This study reveals that women who were exposed to DES in the womb "are less likely to have had full-term live births and more likely to have had premature births, spontaneous pregnancy losses, or ectopic pregnancies" than unexposed women. It thus confirms that pregnancy outcomes for DES-exposed women are significantly worse than those of unexposed women. "Even if it is assumed that DES was no longer used in pregnancy after 1971 in the United States (which is not actually the case), there are still many DES-women of reproductive age. Thus it is important for obstetrician-gynecologists to be aware of the consequences of DES exposure in utero on pregnancy outcome."

This study "is based on the largest number of women with documented in utero exposure to DES to be observed systematically throughout much of their reproductive life span."

With these results, it raises important questions about the possible contributions of other endocrine-disrupting chemicals to fertility impairment in people. These questions cannot be resolved with current public health data, but given the problems that many people are experiencing with fertility, they warrant a focused and aggressive research effort.

What did they do?
Kaufman et al. surveyed DES-exposed daughters for the history of their pregnancies and compared their experience with non-exposed counterparts. This work built on 3 decades of research with exposed cohorts, one the National Collaborative Diethylestilbestrol Adenosis cohort, the other the Chicago Lying-In Hospital cohort. Questionaires were sent to all participants who could be traced, yielding responses from 3373 exposed daughters (88%). These were compared with 1036 questionaires from unexposed women.

Patient histories (numbers of pregnancies, pregnancy outcome) were obtained from the questionaires. Pregnancy outcomes included preterm births, first-trimester spontaneous abortions, ectopic pregnancies and stillbirths or neonatal deaths.

An initial analysis showed that findings were similar between the two cohorts, so both cohorts were combined for comparison with unexposed women. In the analysis, women who were recruited through review of medical records were analyzed separately from those that were physician-referred or self-referred.

What did they find?
Age at menarche, age at first intercourse, marital status, and race did not differ between exposed and unexposed groups. Nonexposed women began smoking at an earlier age and were more likely to have smoked longer.

Exposed women had

• more frequent unsuccessful pregnancy attempts for 12 or more months.
• a lower chance of becoming pregnant at least once
• poorer outcomes of first pregnancies... less likely to have full-term live births and much more likely to have had preterm births, spontaneous abortions and ectopic pregnancies
• A full-term infant was delivered in the first pregnancy of 84.5% of unexposed women compared with 64.1% or 52.9% of exposed women (the different percentages are for women from the medical record group vs. the physican self-referred groups, respectively).
• a greater frequency of at least one second-trimester spontaneous pregnancy loss
• a significantly greater proportion of first-trimester spontaneous abortions
  

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