Effect of diethylstilbestrol on reproductive function

DES-exposed patients must be observed closely for ectopic pregnancy, spontaneous abortion, and PTD

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In 1999, Jeffrey M. Goldberg, M.D., and Tommaso Falcone, M.D reviewed 60 references about DES in order to publish their summary on fertility and sterility issues related to DES exposure.

1999 Study Abstract

OBJECTIVE:
To review the effects of in utero exposure to diethylstilbestrol (DES) on müllerian development and subsequent reproductive function.

DESIGN:
The literature on DES and reproductive function was reviewed and summary data are presented. The studies were identified through the computerized MEDLINE database and a manual search of relevant bibliographies.

RESULT(S):
In utero exposure to DES resulted in reduced fertility and increased rates of ectopic pregnancy, spontaneous abortion, and preterm delivery.

CONCLUSION(S):
An understanding of the reproductive performance of women who were exposed to DES in utero is useful for counseling these patients regarding their risks and treatment options.

1999 Study Summary

In the wake of the DES and thalidomide tragedies, the effect of new pharmaceuticals on pregnancy is now considered and medications are used more judiciously during pregnancy. The anatomic changes associated with exposure to DES in utero are well known even though the pathogenic mechanisms are not. Although new cases of vaginal clear cell adenocarcinoma resulting from exposure to DES in utero are not expected at this point, an unknown number of exposed women are still facing several reproductive hazards in their quest for a viable live birth. These patients must be observed closely for ectopic pregnancy, spontaneous abortion, and PTD. In spite of their poor obstetric histories, they can be reassured that approximately 80% ultimately will be successful. Surgical correction of the structural abnormalities in an attempt to improve their reproductive performance is not advised. The use of prophylactic cervical cerclage may be beneficial, but a consensus is lacking.

Sources
  • Effect of diethylstilbestrol on reproductive function, Goldberg JM1, Falcone T., Fertil Steril. 1999 Jul;72(1):1-7., NCBI PMID: 10428139.
  • Full text, FERTILITY AND STERILITY, VOL. 72, NO. 1, JULY 1999, S0015-0282(99)00153-3.
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