Psychological consequences of DES exposure in utero

Between the 1950s and the late 1970s, millions of women worldwide took diethylstilbestrol (DES) during pregnancy. It was claimed that DES prevented miscarriage, even though a clinical trial was interrupted in 1953 when an interim analysis showed no beneficial effect in the prevention of miscarriage. In 1971, it emerged that DES exposure in utero was associated with somatic effects in adulthood, including female genital abnormalities with obstetric consequences, vaginal cancer, and male urogenital disorders. This article examines the psychological effects of exposure to DES in utero, based on a review of the literature using the standard Prescrire methodology. In two experimental studies, mice exposed to DES during gestation were found to be more aggressive than unexposed mice. A randomised clinical trial and epidemiological studies have pointed to a risk of psychological disorders during adolescence and adulthood after DES exposure in utero. A placebo-controlled randomised trial of DES was conducted in London in the 1950s but was never published. In the 1980s, a research team recovered some of the original data and obtained information on the adult health status of the persons exposed in utero. Compared to the placebo group, psychological disorders were twice as frequent in the adults who were likely to have been exposed to DES in utero. Three large epidemiological studies were also conducted. One study showed that major depressive episodes were about 1.5 times more frequent in women exposed to DES in utero than in unexposed women; the second showed that exposed women had an episode of major weight loss more often than unexposed women; while the third showed no significant difference between the groups in terms of depressive episodes. Smaller studies also suggest that depressive episodes tend to be more frequent after DES exposure in utero. In practice, these data suggest that persons exposed to DES in utero have an increased risk of experiencing psychological disorders and should be monitored accordingly.