Health Risks for Women Exposed to DES in Utero

Increased adverse outcomes for diethylstilbestrol-exposed women with vaginal epithelial changes

WEDNESDAY, Oct. 5 (HealthDay News) -- Women who were exposed in utero to diethylstilbestrol (DES) have a higher lifetime risk for several adverse health outcomes, according to a study published in the Oct. 6 issue of the New England Journal of Medicine.

Robert N. Hoover, M.D., Sc.D., from the U.S. Department of Health and Human Services in Bethesda, Md., and colleagues investigated the cumulative health outcomes in women who were exposed in utero to DES before 1971. Long-term data were collected from 4,653 DES-exposed women and 1,927 unexposed controls who participated in three studies initiated in the 1970s. Twelve DES exposure-linked adverse outcomes were assessed, including cumulative reproductive outcome risks to 45 years of age and other outcome risks to 55 years of age, and their relationship to the baseline presence or absence of vaginal epithelial changes (correlating to early and higher dose DES exposure).

The investigators found that, compared to unexposed controls, those with in utero DES exposure had higher cumulative risks for adverse health outcomes: infertility (hazard ratio [HR], 2.37), spontaneous abortion (HR, 1.64), preterm delivery (HR, 4.68), loss of second-trimester pregnancy (HR, 3.77), ectopic pregnancy (HR, 3.72), preeclampsia (HR, 1.42), stillbirth (HR, 2.45), early menopause (HR, 2.35), grade 2 or higher cervical intraepithelial neoplasia (HR, 2.28), and breast cancer at 40 years of age or older (HR, 1.82). DES-exposed women with vaginal epithelial changes had greater risks for most adverse outcomes than those without the epithelial changes.

"In utero exposure of women to DES is associated with a high lifetime risk of a broad spectrum of adverse health outcomes," the authors write.

Two of the study authors disclosed financial ties to the biopharmaceutical and medical technology industries.

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