Diethylstilbestrol
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Diethylstilbestrol
Diethylstilbestrol (DES) is a drug, a synthetic estrogen that was developed to supplement a woman's natural estrogen production. First prescribed by physicians in 1938 for women who experienced miscarriages or premature deliveries, DES was originally considered effective and safe for both the pregnant woman and the developing baby. A double-blind study was not done until DES had been on the market for more than a decade (Dieckmann, 1953). Even though it found that pregnant women given DES had just as many miscarriages and premature deliveries as the control group, DES continued to be aggressively marketed and routinely prescribed.
In the United States, an estimated 5-10 million persons were exposed to DES during 1938-1971, including women who were prescribed DES while pregnant and the female and male children born of these pregnancies. In 1971, the Food and Drug Administration (FDA) issued a Drug Bulletin advising physicians to stop prescribing DES to pregnant women because it was linked to a rare vaginal cancer in female offspring.
More than 30 years of research have confirmed that health risks are associated with DES exposure. However, not all exposed persons will experience the following DES-related health problems.
- Women prescribed DES while pregnant are at a modestly increased risk for breast cancer.
- Women exposed to DES before birth (in the womb), known as DES Daughters, are at an increased risk for clear cell adenocarcinoma (CCA) of the vagina and cervix, reproductive tract structural differences, pregnancy complications, and infertility. Although DES Daughters appear to be at highest risk for clear cell cancer in their teens and early 20s, cases have been reported in DES Daughters in their 30s and 40s (Hatch, 1998).
- Men exposed to DES before birth (in the womb), known as DES Sons, are at an increased risk for non-cancerous epididymal cysts.
Researchers are still following the health of persons exposed to DES to determine whether other health problems occur as they grow older.
Current research also looks at DES Third Generation. Third Generation refers to the offspring of DES Sons and Daughters. There is not yet much information avaiable because the Third Generation are at an age where they can start to be physiologically affected by the DES exposure of his or her parent(s).
Third gerantion injuries are associated with preterm labor or deliveries resulting in premature birth and cerebral palsay, blindess or other neurological deficits or death of a child. One DES Daughter had a child who, at the age of four years, had such a severe case of cerebral palsay that the child was unable to turn himself over; the cerebral palsay was linked to the DES exposure of the mother.
Another study (J Pediatr Hematol Oncol 2003; 25:635-636.) found DES to be transgenerational, meaning that the maternal grandmother had taken DES while pregnant but the mother did not experience any health associated with the DES exposure. This was realized when a rare tumor was discovered on a 15 year old girl. For a project for our Childbirth and Pregnancy in America class, we conducted a poll to see how many of our peers (ages 19-23) had actually heard about DES. Out of 38 participants, only six had heard of DES, and that was primarily because some of their relatives had taken it and had suffered physiological effects. We spread awareness, however, by informing the participants that had never heard about DES. Conducting this poll was a very easy task. We highly encourage everyone reading this to conduct a poll on your own among family and friends. You too can help raise awareness.
The importance of knowing about such a crisis is crucial in many ways. We must know about the history of DES so that in the future, drugs are tested several times over and ensured for safety so that a crisis like DES does not happen again. The other reason is simply because of the possibility that DES abnormalities may be passed on genetically and could affect third generation DES family members.
The psychological effects of DES often go unnoticed. To Do No Harm, a book by Roberta Apfel and Susan Fisher examines the psychology behind DES. Many victimes of DES experience DES Trauma including those who were born DES sons and daughters as well as DES mothers. To them, the usual source of help was their greatest source of pain. Doctors, once thought of as safe, became targets of depression, anger, and all the feelings involved in mourning (Apfel, Roberta J., and Susan M. Fisher 70. To Do No Harm. New Haven: Yale UP , 1984.). DES was distinct in that it led to great isolation between mothers and daughters. For daughters the greatest source of pain came from their own mothers, which led to a unique and powerful trauma for both these actors.
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Check out an amazing slideshow presentation made by 2 amazingly dedicated college students! http://home.uchicago.edu/~ray/DES.ppt
See also
External links
- DES Action USA (http://www.desaction.org/) offers information and resources for DES-exposed mothers, daughters, and sons who may need special health care.
- DES Update (http://www.cdc.gov/DES/) from the U.S. Centers for Disease Control and Prevention
- DES Cancer Network (http://www.descancer.org/)
- National Cancer Institutes's Cancer Information Servive (http://www.cancer.gov/)
- University of Chicago DES Program (http://obgyn.bsd.uchicago.edu/registry.html/) is a registry of patients with CCA of the vagina and/or cervix.