Offspring of Women Exposed In Utero to Diethylstilbestrol (DES)

Department of Community and Family Medicine, Dartmouth Medical School, and the Norris Cotton Cancer Center, Lebanon, NH 03756, USA.
Epidemiology (Impact Factor: 6.2). 04/2008; 19(2):251-7. DOI: 10.1097/EDE.0b013e318163152a
Source: PubMed


Animal studies suggest that prenatal exposure to the synthetic estrogen diethylstilbestrol (DES) causes epigenetic changes that may be transmitted to the next generation. Specifically, these studies show an elevated incidence of reproductive tumors in the female offspring of prenatally-exposed mice.
We assessed cancer and benign pathology diagnoses occurring in the offspring of women whose prenatal exposure to DES (or lack of exposure) was verified by medical record. Our data arose from 2 sources: the mothers' reports of cancers occurring in 8216 sons and daughters, and pathology-confirmed cancers and benign diagnoses self-reported by a subset of 793 daughters.
Although statistical power is limited, our data are consistent with no overall increase of cancer in the sons or daughters of women exposed in utero to DES. Based on pathology-confirmed diagnoses reported by the daughters, we saw no association between DES and risk of benign breast disease or reproductive tract conditions. Based on 3 cases, the incidence of ovarian cancer was higher than expected in the daughters of women exposed prenatally to DES.
Our data do not support an overall increase of cancer risk in the sons or daughters of women exposed prenatally to DES, but the number of ovarian cancer cases was greater than expected. While preliminary, this finding supports continued monitoring of these daughters.

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    • "Moreover, the delayed adverse health effects of exposures occurring during critical windows of vulnerability (e.g., early life, including the prenatal period and puberty) remain largely unknown. One well known exception is in utero exposure to diethylstilbestrol (DES) which increases the risk of benign and malignant pathology in the third generation [8]. Other agents such as ambient air PAHs and PM2.5 have been shown to influence maturation of the immune system during gestation via shifts in cord blood lymphocytes distributions [9,10]. "
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    • "The benign and carcinogenic effects of prenatal exposure to diethylstilbestrol (DES), a potent synthetic estrogen used to prevent miscarriage in the late 1940s through the 1970s, is an example of the harmful effects that estrogenic chemicals can cause during development, many of which are not apparent until much later in adult life. Although the use of DES during pregnancy was discontinued > 30 years ago, we are still reminded of this chemical's legacy as the DES-exposed offspring age and their health care problems continue to mount [National Institutes of Health (NIH) 1999; Palmlund 1996] including the possibility of adverse effects on subsequent generations (Blatt et al. 2003; Newbold 2004; Titus-Ernstoff et al. 2008). Unfortunately, developing fetuses and young children continue to be inadvertently exposed to a wide number of environmental chemicals, many with hormone-like activity. "
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