American Journal of Epidemiology Vol. 154, No. 4 : 316-321
Copyright © 2001 by The Johns Hopkins University School of Hygiene and Public Health
ORIGINAL CONTRIBUTIONS |
Infertility among Women Exposed Prenatally to Diethylstilbestrol
1 Slone Epidemiology Unit, Boston University School of Medicine, Brookline, MA.
2 Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD.
3 Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, TX.
4 Department of Obstetrics and Gynecology, University of Chicago, Chicago, IL.
5 Department of Obstetrics and Gynecology, University of Massachusetts Medical Center, Worcester, MA.
6 Norris Cotton Cancer Center, Dartmouth-Hitchcock Medical Center, Lebanon, NH.
Although it is well established that women exposed to diethylstilbestrol in utero have an increased risk of spontaneous abortion, ectopic pregnancy, and preterm delivery, it is not known whether they also have an increased risk of infertility. The authors assessed this question in data from a collaborative follow-up study of the offspring of women who took diethylstilbestrol during pregnancy. In 1994, 1,753 diethylstilbestrol-exposed and 1,050 unexposed women from an ongoing cohort study (National Cooperative Diethylstilbestrol Adenosis Study and Dieckmann cohorts) provided data on difficulties in conceiving and reasons for the difficulty. Age-adjusted relative risks were computed for the association of diethylstilbestrol exposure with specific types of infertility. A greater proportion of exposed than unexposed women were nulligravid (relative risk (RR) = 1.3, 95% confidence interval (CI): 1.1, 1.5), and a greater proportion had tried to become pregnant for at least 12 months without success (RR = 1.8, 95% CI: 1.6, 2.1). Diethylstilbestrol exposure was significantly associated with infertility due to uterine and tubal problems, with relative risks of 7.7 (95% CI: 2.3, 25) and 2.4 (95% CI: 1.2, 4.6), respectively. The present findings indicate that diethylstilbestrol-exposed women have a higher risk of infertility than do unexposed women and that the increased risk of infertility is primarily due to uterine or tubal problems.
diethylstilbestrol; infertility
Abbreviations: CI, confidence interval; DESAD, National Cooperative Diethylstilbestrol Adenosis Study; OR, odds ratio; RR, relative risk
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