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• W2334691243 abstract "Diethylstilbestrol (DES) was commonly given to pregnant women in the United States in the 1940s to prevent complications of pregnancy. Its use declined after publication of several studies in the early 1950s, which found no evidence of efficacy. DES was no longer prescribed in pregnant women after 1971 following publication of a study reporting a strong association between in utero exposure to DES and the occurrence of clear cell adenocarcinoma of the vagina and cervix in adolescent girls and young women. Several subsequent studies showed that exposure in utero was also associated with developmental defects of the genital tract and other adverse outcomes. Although DES has not been used in pregnant women for 4 decades, there is continuing concern for cumulative adverse outcomes among the millions of women with a history of in utero exposure. These cumulative effects are poorly understood. This follow-up study investigated the long-term outcomes among 4653 women exposed in utero to DES who had participated in 3 cohort studies initiated in the mid-1970s. The control group was comprised of 1927 unexposed women. The cumulative risks of 12 adverse outcomes significantly associated with DES exposure in previous analyses of the cohort were examined, including cumulative risks among women to 45 years of age for reproductive outcomes and to 55 years of age for other outcomes. The relationships of these outcomes to vaginal epithelial changes (a histological marker of high-dose and early exposure to DES in utero) also was investigated. The cumulative risks for individual adverse outcomes in women exposed to DES compared with unexposed controls were as follows: (1) infertility: 33.3% versus 15.5% (hazards ratio [HR], 2.37; 95% confidence interval [CI], 2.05–2.75); (2) spontaneous abortion at <37 weeks' gestation: 50.3% versus 38.6% (HR, 1.64; 95% CI, 1.42–1.88); (3) preterm delivery at <37 weeks' gestation: 53.3% versus 17.8% (HR, 4.68; 95% CI, 3.74–5.86); (4) loss of pregnancy in second trimester at 14 to 27 weeks' gestation: 16.4% versus 1.7% (HR, 3.77; 95% CI, 2.56–5.54); (5) ectopic pregnancy: 14.6% versus 2.9% (HR, 3.72; 95% CI, 2.58– 5.38); (6) preeclampsia: 26.4% versus 13.7% (HR, 1.42; 95% CI, 1.07–1.89); (7) stillbirth at >27 weeks' gestation: 8.9% versus 2.6% (HR, 2.45; 95% CI, 1.33–4.54); (8) early menopause: 5.1% versus 1.7% (HR, 2.35; 95% CI, 1.67–3.31); (9) grade 2 or higher cervical intraepithelial neoplasia: 6.9% versus 3.4% (HR, 2.28; 95% CI, 1.59–3.27); and (10) breast cancer at 40 years of age or older: 3.9% versus 2.2% (HR, 1.82; 95% CI, 1.04–3.18). Data for 2 other outcomes, neonatal death and clear cell adenocarcinoma, were unreliable due to the small number of cases. The risks for most outcomes were higher among exposed women with vaginal epithelial changes compared with those without such changes. These findings show a high lifetime risk of several adverse health outcomes among women exposed in utero to DES." @default.
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• W2334691243 date "2012-02-01" @default.
• W2334691243 modified "2023-09-26" @default.
• W2334691243 title "Adverse Health Outcomes in Women Exposed In Utero to Diethylstilbestrol" @default.
• W2334691243 doi "https://doi.org/10.1097/ogx.0b013e318247c7e1" @default.
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