The presence of anomalies in vagina, cervix, and uterine body of women exposed to diethylstilbestrol in utero has provoked interest and concern regarding the reproductive potential of these women. To expand and to evaluate better better the current knowledge in this matter, the outcomes of the pregnancies of exposed women registered in the Stilbestrol Clinic at the Stanford University Medical Center were examined. The results were combined with the published results of similar examinations of other institutions and a summation of all available data is presented. Although it is evident that the majority (79%) of exposed women who have become pregnant and not regularly sought abortion have obtained at least one living infant, the incidence of spontaneous abortion and preterm delivery has consistently been found to be greater in exposed women than in unexposed control women. One of every 30 pregnancies reported in exposed patients has been ectopically located. Additionally, there is suggestive evidence that exposed women with teratologic changes have a higher incidence of pregnancy loss than those without such changes. However, few of these observations can boast statistical validity and statistical validation of the same observation by separate investigators has not been obtained. Moreover, none of th teratologic changes in exposed patients has been seen to preclude normal pregnancy and term delivery.
PIP: Current knowledge regarding the pregnancy outcome for women exposed to DES (diethylstilbestrol) in utero is presented using information from a follow-up study of patients at the Stanford Stilbestrol Clinic and from other published data from similar studies. 2/3 of all women exposed to DES in utero have teratologic changes in the vagina, cervix, and/or uterine cavity, leading to a question as to the reproductive capacity of these women. A compilation of the study material revealed a doubled incidence of spontaneous abortion, a 3-fold increase in the incidence of preterm delivery, and a substantially greater occurrence of ectopic pregnancy in exposed women when compared to unexposed women. These findings were true for all and for the 1st pregnancies. Exposed patients had obtained at least 1 surviving infant in only approximately 80% of all cases whereas unexposed patients had done so in 95% of all instances. It is not clear whether teratologic changes in any part of the reproductive tract of exposed patients have an influence on pregnancy outcome. None of the vaginal, cervical, uterine, or tubal changes alone or in any combination was found to preclude a term intrauterine pregnancy and delivery of a viable infant. It is emphasized that the relevant study literature was minimal and incomplete.