Tracking the devastating effects of diethylstilbestrol (DES), a trans-placental carcinogen

2011

Challenge

Between 1940 and the early 1970s, millions of pregnant women were given diethylstilbestrol (DES), the first synthetic estrogen, to prevent pregnancy complications. DES was later found to be a carcinogen that could cross the placenta and cause a range of health-related issues in women, including developmental defects and cancers. Rigorous follow-up reporting and analysis would be required to fully understand the devastating effects of DES on the women who were exposed in utero years before.

Advance

IRP investigators led by Robert Hoover, M.D., Sc.D., re-contacted more than 4,600 women who had participated in an initial landmark study, which described a rare vaginal cancer typically seen only in older women. These women were then followed long-term, and researchers were able to identify and track a number of adverse health outcomes linked to DES exposure, including pre-term delivery, ectopic pregnancy, and cancers of the cervix.

Impact

Without long-term follow-up studies, many outcomes of DES exposure might have gone unreported. This investigation, and others like it, serves as a model for an entire area of research focused on the role of endocrine disruption in early life and subsequent health effects.

Publications

Hoover RN, Hyer M, Pfeiffer RM, Adam E, Bond B, Cheville AL, Colton T, Hartge P, Hatch EE, Herbst AL, Karlan BY, Kaufman R, Noller KL, Palmer JR, Robboy SJ, Saal RC, Strohsnitter W, Titus-Ernstoff L, Troisi R. (2011). Adverse health outcomes in women exposed in utero to diethylstilbestrol. N Engl J Med. 365(14), 1304-14.