the adverse effects of chemical weapons on pregnant women and their offspring?
Dr. Jabri: We found that 45 percent of exposed women spontaneously miscarried, compared to 14 percent of unexposed women. The usual proportion of global pregnancies ending in spontaneous miscarriage is 10–15 percent. The rate of stillbirths among the exposed group was 27.2 per 1,000 births, compared to a rate of 12.4 per 1,000 for Syria in 2009. Among the 110 exposed women, seven delivered newborns with serious malformations, of whom five died after a few hours to a few days and the other two survived. One of the surviving infants had cardiac abnormalities and the other was born with cerebral edema. The congenital anomalies and malformations happened only in cases of exposure, which suggests that there might be a link between sarin attacks and adverse birth outcomes.
Syria Deeply: What are the long-term consequences of exposure to sarin gas? Why are these consequences harder to recognize?
Dr. Jabri: The immediate effect is very clear: death. In the long run, it’s very hard to tell. One issue that needs to be studied is how much of the chemical remains in the environment, the soil and in the groundwater, which could have an adverse affect on generations to come. The chemicals can have an adverse effect on the nervous system development, especially in pregnant women and newborns in their first year of life. The effects on the nervous system development can be associated with congenital abnormalities, stillbirths and spontaneous miscarriages.
Syria Deeply: Will you collect data on birth outcomes from other hospitals serving areas affected by the chemical attack?
Dr. Jabri: The data we have so far is only from Moadamyah. We hope to collect data on birth outcomes from other hospitals serving areas affected by chemical attacks, to try and figure out if they are seeing higher rates of adverse effects of chemical weapons on pregnant women and their offspring.
In Moadamyah, there is a very good team that is trying to collect data and document cases of chemical weapon attacks since 2013. However, it is very hard to collect this data in Syria today. For example, Douma and Irbin, two of the cities affected by chemical attacks in 2013, are being shelled and bombarded on a daily basis, making it extremely hard to collect data. They are also prioritizing taking care of casualties of the violence.
Detection is even harder because of the limited resources for laboratory examinations and environmental detection of the chemical warfare agent’s residue that the area is suffering from. We also need research on the long-term consequences of chlorine attacks. We are hoping our research will open the door to way more research and study.