Adverse health outcomes in women exposed in utero to diethylstilbestrol

January 01, 0001

Adverse health outcomes in women exposed in utero to diethylstilbestrol

Before 1971, several million women were exposed in utero to diethylstilbestrol (DES) given to their mothers to prevent pregnancy complications. These US authors combined data from three studies initiated in the 1970s with continued long-term follow-up of 4653 women exposed in utero to DES and 1927 unexposed controls. They assessed the risks of 12 adverse outcomes linked to DES exposure, including cumulative risks to 45 years of age for reproductive outcomes and to 55 years of age for other outcomes, and their relationships to the baseline presence or absence of vaginal epithelial changes, which are correlated with a higher dose of, and earlier exposure to, DES in utero.

They found: "Cumulative risks in women exposed to DES, as compared with those not exposed, were as follows: for infertility, 33.3% vs. 15.5% (hazard ratio, 2.37); spontaneous abortion, 50.3% vs. 38.6% (hazard ratio, 1.64); preterm delivery, 53.3% vs. 17.8% (hazard ratio, 4.68); loss of second- trimester pregnancy, 16.4% vs. 1.7% (hazard ratio, 3.77); ectopic pregnancy, 14.6% vs. 2.9% (hazard ratio, 3.72); preeclampsia, 26.4% vs. 13.7% (hazard ratio 1.42); stillbirth, 8.9% vs. 2.6% (hazard ratio, 2.45); early menopause, 5.1% vs. 1.7% (hazard ratio, 2.35); grade 2 or higher cervical intraepithelial neoplasia, 6.9% vs. 3.4% (hazard ratio, 2.28); and breast cancer at 40 years of age or older, 3.9% vs. 2.2% (hazard ratio, 1.82). For most outcomes, the risks among exposed women were higher for those with vaginal epithelial changes than for those without such changes."

The authors concluded: "In utero exposure of women to DES is associated with a high lifetime risk of a broad spectrum of adverse health outcomes."

Most of these women are now menopausal and beyond, so the risks other than reproductive will take the fore.

For the full abstract, click here.

N Engl J Med 365:1304-1314, 6 October 2011 © 2011 to the Massachusetts Medical Society
Adverse Health Outcomes in Women Exposed In Utero to Diethylstilbestrol. Robert N. Hoover, Marianne Hyer, Ruth M. Pfeiffer, et al. Correspondence to Dr. Hoover: hooverr@mail.nih.gov

Category: X. Female Genital System, Breast. W. Pregnancy, Family Planning. Keywords: diethylstilbestrol, DES, adverse outcomes, case-control study, journal watch.
Synopsis edited by Dr Linda French, Toledo, Ohio. Posted on Global Family Doctor 25 October 2011

Pearls are an independent product of the Cochrane primary care group and are meant for educational use and not to guide clinical care.