Medical Abbreviations: A Closer Look at DES

Diethylstilbestrol (DES) is a synthetic estrogen that was originally developed to supplement a women’s natural estrogen production. DES was first prescribed in 1938 for women with the intention of preventing miscarriages and premature deliveries. When first developed it was believed by practioners to be safe both for the pregnant women and the developing baby. In 1953, it was demonstrated that DES did not prevent miscarriages or premature deliveries, however, some practioners continued to prescribe DES until at least 1971.

In 1971, a connection was substantiated between in utero DES exposure and the development of clear cell adenocarcinoma of the vagina and cervix in the daughters of women who had been prescribed DES during their pregnancies. Due to that finding, the FDA issued a warning in 1971 against the use of DES in pregnant women. Although the U.S. Food and Drug administration issued such a warning, the use of DES has been clearly documented in European countries until the early 1980’s.

In the United States, an estimated 5-10 million persons were exposed to DES, which includes those who were prescribed DES while pregnant with their female and male children. As a result, there are at least three different populations that have been negatively impacted because of their respective exposure to this drug. The first group is the women who were administered this drug. Women who used DES may have a slightly increased risk of breast cancer. Current research has noted that the risk of breast cancer to women who took this drug is as much as 30% higher than those women who have never been exposed to this drug.

Daughters of women (Daughters of DES) who took this drug while pregnant have had several different health concerns rise directly from their in utero exposure. First is the incidence of clear cell adenocarcinoma of the vagina and cervix, a rare kind of vaginal and cervical cancer. Increased risk for this type of cancer has been noted to be the highest for DES daughters in their teen and early 20’s. However, as this generation of women ages there are now some suggestions that there is again an increase incidence of this type of cancer in their 30’s and 40’s. Another side effect of this exposure is the structural abnormalities found in the uterine, cervical and vaginal areas. The incidence of these abnormalities has been found to be as high as thirty-three percent.

Daughters of DES have also been found to have increased incidence of infertility and adverse pregnancy outcome. Recent research findings have discovered that these women were three times more likely to have premature birth and four times more likely to have had a miscarriage or ectopic pregnancy when compared to the unexposed population. Full-term infants were delivered in the first pregnancy of 64.1 percent of exposed women compared with 84.5 percent of unexposed women. The infertility problems found in this population is believed related to the structural abnormalities discussed earlier.

The sons of women who took DES during pregnancy are three times more likely to have genital structural abnormalities than men without such exposure. The most common abnormalities are epididymal cysts, undescended testes and small testes. Undesdended testes and small testes are associated with an increased risk of cancer. There have been no findings to indicate an increased risk of infertility or sexual dysfunction. Concerns regarding the effects on the prostrate remain inconclusive.

If your client thinks that they either took DES or are a daughter or son of DES it may be difficult for them to confirm their suspicion. One attempt to access these records could be to contact the attending delivery physician or the delivery hospital. If the attending delivering physician is no longer in practice the county health department may be able to provide information regarding where those medical records have been stored. If any pills were taken during pregnancy, obstetrical records should be checked to determine the name of the drug. Pharmacies have been know to keep records for a long time and can be contacted regarding prescription dispensing information.

References:
Schrager S. and Potter B.E. Diethylstilbestrol Exposure. American Family Physician. 2004; 69:2395-2400. Retrieved February 2007 from www.aafp.org/afp.

National Cancer Institute Fact Sheet. DES Questions and Answers. National Cancer Institute, 2006. Retrieved February 2007 from http://www.cancer.gov.

Center for Disease Control and Prevention. DES Update Consumer: About DES. Retrieved February 2007 from http://www.cdc.gov/DES/consumers/about/index.html.

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