Int. J. Environ. Res. Public Health 2011, 8, 89-96; doi:10.3390/ijerph8010089 OPEN ACCESS International Journal of Environmental Research and Public Health ISSN 1660-4601 www.mdpi.com/journal/ijerph Case Report Four Polygamous Families with Congenital Birth Defects from Fallujah, Iraq Samira Alaani 1, Mozhgan Savabieasfahani 2, Mohammad Tafash 1,3 and Paola Manduca 4,* 1 Fallujah General Hospital, Althubbadh District, Fallujah, 00964, Iraq; E-Mails: samiraalaani@hotmail.com (S.A.); m_tafash@yahoo.com (M.T.) 2 P.O. Box 7038; Ann Arbor, MI 48107, USA; E-Mail: bahar@umich.edu 3 Medical College, Al-Anbar University, Fallujah, 00964, Iraq 4 Laboratory of Genetics, DIBIO, University of Genoa, Genoa 16132, Italy * Author to whom correspondence should be addressed; E-Mail: paolamanduca@gmail.com; Tel.: +39-10-2470145/+39-10-3538240/ +39-3472540531. Received: 27 October 2010; in revised form: 3 December 2010 / Accepted: 21 December 2010 / Published: 31 December 2010 Abstract: Since 2003, congenital malformations have increased to account for 15% of all births in Fallujah, Iraq. Congenital heart defects have the highest incidence, followed by neural tube defects. Similar birth defects were reported in other populations exposed to war contaminants. While the causes of increased prevalence of birth defects are under investigation, we opted to release this communication to contribute to exploration of these issues. By using a questionnaire, containing residential history and activities that may have led to exposure to war contaminants, retrospective reproductive history of four polygamous Fallujah families were documented. Our findings point to sporadic, untargeted events, with different phenotypes in each family and increased recurrence. The prevalence of familial birth defects after 2003 highlights the relevance of epigenetic mechanisms and offers insights to focus research, with the aim of reducing further damage to people’s health. Keywords: Iraq; birth defects; war contaminants; epigenetics