DES exposure: implications for childbearing

Abstract

From the 1940s to the early 1970s, diethylstilbestrol (DES), an oral, nonsteroidal synthetic estrogen, was prescribed by physicians to 2-6 million women in the US alone to prevent miscarriages.

In 1970, and article documented the correlation between in utero DES exposure and development of a rare vaginal cancer, clear-cell adenocarcinoma. In 1971, the US Federal Drug Administration contraindicated the drug from use during pregnancy.

DES exposure: implications for childbearing, The International journal of childbirth education : the official publication of the International Childbirth Education Association, NCBI PubMed PMID 12286762, 1992 Nov-Dec.

Image Luca Bartolini.

Since then, controlled studies have proven that administration of DES was associated with increased spontaneous abortions, premature delivery, complications during delivery, and neonatal deaths.

DES-exposed daughters in reproductive age faced increased rates of infertility, spontaneous abortion, ectopic pregnancy, and premature delivery. DES-exposed daughters may suffer more pelvic inflammatory disease and dysmenorrhea. A 1988 study related the infertility experience of 796 daughters born to mothers who took part in a double-blind, controlled study of DES use during pregnancy at a Chicago hospital in 1951 and 1952. In early 1986, primary infertility was reported by 33% of the DES-exposed daughters as opposed to 14% of the unexposed subjects. However, 81% of pregnant DES daughters have at least one full-term live birth. Uterine abnormalities including a T-shaped or hypoplastic cavity, a septate uterus, intrauterine adhesions, or irregular uterine margins were documented in 46% of the DES-exposed daughters with primary infertility. Vaginal adenosis is reported to occur in 30%-90% of DES-exposed daughters. Cervical hypoplasia and shortened cervical structure are the primary cervical abnormalities.

In addition, for 10 years researchers have observed certain alterations in the immune systems of DES-exposed women.

Most physicians recommend alternative birth control methods to oral contraceptives to avoid an additional exposure to synthetic estrogens.

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