Continued follow-up of pregnancy outcomes in diethylstilbestrol-exposed offspring

pregnancy-outcomes-in-des-exposed chart
It is important for obstetrician-gynecologists to be aware of the consequences of DES exposure in utero on pregnancy outcome.

Abstract

Continued follow-up of pregnancy outcomes in diethylstilbestrol-exposed offspring, Obstetrics and gynecology, NCBI PubMed PMID: 11004345, 2000 Oct.
Full text: The American College of Obstetricians and Gynecologists, VOL. 96, NO. 4, OCTOBER 2000 pregnancyoutcomesdes2000, October 2000.

OBJECTIVE
To evaluate long-term pregnancy experiences of women exposed to diethylstilbestrol (DES) in utero compared with unexposed women.

METHODS
This study was based on diethylstilbestrol-exposed daughters, the National Collaborative Diethylstilbestrol Adenosis cohort and the Chicago cohort, and their respective nonexposed comparison groups. Subjects who could be traced were sent a detailed questionnaire in 1994 that contained questions on health history, including information on pregnancies and their outcomes. We reviewed 3373 questionnaires from exposed daughters and 1036 questionnaires from unexposed women.

RESULTS
The response rate was 88% among exposed and unexposed women.

Diethylstilbestrol-exposed women were less likely than unexposed women to have had full-term live births and more likely to have had premature births, spontaneous pregnancy losses, or ectopic pregnancies.

  • Full-term infants were delivered in the first pregnancies of 84.5% of unexposed women compared with 64. 1% of exposed women identified by record review (relative risk [RR] 0.76, confidence interval [CI] 0.72, 0.80). (64.5 percent of women with in utero DES exposure had full-term infants, compared with 84.5 percent of matched women who had not been exposed to DES).
  • Preterm delivery of first births occurred in 4.1% of unexposed compared with 11.5% of exposed women and ectopic pregnancies in 0.77% of unexposed compared with 4.2% of exposed women. The DES-exposed women had higher rates of ectopic pregnancy (4.2 percent versus 0.77 percent).
  • Spontaneous abortion was reported in 19.2% of DES-exposed women compared with 10.3% in control women (RR 2.00, CI 1.54, 2.60).
  • According to complete pregnancy histories (many women had more than one pregnancy), preterm births were more common in DES-exposed women (19.4% exposed versus 7.5% unexposed (RR 2.93 CI 2.23, 3.86). The DES-exposed women had higher rates of preterm delivery (19.4 percent versus 7.5 percent)
  • Second-trimester spontaneous pregnancy losses were more common in DES-exposed women (6.3% versus 1.6%; RR 4.25, CI 2.36, 7.66). The DES-exposed women had higher rates of second-trimester spontaneous abortion (6.3 percent versus 1.6 percent).
  • More first-trimester spontaneous abortions occurred in DES-exposed women than in controls (RR 1.31, CI 1.13, 1.53), and DES-exposed women had at least one ectopic pregnancy more often than unexposed women (RR 3.84, CI 2.26, 6.54).

CONCLUSION
This comprehensive review confirmed that pregnancy outcomes for DES-exposed women are significantly worse than those of unexposed women.

Among DES-exposed women identified by record review, 74.5% became pregnant (5.6% fewer than unexposed controls), and among those women 85% delivered at least one live full-term infant. Although pregnancy outcomes in DES-exposed women were significantly worse than those of unexposed women, many of the exposed women were able to conceive and deliver a live full-term infant.

Even if it is assumed that DES was no longer used in pregnancy after 1971 in the United States (which is not actually the case), there are still many DES-exposed women of reproductive age. Thus, it is important for obstetrician-gynecologists to be aware of the consequences of DES exposure in utero on pregnancy outcome. Consequently, high-risk obstetric care may be indicated for pregnant women who were exposed to DES in utero.

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