In utero DES exposure carries lifelong health implications

Millions of women exposed to diethylstilbestrol (DES) in utero before 1971 have a high lifelong risk of an array of adverse health outcomes, a new study reveals. 

Researchers assessed the risks of 12 adverse outcomes linked to DES by combining data from 3 studies started in the 1970s with continued long-term follow-up of 4,653 women whose mothers took DES during pregnancy and 1,927 unexposed controls. They examined cumulative risks to 45 years of age for reproductive outcomes and to 55 years of age for other outcomes.

Compared with controls, DES-exposed women had 5 times the risk of delivering a premature baby and nearly 4 times the risk of a second-trimester miscarriage or ectopic pregnancy. They also had significantly higher risks of infertility, spontaneous abortion, stillbirth, preeclampsia, early menopause, and early signs of uterine cancer. The study was published in the New England Journal of Medicine (2011;365[14]:1304-1314).

The study also examined the relationships between the risks of adverse outcomes and the baseline presence or absence of vaginal epithelial changes, which correlate with a higher dose of, and earlier exposure to, DES in utero. It found a high incidence of reproductive problems among women with higher exposures to the hormone: 66% had premature babies; almost 60% had spontaneous abortions; 41% were infertile; 25% had ectopic pregnancies or preeclampsia; and nearly 20% suffered a second-trimester miscarriage.

Women with greater exposure to DES, as indicated by vaginal epithelial changes, also had a higher risk of breast cancer than those with lower DES exposure-4% compared with 2.3%.

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