Diethylstilbestrol (DES), a synthetic estrogen, was prescribed to pregnant individuals from the late 1930s until the early 1970s. It was administered with the belief it could prevent complications like miscarriage and premature birth. However, later research revealed that DES exposure during pregnancy led to significant health issues for mothers, their offspring, and potentially later generations.
The History of DES Use
Diethylstilbestrol (DES) was widely prescribed in the United States between 1938 and 1971. Healthcare providers at the time believed it could support pregnancies and reduce adverse outcomes like miscarriage. This led to its widespread adoption. The drug continued to be prescribed in parts of Europe until 1978, ceasing once its long-term dangers became evident.
Health Impacts on Mothers Exposed to DES
Mothers prescribed DES during pregnancy face specific health concerns. Studies have indicated an increased risk of breast cancer in these mothers. While breast cancer is the most consistently linked risk, some research also suggests a potentially elevated risk for other cancers, such as ovarian and endometrial cancers.
Health Impacts on DES Daughters
DES daughters, whose mothers took DES during pregnancy, face a spectrum of reproductive health challenges. They have an increased risk of developing clear cell adenocarcinoma (CCA) of the vagina or cervix, a rare form of cancer. The risk for DES daughters is approximately 40 times higher than unexposed women, with about 1 in 1,000 developing this condition. This risk is considered lifelong, necessitating ongoing vigilance.
Beyond cancer, DES daughters may experience structural abnormalities in their reproductive organs. These can include a T-shaped uterus, which is an unusually shaped uterus, as well as paraovarian cysts and benign vaginal adenosis. Such anatomical variations can contribute to fertility challenges; infertility is reported in about 33% of DES daughters, compared to 14% in unexposed women.
Pregnancy complications are also more frequent. These include a higher likelihood of ectopic pregnancies (4.2% vs. 0.77% in unexposed women), an increased risk of spontaneous abortion in both trimesters, and higher rates of preterm delivery (19.4% vs. 7.5% in unexposed individuals). While most DES daughters can still achieve successful pregnancies, these elevated risks warrant careful medical supervision.
Health Impacts on DES Sons and Grandchildren
DES sons, males exposed to DES in utero, exhibit specific health concerns. They have an increased likelihood of developing non-cancerous epididymal cysts. Other genital abnormalities, such as undescended testicles, are also observed more frequently in DES sons. While the risk of testicular cancer for DES sons is less clear, undescended testicles generally increase this risk.
Current research indicates DES sons do not have an increased risk of infertility, even with genital abnormalities. For the third generation, DES grandchildren, health links are less definitive and remain under study. Some research explores potential associations, such as an increased incidence of hypospadias in grandsons, but these connections require further investigation.
Recommendations for Exposed Individuals
Individuals who suspect DES exposure should inform their healthcare providers. Regular medical screenings are advised to facilitate early detection of any potential health issues.
For Mothers
Annual mammograms and breast examinations are recommended due to the increased breast cancer risk.
For DES Daughters
Yearly pelvic examinations and Pap tests are important for monitoring the vagina and cervix for clear cell adenocarcinoma. The specific screening guidelines for DES daughters differ from general population recommendations, particularly regarding HPV testing.
For DES Sons
Periodic examinations by healthcare providers and testicular self-examinations are advised to identify any changes.
Seeking specialized care from gynecologists experienced with DES exposure or other relevant specialists can provide comprehensive management and support.