Can a Pregnancy Drug Trigger ADHD Generations Later ? You Bet !

Aattention-Deficit/Hyperactivity Disorder Much More Common in Grandchildren of Women Who Were Prescribed the DES Drug in Pregnancy

A cohort study – Association of Exposure to Diethylstilbestrol During Pregnancy With Multigenerational Neurodevelopmental Deficits – published May 21, 2018, shows that prenatal diethylstilbestrol exposure may lead to neurodevelopmental disorders across several generations : DES grandchildren are more likely to be diagnosed with ADHD (36% to 63%).

The audio summary above reviews the cohort study that uses Nurses’ Health Study data to investigate associations between diethylstilbestrol (DES) use in pregnancy and self-reported development of ADHD in grandchildren.

Press Releases

More DES DiEthylStilbestrol Resources

Follow-up of Patients with Clear-Cell Adenocarcinoma of the Vagina and Cervix

New England Journal of Medicine, May 3, 2018 – Supported by the National Cancer Institute, National Institutes of Health, through a cooperative agreement

A new report on the risks of exposure during pregnancy to a supplement, diethylstilbestrol (DES), that is linked to a rare cancer. The study found that DES-exposed patients with clear-cell adenocarcinoma had ‘increased mortality across their life span.’ For women aged 10 to 34 with DES-related clear-cell adenocarcinoma, the risk of death was 27 times higher than for other US women in that age group.

Women who had prenatal exposure to diethylstilbestrol (DES) are at increased risk for clear-cell adenocarcinoma of the vagina and cervix early in life. Previous studies have investigated the clinical features of this disease and survival among these patients, but data on their long-term survival are lacking. Women with DES-related clear-cell adenocarcinoma are aging into their 50s and 60s, but the effect of this condition during their overall life span has not been well established.

A total of 695 patients with clear-cell adenocarcinoma in the Registry for Research on Hormonal Transplacental Carcinogenesis were followed through 2014 (see the Methods section of the Supplementary Appendix, available with the full text of this letter at NEJM.org). The mean year of birth was 1955. The mean age at diagnosis of clear-cell adenocarcinoma was 22 years, and 80% of the patients received the diagnosis between the ages of 15 and 30 years. In 415 patients, evidence of prenatal DES exposure was documented.

During a median follow-up of 22.7 years, 219 patients died, yielding a probability of 20-year survival of 69%. The 5-year probability of survival differed between the patients with prenatal DES exposure (86.1%) and patients without documentation of DES exposure (81.2%), but the 20-year probability of survival was similar between the two groups. After adjustment for tumor stage, histologic type, and age, the difference in probability of survival between patients with DES exposure and those without DES exposure was significant only in the first 5 years (P=0.025).

Since the epidemiologic curve was similar between the two groups, some of the patients with clear-cell adenocarcinoma for whom there was no documentation of DES exposure may have actually been exposed to DES in utero, and thus the true survival difference between women with DES exposure and those with idiopathic clear-cell adenocarcinoma would be larger without potential misclassification. This differential effect of DES according to time suggests that clear-cell adenocarcinoma associated with DES exposure and idiopathic clear-cell adenocarcinoma may have different tumor biologic features. Idiopathic clear-cell adenocarcinoma may be more likely to progress quickly or recur earlier, whereas clear-cell adenocarcinoma associated with DES exposure may be more likely to recur later. This interesting phenomenon has also been observed in other estrogen-associated cancers, including breast and endometrial cancers. During the first 5 to 7 years after diagnosis, patients with estrogen receptor (ER)–negative breast cancer have a worse survival than patients with ER-positive breast cancer, but the survival rates between the two groups become similar thereafter. Data from molecular studies of germline genetic mutations, tumor genomic changes, and epigenetic alterations to elucidate the underlying mechanisms for this improved behavior of estrogen-associated cancers are lacking.

We found that patients with clear-cell adenocarcinoma had increased mortality across their life span. The risk of death among women with DES-related clear-cell adenocarcinoma was 27 times higher than that in the general U.S. population of women between 10 and 34 years of age, 5 times higher between 35 and 49 years of age, and 2 times higher between 50 and 65 years of age. The excess mortality risk between the ages of 35 and 49 years is mainly due to late recurrences, whereas the excess mortality risk after 50 years of age may be due to other life-threatening health conditions in the population of women who were exposed to DES. It is therefore important to continue the surveillance of this unique cohort of patients with DES-related clear-cell adenocarcinoma to examine their health conditions late in life.

Press Releases

  • ‘DES daughters’ with rare cancer continue to face higher death rates, reuters, MAY 2, 2018.
  • The DES saga: Death risk high for young women exposed in utero, sciencedaily, May 2, 2018.
  • The pill that gave a generation deadly rare cancers: Mothers-to-be took DES to avoid the pain of a miscarriage – now their daughters are paying the price, DailyMail, 3 May 2018.
  • Mortality Risk Persists for Cancer Tied to Prenatal DES Exposure, empr, May 04, 2018.
DES DiEthylStilbestrol Resources

Retour sur un Scandale Sanitaire

Présentation – sous forme d’un reportage – sur le thème du distilbène, 2017

Vidéos en français: Distilbène DES : 60 vidéos à visionner sur YouTube.

Sont évoqués : trois témoignages de femmes victimes du distilbène®,  les conséquences sur la santé des personnes traitées, ce que disent les recherches épidémiologiques, l’organisme en charge de la surveillance des médicaments, la reconnaissance du risque et la situation de crise sanitaire véritable.

Le Distilbène DES, en savoir plus

Petites-filles DES : malformations utérines, fertilité, reproduction

Professeur Michel Tournaire, Réseau DES France, Forum d’Infertilité 2017

Vidéos en français: Distilbène DES : 60 vidéos à visionner sur YouTube.

Le troisième génération de victimes du médicament Distilbène® arrive aujourd’hui en âge de procréer.

Qu’en est-il au niveau de leur fertilité et risques supplémentaires en cas de grossesse ?

Le Professeur Michel Tournaire, membre du Conseil Scientifique de Réseau DES France, présente de nouveaux résultats de l’étude Distilbène 3 générations :

  • petites filles DES : malformations utérines.
  • petites filles DES : fertilité et reproduction.

Enregistrement provenant de la 4ème Journée Nationale de l’Infertilité, un forum d’information et d’aide aux personnes infertiles organisé cet automne 2017, Paris 12.

Le Distilbène DES, en savoir plus

Mécanismes épigénétique des perturbateurs endocriniens

Dr Anne Wautier, Réseau DES France, Forum d’Infertilité 2017

Vidéos en français: Distilbène DES : 60 vidéos à visionner sur YouTube.

Image credit @magicmaman_com.

Le Dr Anne Wautier, gynécologue médicale, aborde de façon très claire (et avec des exemples aidant à la compréhension) des notions complexes telles que : épigénétique, perturbateurs endocriniens, effets transgénérationnels du distilbene DES.

Enregistrement provenant de la 4ème Journée Nationale de l’Infertilité, un forum d’information et d’aide aux personnes infertiles organisé cet automne 2017, Paris 12.

Le Distilbène DES, en savoir plus

Forum d’Infertilité 2017

Avec les Dr Anne Wautier et Pr Michel Tournaire, Réseau DES France

Vidéos en français: Distilbène DES : 60 vidéos à visionner sur YouTube.

Lors de la 4ème Journée Nationale de l’Infertilité, un forum d’information et d’aide aux personnes infertiles organisé cet automne, deux personnalités de l’association Réseau DES France ont partagé leur expertise.

  • le Dr Anne Wautier (45:40) a abordé des notions telles que effets distilbène, épigénétique, perturbateurs endocriniens, effets transgénérationnels.
  • le Pr Michel Tournaire (51:45) a présenté de nouveaux résultats de l’étude Distilbène 3 générations : fertilité et grossesses des “petites-filles DES“.
Le Distilbène DES, en savoir plus

Perturbateurs Endocriniens : du Poison pour Nos Enfants

Nos enfants sont- ils condamnés ?

RTBF Auvio, Questions à la une, 16.11.2017.

Ecoutez Tifenn, de l’association Réseau DES France, nous parler de la 3ème génération de victimes exposées au médicament distilbène, modèle de perturbateurs endocriniens.

Avec l’avènement de la chimie, les perturbateurs endocriniens ont envahi notre environnement. Ils sont partout : dans le plastique de nos cuisines, au coeur de nos ordinateurs, dans le moteur et la peinture de nos voitures, dans nos assiettes, et même dans l’air que nous respirons. Impossible d’y échapper !

Mais ces substances parasitent notre système hormonal et dérèglent notre organisme. Les scientifiques tirent la sonette d’alarme. Infertilité, obésité, trouble de l’attention, perte de mémoire et même cancer… Les pathologies qu’on attribue aux perturbateurs endocriniens explosent.

Le Distilbène DES, en savoir plus

Trajectoires clinique des enfants distilbène

Vivre la maladie : expériences et identités contemporaines

  • Comment n’a-t-on rien appris du distilbène ?
  • Comment personne n’est-il au courant ?
  • Comment les médecins ne savent-ils rien et ne font-ils rien ?
  • Comment les personnes exposées se retrouvent-elles dans des états divers et variés ; le plus souvent de méconnaissance
    • soit de leur statut ?
    • soit des effets de cet éventuel statut ?

Il y a trois facteurs importants limitant la diffusion des connaissances :

  1. L’absence d’identification des problêmes de santé publique et des populations exposées.
  2. Les limites imposées à la production et à la diffusion des connaissances.
  3. Une généralisation tardive ; le distilbène a longtemps été considéré comme un dossier à part

Vidéo publiée le 3 février 2015 par la chaine Paris Diderot.

Suite à leur enquête – Distilbène : quelles leçons sociologiques – menée de 2010 à 2013, Emmanuelle Fillion (EHESP) et Didier Torny (INRA), sociologues, poursuivent leurs travaux et interviennent dans différents colloques.

Emmanuelle Fillion et Didier Torny

Le Distilbène DES, en savoir plus

Animal models of prenatal exposure to diethylstilboestrol

The multigeneration effect of DES provides a model to test the mechanism of transmission of cancer risk from one generation to the next

1989 Study Abstract

Animals of several species exposed perinatally to diethylstilboestrol (DES) have been evaluated for anomalies and tumours.

In male offspring, anomalies of the testis and epididymis have been reported, but evidence for tumours has been very limited.

Many anomalies and tumours have been recorded in female offspring, and some of these duplicate the anomalies and tumours reported in DES-exposed women, whereas others either have not yet been discovered or else do not occur in the human species..

Animal models of prenatal exposure to diethylstilboestrol, US National Library of Medicine National Institutes of Health, IARC scientific publications, NCBI PubMed PMID: 2680952, 1989.

A variety of abnormal physiological responses has been identified in animals exposed perinatally to DES.

There were altered levels of hormones and receptors; responses to postnatal injection of hormones were often modified; and an increased susceptibility to other carcinogens has been established.

Several mechanisms have been postulated to explain tumour production later in life after perinatal exposure to DES:

  1. Deficiencies in immune function indicate a mechanism of impaired immune surveillance.
  2. The presence of DES and its metabolites in the fetus and neonate raise the issue of somatic mutation. Evidence for sister chromatid exchange, cell transformation in tissue culture and other toxic effects on chromosomes support the somatic mutation hypothesis.
  3. A third hypothesis is involvement of abnormal differentiation of the hypothalamus. Structural, hormonal and behavioural changes support this idea.

Possible additional problems in humans after exposure to DES, on the basis of animal model studies, are increased tumour frequency with ageing and transmission of cancer risk to the third generation.

The multigeneration effect of DES provides a model to test the mechanism of transmission of cancer risk from one generation to the next.

The outcome of such experiments could have considerable impact on the understanding of the association between DES and cancer specifically and transplacental cancer generally.

More DES DiEthylStilbestrol Resources

Environmental factors, epigenetics, and developmental origin of reproductive disorders

US National Library of Medicine National Institutes of Health, Reproductive toxicology, 2016

Highlights

  • Epidemiological and model system studies support an early origin of reproductive dysfunction.
  • Estrogenic/anti-androgenic chemicals as endocrine disrupting chemicals (EDCs) have vast developmental influences on adult reproductive outcomes.
  • Gestational, perinatal, neonatal, and pubertal periods are “windows of susceptibility” for epigenetic programming.
  • EDCs induce exposure-specific epigenetic modifications in regulatory genes in organs of the reproductive system.
  • Germline epigenetic disruption is a mechanism underlying transgenerational inheritance of reproductive disorders.

2017 Study Abstract

Environmental factors, epigenetics, and developmental origin of reproductive disorders, US National Library of Medicine National Institutes of Health, Reproductive toxicology (Elmsford, N.Y.), NCBI PubMed PMID: 27421580, 2016 Jul.

Image credit Daniel Friedman.

Sex-specific differentiation, development, and function of the reproductive system are largely dependent on steroid hormones.

For this reason, developmental exposure to estrogenic and anti-androgenic endocrine disrupting chemicals (EDCs) is associated with reproductive dysfunction in adulthood.

Human data in support of “Developmental Origins of Health and Disease” (DOHaD) comes from multigenerational studies on offspring of diethylstilbestrol-exposed mothers/grandmothers.

Animal data indicate that ovarian reserve, female cycling, adult uterine abnormalities, sperm quality, prostate disease, and mating behavior are susceptible to DOHaD effects induced by EDCs such as bisphenol A, genistein, diethylstilbestrol, p,p’-dichlorodiphenyl-dichloroethylene, phthalates, and polyaromatic hydrocarbons.

Mechanisms underlying these EDC effects include direct mimicry of sex steroids or morphogens and interference with epigenomic sculpting during cell and tissue differentiation.

Exposure to EDCs is associated with abnormal DNA methylation and other epigenetic modifications, as well as altered expression of genes important for development and function of reproductive tissues.

Here we review the literature exploring the connections between developmental exposure to EDCs and adult reproductive dysfunction, and the mechanisms underlying these effects.

DES DiEthylStilbestrol Resources