Increased sex ratio in Russia and Cuba after Chernobyl: a radiological hypothesis

Population monitoring of trisomy 21: problems and approaches

Trisomy 21 (Down syndrome) is the most common autosomal aneuploidy among newborns. About 90% result from meiotic nondisjunction during oogenesis, which occurs around conception, when also the most profound epigenetic modifications take place. Thus, maternal meiosis is an error prone process with an extreme sensitivity to endogenous factors, as exemplified by maternal age. This contrasts with the missing acceptance of causal exogenous factors. The proof of an environmental agent is a great challenge, both with respect to ascertainment bias, determination of time and dosage of exposure, as well as registration of the relevant individual health data affecting the birth prevalence. Based on a few exemplary epidemiological studies the feasibility of trisomy 21 monitoring is illustrated. In the nearer future the methodical premises will be clearly improved, both due to the establishment of electronic health registers and to the introduction of non-invasive prenatal tests. Down syndrome is a sentinel phenotype, presumably also with regard to other congenital anomalies. Thus, monitoring of trisomy 21 offers new chances for risk avoidance and preventive measures, but also for basic research concerning identification of relevant genomic variants involved in chromosomal nondisjunction.

Association between occupational testicular radiation exposure and lower male sex ratio of offspring among orthopedic surgeons

Background

Exposure to occupational radiation can lower the male sex ratio. However, specific radiation exposure to the testes has not been evaluated.

Objective

This study aimed to examine the association between testicular radiation exposure and lower male sex ratio in children.

Methods

A comprehensive questionnaire survey was administered to 62 full-time male doctors with children aged < 10 years at 5 hospitals. Based on the possibility of testicular radiation exposure 1 year before the child’s birth, participants were assigned to 3 groups as follows: RT (orthopedic surgery), RNT (cardiology/neurosurgery), and N (others). Intergroup differences in the proportion of female children were ascertained, and the female sex ratio (number of female/total number) of each group was compared against the standard value of 0.486. Multivariate logistic regression analysis with a generalized estimating equation was used to model the effects on the probability of female birth while controlling for the correlation among the same fathers.

Results

The study population included 62 fathers and 109 children, 49 were female: 19/27, 11/30, and 19/52 in the RT, RNT, and N group, respectively; the RT group had the highest proportion of females (p = 0.009). The p values for comparisons with the standard sex ratio (0.486) were 0.02, 0.19, and 0.08 for the RT, RNT, and N groups, respectively. Based on the N group, the adjusted odds ratios for the child to be female were 4.40 (95% confidence interval 1.60–2.48) and 1.03 (0.40–2.61) for the RT and RNT groups, respectively.

Conclusions

Our results imply an association between testicular radiation exposure and low male sex ratio of offspring. Confirmatory evidence is needed from larger studies which measure the pre-conceptional doses accumulated in various temporal periods, separating out spermatogonial and spermatid effects.

Projecting sex imbalances at birth at global, regional and national levels from 2021 to 2100: scenario-based Bayesian probabilistic projections of the sex ratio at birth and missing female births based on 3.26 billion birth records

INTRODUCTION

Skewed levels of the sex ratio at birth (SRB) due to sex-selective abortions have been observed in several countries since the 1970s. They will lead to long-term sex imbalances in more than one-third of the world's population with yet unknown social and economic impacts on affected countries. Understanding the potential evolution of sex imbalances at birth is therefore essential for anticipating and planning for changing sex structures across the world.

METHODS

We produced probabilistic SRB projections from 2021 to 2100 based on different scenarios of sex ratio transition and assessed their implications in terms of missing female births at global, regional and national levels. Based on a comprehensive SRB database with 3.26 billion birth records, we project the skewed SRB and missing female births with a Bayesian hierarchical time series mixture model. The SRB projections under reference scenario S1 assumed SRB transitions only for countries with strong statistical evidence of SRB inflation, and the more extreme scenario S2 assumed a sex ratio transition for countries at risk of SRB inflation but with no or limited evidence of ongoing inflation.

RESULTS

Under scenario S1, we projected 5.7 (95% uncertainty interval (1.2; 15.3)) million additional missing female births to occur by 2100. Countries affected will be those already affected in the past by imbalanced SRB, such as China and India. If all countries at risk of SRB inflation experience a sex ratio transition as in scenario S2, the projected missing female births increase to 22.1 (12.2; 39.8) million with a sizeable contribution of sub-Saharan Africa.

CONCLUSION

The scenario-based projections provide important illustrations of the potential burden of future prenatal sex discrimination and the need to monitor SRBs in countries with son preference. Policy planning will be needed in the years to come to minimise future prenatal sex discrimination and its impact on social structures.

The secondary sex ratio in Italy over the past eighty years (1940 to 2019) and potential impact of radiological contamination after atmospheric nuclear testing and after Chernobyl: Temporal change-point analysis using Markov Chain Monte Carlo

In Europe, the male to female ratio at birth (secondary sex ratio: SSR; sex odds: SO) is 1.04-1.06, is influenced by many factors and is declining in industrialized countries. This study was carried out to identify possible impacts of fallout by atomic bomb tests or by the Chernobyl event on SSR in Italy. Italy is a country without commercial nuclear power generation for the last four decades and thus nearly free of radiological confounders. Counts of annual male and female live births in Italy are provided by the World Health Organization (WHO) and by the Italian Istituto Nazionale di Statistica (ISTAT). This study included 57.7 million live births (1940-2019) with overall SSR 1.05829. The Italian SSR trend was modelled with linear and non-linear logistic regression. Trend changes, i.e., periods with level shifts were estimated with Markov Chain Monte Carlo (MCMC). Two distinct idealized level shifts were identified superimposed on a uniform secular downward trend. The first one is seen towards the end of the 1960s with a jump sex odds ratio (SOR) 1.00681, p < 0.0001. The second one occurred in 1987 with SOR 1.00474, p < 0.0001. In each of the 3 periods separated by the two jumps, SSR uniformly decreased with trend SOR per 100 years of 0.98549, p < 0.0001. In conclusion, the secular trend in the Italian SSR showed two marked level shifts, at the end of the 1960s and from 1987 onward. These follow the release of radioactivity by atmospheric atomic bomb tests during the 1960s and by Chernobyl in 1986 and corroborate the hypothesis that ionizing radiation increases SSR.

Response to the "letter to the editor" by Sani Rachman Soleman et al., "spatiotemporal association of low birth weight with Cs-137 deposition at the prefecture level in Japan after the Fukushima nuclear power plant accidents"

We thank Sani Rachman Soleman et al. for three specific points of criticism concerning our investigation of the ecological association between low birth weight (LBW) and radioactive contamination in Japan after the Fukushima Daiichi Nuclear Power Plant (FDNPP) accidents: 1. Ecological variables are not justified enough to adjust potential confounding. 2. The spatiotemporal regression model does not consider temporal reduction in radiation dose rate. 3. Dose-response plot between dose rates and odds ratios overestimates R² and underestimates p-value. This criticism is a good starting point to explain some of the technical backgrounds of our approach in more detail.

Spatiotemporal association of low birth weight with Cs-137 deposition at the prefecture level in Japan after the Fukushima nuclear power plant accidents: an analytical-ecologic epidemiological study

BACKGROUND

Perinatal mortality increased in contaminated prefectures after the Fukushima Daichi Nuclear Power Plant (FDNPP) accidents in Japan in 2011. Elevated counts of surgeries for cryptorchidism and congenital heart malformations were observed throughout Japan from 2012 onward. The thyroid cancer detection rate (2011 to 2016) was associated with the dose-rate at the municipality level in the Fukushima prefecture. Since the birth weight is a simple and objective indicator for gestational development and pregnancy outcome, the question arises whether the annual birth weight distribution was distorted in a dose-rate-dependent manner across Japan after Fukushima.

METHODS

The Japanese Ministry of Health, Labour, and Welfare provides prefecture-specific annual counts for 26.158 million live births from 1995 to 2018, of which 2.366 million births (9.04%) with weights < 2500 g. Prefecture-specific spatiotemporal trends of the low birth weight proportions were analyzed. Logistic regression allowing for level-shifts from 2012 onward was employed to test whether those level-shifts were proportional to the prefecture-specific dose-rates derived from Cs-137 deposition in the 47 Japanese prefectures.

RESULTS

The overall trend of the low birth weight prevalence (LBWp) in Japan discloses a jump in 2012 with a jump odds ratio (OR) 1.020, 95%-confidence interval (1.003,1.037), p-value 0.0246. A logistic regression of LBWp on the additional dose-rate after the FDNPP accidents adjusted for prefecture-specific spatiotemporal base-line trends yields an OR per μSv/h of 1.098 (1.058, 1.139), p-value < 0.0001. Further adjusting the logistic regression for the annual population size and physician density of the prefectures, as well as for the counts of the dead, the missing, and the evacuees due to earthquake and tsunami (as surrogate measures for medical infrastructure and stress) yields an OR per μSv/h of 1.109 (1.032, 1.191), p-value 0.0046.

CONCLUSIONS

This study shows increased low birth weight prevalence related to the Cs-137 deposition and the corresponding additional dose-rate in Japan from 2012 onward. Previous evidence suggesting compromised gestational development and pregnancy outcome under elevated environmental ionizing radiation exposure is corroborated.

A systematic search of the factors that influence the sex ratio at birth

INTRODUCTION

The sex ratio at birth has been studied for decades. A systematic review of the factors that influence this has never been performed. This study conducted a systematic search of this topic.

METHODS

A scoping review of the literature was initially carried out in January 2012 and this was formally updated for contemporaneity in December 2017. A systematic search of the literature subsequently followed in May 2019 and was conducted based on PRISMA statement's flow diagram. The search was applied across five databases: Cumulative Index to Nursing and Allied Health Literature (CINAHL), MEDLINE, PubMed, The Cochrane Library and Web of Science and was restricted to January 1, 1990 to May 31, 2019. The systematic review stopped at screening stage of the PRISMA. A narrative approach was adopted to report study findings.

RESULTS

494 studies were included. Ten factors were identified from the literature as having an influence on M/F, with stress and sex-selective termination being the most predominant. Additional factors included the hormonal theory, geographical trends, coital rates, radiation, secular trends, seasonality and theoretical modeling.

DISCUSSION

Future studies addressing M/F should adopt similar methodologies in order to provide the possibility of comparison between findings and a more formal form of systematic review.

Sex-ratio bias induced by mutation

A question in evolutionary biology is why the number of males is approximately equal to that of females in many species, and Fisher's theory of equal investment answers that it is the evolutionarily stable state. The Fisherian mechanism can be given a concrete form by a genetic model based on the following assumptions: (1) Males and females mate at random. (2) An allele acts on the father to determine the expected progeny sex ratio. (3) The offspring inherits the allele from either side of the parents with equal probability. The model is known to achieve the 1:1 sex ratio due to the invasion of mutant alleles with different progeny sex ratios. In this study, however, we argue that mutation plays a more subtle role in that fluctuations caused by mutation renormalize the sex ratio and thereby keep it away from 1:1 in general. This finding shows how the sex ratio is affected by mutation in a systematic way, whereby the effective mutation rate can be estimated from an observed sex ratio.

India's Distorted Sex Ratio: Dire Consequences for Girls

Female gender discrimination related to cultural preference for males is a common global problem, especially in Asian countries. Numerous laws intended to prevent discrimination on the basis of gender have been passed in India, yet the distorted female-to-male sex ratio seems to show worsening tendencies. Using detailed, two-year longitudinal chart abstraction data about delivery records of a private mission hospital in rural India, we explored if hospital birth ratio data differed in comparison to regional data, and what demographic and contextual variables may have influenced these outcomes. Using quantitative chart abstraction and qualitative contextual data, study results showed the female-to-male ratio was lower than the reported state ratio at birth. In the context of India's patriarchal structure, with its strong son preference, women are under tremendous pressure or coerced to access community-based, sex-selective identification and female fetus abortion. Nurses may be key to turning the tide.

Increases in perinatal mortality in prefectures contaminated by the Fukushima nuclear power plant accident in Japan: A spatially stratified longitudinal study

Descriptive observational studies showed upward jumps in secular European perinatal mortality trends after Chernobyl. The question arises whether the Fukushima nuclear power plant accident entailed similar phenomena in Japan. For 47 prefectures representing 15.2 million births from 2001 to 2014, the Japanese government provides monthly statistics on 69,171 cases of perinatal death of the fetus or the newborn after 22 weeks of pregnancy to 7 days after birth. Employing change-point methodology for detecting alterations in longitudinal data, we analyzed time trends in perinatal mortality in the Japanese prefectures stratified by exposure to estimate and test potential increases in perinatal death proportions after Fukushima possibly associated with the earthquake, the tsunami, or the estimated radiation exposure. Areas with moderate to high levels of radiation were compared with less exposed and unaffected areas, as were highly contaminated areas hit versus untroubled by the earthquake and the tsunami. Ten months after the earthquake and tsunami and the subsequent nuclear accident, perinatal mortality in 6 severely contaminated prefectures jumped up from January 2012 onward: jump odds ratio 1.156; 95% confidence interval (1.061, 1.259), P-value 0.0009. There were slight increases in areas with moderate levels of contamination and no increases in the rest of Japan. In severely contaminated areas, the increases of perinatal mortality 10 months after Fukushima were essentially independent of the numbers of dead and missing due to the earthquake and the tsunami. Perinatal mortality in areas contaminated with radioactive substances started to increase 10 months after the nuclear accident relative to the prevailing and stable secular downward trend. These results are consistent with findings in Europe after Chernobyl. Since observational studies as the one presented here may suggest but cannot prove causality because of unknown and uncontrolled factors or confounders, intensified research in various scientific disciplines is urgently needed to better qualify and quantify the association of natural and artificial environmental radiation with detrimental genetic health effects at the population level.

Sex ratios at birth after induced abortion

BACKGROUND

Skewed male:female ratios at birth have been observed among certain immigrant groups. Data on abortion practices that might help to explain these findings are lacking.

METHODS

We examined 1 220 933 births to women with up to 3 consecutive singleton live births between 1993 and 2012 in Ontario. Records of live births, and induced and spontaneous abortions were linked to Canadian immigration records. We determined associations of male:female infant ratios with maternal birthplace, sex of the previous living sibling(s) and prior spontaneous or induced abortions.

RESULTS

Male:female infant ratios did not appreciably depart from the normal range among Canadian-born women and most women born outside of Canada, irrespective of the sex of previous children or the characteristics of prior abortions. However, among infants of women who immigrated from India and had previously given birth to 2 girls, the overall male:female ratio was 1.96 (95% confidence interval [CI] 1.75-2.21) for the third live birth. The male:female infant ratio after 2 girls was 1.77 (95% CI 1.26-2.47) times higher if the current birth was preceded by 1 induced abortion, 2.38 (95% CI 1.44-3.94) times higher if preceded by 2 or more induced abortions and 3.88 (95% CI 2.02-7.50) times higher if the induced abortion was performed at 15 weeks or more gestation relative to no preceding abortion. Spontaneous abortions were not associated with male-biased sex ratios in subsequent births.

INTERPRETATION

High male:female ratios observed among infants born to women who immigrated from India are associated with induced abortions, especially in the second trimester of pregnancy.

Human sex ratio at birth and residential proximity to nuclear facilities in France

The possible detrimental genetic impact on humans living in the vicinity of nuclear facilities has been previously studied. We found evidence for an increase in the human secondary sex ratio (sex odds) within distances of up to 35km from nuclear facilities in Germany and Switzerland. Here, we extend our pilot investigations using new comprehensive data from France. The French data (1968-2011) account for 36,565 municipalities with 16,968,701 male and 16,145,925 female births. The overall sex ratio was 1.0510. Using linear and nonlinear logistic regression models with dummy variables coding for appropriately grouped municipalities, operation time periods, and corresponding spatiotemporal interactions, we consider the association between annual municipality-level birth sex ratios and minimum distances of municipalities from nuclear facilities. Within 35km from 28 nuclear sites in France, the sex ratio is increased relative to the rest of France with a sex odds ratio (SOR) of 1.0028, (95% CI: 1.0007, 1.0049). The detected association between municipalities' minimum distances from nuclear facilities and the sex ratio in France corroborates our findings for Germany and Switzerland.

Ionizing radiation and the human gender proportion at birth--A concise review of the literature and complementary analyses of historical and recent data

It has long been known that ionizing radiation causes genetic mutations and that nuclear bomb testing, nuclear accidents, and the regular and incidental emissions of nuclear facilities enhance environmental radioactivity. For this reason, the carcinogenic and genetic impact of ionizing radiation has been an escalating issue for environmental health and human health studies in the past decades. The Windscale fire (1957) and the Chernobyl accident (1986) caused alterations to the human birth sex ratio at national levels across Europe, and childhood cancer and childhood leukemia are consistently elevated near nuclear power plants. These findings are generalized and corroborated by the observation of increased sex ratios near nuclear facilities in Austria, France, Germany, Luxembourg, Switzerland, and The Netherlands. We present a concise review of the pertinent literature and we complement our review by spatiotemporal analyses of historical and most recent data. Evidence of genetic damage by elevated environmental radioactivity is provided.

Sex ratio at birth: scenario from normal- and high-level natural radiation areas of Kerala coast in south-west India

Newborns were monitored for congenital malformations in four government hospitals located in high-level (ambient dose >1.5 mGy/year) and normal-level (≤ 1.5 mGy/year) natural radiation areas of Kerala, India, from August 1995 to December 2012. Sex ratio at birth (SRB) among live singleton newborns and among previous children, if any, of their mothers without history of any abortion, stillbirth or twins is reported here. In the absence of environmental stress or selective abortion of females, global average of SRB is about 1050 males to 1000 females. A total of 151,478 singleton, 1031 twins, 12 triplets and 1 quadruplet deliveries were monitored during the study period. Sex ratio among live singleton newborns was 1046 males (95 % CI 1036-1057) for 1000 females (77,153 males:73,730 females) and was comparable to the global average. It was similar in high-level and normal-level radiation areas of Kerala with SRB of 1050 and 1041, respectively. It was consistently more than 1000 and had no association with background radiation levels, maternal and paternal age at birth, parental age difference, gravida status, ethnicity, consanguinity or year of birth. Analysis of SRB of the children of 139,556 women whose reproductive histories were available suggested that couples having male child were likely to opt for more children and this, together with enhanced rate of males at all birth order, was skewing the overall SRB in favour of male children. Though preference for male child was apparent, extreme steps of sex-selective abortion or infanticide were not prevalent.

The Chernobyl accident, the male to female ratio at birth and birth rates

INTRODUCTION

The male:female ratio at birth (male births divided by total live births - M/T) has been shown to increase in response to ionizing radiation due to gender-biased fetal loss, with excess female loss. M/T rose sharply in 1987 in central-eastern European countries following the Chernobyl accident in 1986. This study analyses M/T and births for the former Soviet Republics and for the countries most contaminated by the event.

METHODS

Annual birth data was obtained from the World Health Organisation. The countries with the highest exposure levels (by ¹³⁷Cs) were identified from an official publication of the International Atomic Energy Agency. All of the former Soviet states were also analysed and the periods before and after 1986 were compared.

RESULTS

Except for the Baltic States, all regions in the former USSR showed a significant rise in M/T from 1986. There were significant rises in M/T in the three most exposed (Belarus, Ukraine and the Russian Federation). The birth deficit in the post-Soviet states for the ten years following Chernobyl was estimated at 2,072,666, of which 1,087,924 are accounted by Belarus and Ukraine alone.

DISCUSSION

Chernobyl has resulted in the loss of millions of births, a process that has involved female even more than male fetuses. This is another and oft neglected consequence of widespread population radiation contamination.

The influence of migration on secular trends in sex ratios at birth in cuba in the past fifty years

BACKGROUND

Secular trends have been found in the male-female ratio at birth (M/F: male births divided by total births) in various countries and this ratio is anticipated to approximate 0.515.

METHODS

Annual national data for male and female live births in Cuba with contingency tables were obtained from the World Health Organisation and analysed.

RESULTS

There were 3 736 718 male and 3 534 270 female births (1960-96). Births declined steadily over the entire period. The male-female ratio at birth remained relatively stable over the period 1960-1985 with significant sharp dips for the years 1966, 1980 and 1985. There was a sharp rise in M/F from 1966 to 1969, another rise after 1985, a steep drop to 1989, and then a sharp rise once more after 1993 (all p < 0.0001).

CONCLUSION

The single year dips are associated with the passage of laws in the United States of America (USA) that facilitated Cuban entry to the USA. The increases in M/F tended to be associated with a skew toward an efflux from Cuba that was predominantly male. This paralleled the situation in the Second World War where a surplus of women left behind led to an increase in M/F in belligerent countries. To the author's knowledge, this is the first report of migration influencing M/F.