Antenatal Exposure to DES: Lessons Learned … Future Concerns

Abstract

The short- and long-term effects of the widespread use of diethylstilbestrol (DES) over 3 decades have become a distant memory for many clinicians. Others are too young to remember the flurry of activity in the early 1970s on the part of many medical centers to identify the offspring of women who were prescribed DES during their pregnancies. This medication was given in an attempt to prevent multiple pregnancy-related problems such as miscarriage, premature birth, and abnormal bleeding. The recognition of the association of DES with an increased incidence of cervical and vaginal cancers in very young women led the Food and Drug Administration to ban its use during pregnancy in 1971. Other pregnancy-related problems for the daughters and genitourinary tract changes in the sons did not become apparent until years later. Ongoing follow-up of these offspring has raised concerns for their future as well as their mothers' future. Clinicians need to be up-to-date with current knowledge regarding risks for cancer and other health-related issues.

Pesticide Exposure and Health Related Issues in Male and Female Reproductive System

“…The damage incurred by the exposure may not be immediate and may only be manifested in adulthood or during aging. The consequences may be apparent even in subsequent generations and the classic example is the cases of vaginal carcinoma in daughters of mothers who were exposed to DES during their pregnancies (Herbst et al, 1999;Anway & Skinner, 2006;Rubin, 2007). The susceptibility of an individual may vary due to genetic polymorphism and so the results of the same exposure could be different.…”

Prospects for Epigenetic Epidemiology

“…Diethylstilbestrol is a synthetic estrogen. Prenatal exposure to diethylstilbestrol has been shown to increase the risk of cervical and vaginal cancer and pregnancy-related problems in women and testicular abnormalities in men (119). Diethylstilbestrol exposure in animals decreases promoter DNA methylation in reproductive tissues and increases methylation (and hence decreases activity) of DNMT (120).…”

Endocrine Disruptors and Breast Cancer Risk - Time to Consider the Environment

“…Finally, it was taken off the market in 1971 subsequent to the elegant report by Herbset and coworkers who observed that in utero DES exposure has predisposed these girls "known as DES daughters" to develop an extremely rare type of cervicovaginal clear-cell adenocarcinoma (CCAC) at a young age (Herbst et al, 1971). In addition to a more than 100-fold increased risk of CCAC, DES daughters also suffered from increased incidences of vaginal dysplasia, vaginal and cervical adenosis, malformations of the cervix, vagina, and uterus, infertility and pregnancy complications (Rubin, 2007).…”