“Birth defects of diethylstilbestrol”的意思、由来-开放百科全书

An estimated 3 million pregnant women in the USA were prescribed DES from 1941 through 1971.^[2]^[3] DES was also widely prescribed to women in Canada, the UK, Europe, Australia, and New Zealand during a similar period. Women who were prescribed DES during pregnancy have been shown to have a modestly increased risk of breast cancer and breast cancer mortality.^[4]

Second generation

DES daughters

DES gained notoriety when it was shown to cause a rare vaginal tumor in girls and young women who had been exposed to this drug in utero. In 1971, the New England Journal of Medicine published a report showing that seven of eight girls and young women (ages 14 to 22) who had been diagnosed with vaginal clear cell adenocarcinoma had been exposed prenatally to DES.^[5] Subsequent studies have shown an approximate 40-fold increased risk of vaginal/cervical clear cell adenocarcinoma in women exposed in utero to DES. As a consequence of this evidence, DES is considered an established human carcinogen. DES was one of the first transplacental carcinogens discovered in humans, meaning a toxin could cross the placenta and harm the fetus. It had originally been believed that the placenta protected the developing fetus but it is now known that is not true. Daughters exposed to DES in utero may also have an increased risk of moderate to severe cervical squamous cell dysplasia and an increased risk of breast cancer.^[6]

In addition to its carcinogenic properties, DES is a known teratogen, an agent capable of causing malformations in daughters and sons who were exposed in utero. DES-exposed daughters are at an increased risk of abnormalities of the reproductive tract, including vaginal epithelial changes such as vaginal adenosis (which means a type of cell normally found in the uterus, columnar cells, are also present in the vagina), an increased cervical transformation zone, and uterine abnormalities, such as T-shaped uterus. These anomalies contribute to an increased risk of infertility and adverse pregnancy outcomes in prenatally DES-exposed daughters. The most recent published research on DES daughters' adverse health outcomes documented by the U.S. National Cancer Institute (NCI) appears in the October 6, 2011 issue of the New England Journal of Medicine under the authorship of RN Hoover et al., and lists these adverse effects and risk factors: Cumulative risks in women exposed to DES, as compared with those not exposed, were as follows: for infertility, 33.3% vs. 15.5%; spontaneous abortion, 50.3% vs. 38.6%; preterm delivery, 53.3% vs. 17.8%; loss of second-trimester pregnancy, 16.4% vs. 1.7%; ectopic pregnancy, 14.6% vs. 2.9%; preeclampsia, 26.4% vs. 13.7%; stillbirth, 8.9% vs. 2.6%; early menopause, 5.1% vs. 1.7%; grade 2 or higher cervical intraepithelial neoplasia, 6.9% vs. 3.4%; and breast cancer at 40 years of age or older, 3.9% vs. 2.2%.^[7] Daughters with prenatal exposure to DES may also have an increased risk of uterine fibroids, and incompetent cervix in adulthood.^[8]

Studies of DES daughters have not found a link between in utero exposure to DES and autoimmune diseases.^[9]

In an animal model designed to study environmental estrogens, DES turned out to be an obesogen capable of causing adult weight gain in female mice which had been exposed to DES during neonatal development. The excess weight gain was not apparent at birth or in infancy, but occurred in adulthood.^[10]^[11]

DES sons

Initially, fewer studies documented risks of prenatal exposure to DES on males (referred to as "DES sons"). In the 1970s and early 1980s, studies published on prenatally DES-exposed males investigated increased risk of testicular cancer, infertility and urogenital abnormalities in development, such as cryptorchidism and hypospadias.^[12]^[13] Research published in the U.S. by Palmer et al. in 2009 further confirmed evidence of these findings.^[14] Additional research published in Finland in 2012 has further confirmed an increased risk of cryptorchidism among males exposed prenatally to DES.^[15]

The U.S. Centers for Disease Control (CDC) has acknowledged the link between DES exposure and noncancerous epididymal cysts.^[16]

The American Association of Clinical Endocrinologists (AACE) has documented that prenatal DES exposure in males is positively linked to a condition known as hypogonadism (low testosterone levels) that may require treatment with testosterone replacement therapy.^[17]

Sexual differentiation

Research investigating the possible behavioral and psychosexual effects of prenatal DES exposure in human males occurred as early as 1973.^[18] This research has centered on a long-standing question of whether prenatal exposure to DES in offspring of mothers who were prescribed DES may have included sexual orientation and gender-related behavioral effects and physical intersex conditions.^[19] Kaplan published the first-known medical study (1959) of intersex condition in a male prenatally-exposed to DES.^[20]

The reference source Dictionary of Organic Compounds, 6th edition (1996) lists diethylstilbestrol (pp. 2175–76) as a nonsteroidal estrogen with carcinogenic properties that "causes male impotence and transsexual changes, especially in offspring exposed in utero".^[21]

There is some evidence linking prenatal hormonal influences on sexual orientation, gender identity and transgender development, but this is an area of behavioral research that remains controversial.^[22]^[23]^[24]^[25] Several published studies in the medical literature on psychoneuroendocrinology have examined the hypothesis that prenatal exposure to estrogens (including DES) may cause significant developmental impact on sexual differentiation of the brain, and on subsequent behavioral and gender identity development in exposed males and females. One of the leading investigators of this area of research is June Reinisch, former director of the Kinsey Institute for Research in Sex, Gender, and Reproduction.^[26]^[18] Reinisch cited several cases of "male feminization" among prenatally DES-exposed males.

Dr. Scott Kerlin, a major DES research scientist and founder of the DES Sons International Research Network in 1996, has documented for the past 20 years a high prevalence of individuals with confirmed prenatal DES exposure in trans women and intersex people and many individuals who report a history of experiencing difficulties with gender dysphoria.^[25]^[27]^[28]^[29]

DES Daughters and Sons study

A study conducted by the US National Cancer Institute, which assessed about 5,600 women and 2,600 men who had documented prenatal exposure to DES, called "DES Daughters" and "DES Sons", respectively, found that "DES Daughters were just as likely as unexposed women to be left-handed. DES Sons were slightly more likely to be left-handed than unexposed men (14% vs. 11%, respectively).^[30] The researchers found no association between DES exposure and reported mental illness in DES Daughters, although the authors cautioned that this aspect may be under-represented due to the nature of self-reported data. In addition, no association was found between DES exposure and anorexia or bulimia."^[31]

Psychological anomalies

Most of the initial research documenting the psychological effects of prenatal DES exposure was poorly conducted, often by mail card. Despite that, some more carefully conducted studies show a clear link to depression,^[32]^[33] and a more recent French study asserts that there was an 83% increase in psychological disorders for offspring that were prenatally exposed to DES.^[34]

Third generation

Current research also looks at DES in the third generation. These are the grandchildren of women who were given DES during pregnancy and whose mother or father was therefore exposed to DES in utero. Studies of the third generation are important because DES might be associated with epigenetic changes, which involve changes to the way genes behave (not involving the DNA itself) that may be heritable from one generation to another. If epigenetic changes occur and are heritable, studies of the DES-exposed third generation have implications for the influence of environmental endocrine disruptors on human health and evolution.

Recent studies from the US National Cancer Institute (NCI) show that the daughters of women who were exposed in utero to DES may be less likely than the unexposed to have regular menstrual periods.^[35] A possible increased risk of infertility in the older, third generation daughters was also noted. The NCI study provides limited evidence of an increased risk of birth defects in the sons or daughters of women who were exposed prenatally to DES. An increased risk of ovarian cancer in the daughters of women exposed in utero was observed, but it was based on three cases of almost 800, so the finding is considered preliminary and requires further study.

Some evidence suggests the sons of prenatally DES-exposed women might have an increased risk of hypospadias,^[36]^[37] but other studies suggest the increase in risk might not be as great as once thought.^[38]

References

1. ^{{cite journal | vauthors = Bamigboye AA, Morris J | title = Oestrogen supplementation, mainly diethylstilbestrol, for preventing miscarriages and other adverse pregnancy outcomes | journal = Cochrane Database Syst Rev | volume = | issue = 3 | pages = CD004353 | date = 2003 | pmid = 12918007 | doi = 10.1002/14651858.CD004353 | url = }}
2. ^{{cite web|title=Problems in Research: Regulations—The Diethylstilbestrol Tragedy|url=http://www.themedicalbag.com/article/problems-in-research-regulations-the-diethylstilbestrol-tragedy|publisher=The Medical Bag|accessdate=29 April 2014|date=12 April 2013}}
3. ^{{cite journal | vauthors = Hammes B, Laitman CJ | title = Diethylstilbestrol (DES) update: recommendations for the identification and management of DES-exposed individuals | journal = Journal of Midwifery & Women's Health | volume = 48 | issue = 1 | pages = 19–29 | date = Jan–Feb 2003 | pmid = 12589302 | doi = 10.1016/s1526-9523(02)00370-7 | url = http://www.medscape.com/viewarticle/450670 }}
4. ^{{cite journal | vauthors = Titus-Ernstoff L,Hatch EE, Hoover RN,Palmer J, Greenberg ER, Ricker W, Kaufman R, Noller K, Herbst A, Colton T, Hartge P | title = Longterm cancer risk in women given diethystilbestrol (DES) in pregnancy | journal = British Journal of Cancer | volume = 84 | issue = 1 | pages = 126–133 | date = January 2001 | pmid = 11139327 | doi = 10.1054/bjoc.2000.1521 | pmc = 2363605 }}
5. ^{{cite journal | vauthors = Herbst AL, Ulfelder H, Poskanzer DC | title = Adenocarcinoma of the vagina. Association of maternal stilbestrol therapy with tumor appearance in young women | journal = The New England Journal of Medicine | volume = 284 | issue = 15 | pages = 878–81 | date = April 1971 | pmid = 5549830 | doi = 10.1056/NEJM197104222841604 }}
6. ^{{cite journal | vauthors = Troisi R, Hatch EE, Titus-Ernstoff L, Hyer M, Palmer JR, Robboy SJ, Strohsnitter WC, Kaufman R, Herbst AL, Hoover RN | title = Cancer risk in women prenatally exposed to diethylstilbestrol | journal = International Journal of Cancer | volume = 121 | issue = 2 | pages = 356–60 | date = July 2007 | pmid = 17390375 | doi = 10.1002/ijc.22631 }}
7. ^{{cite journal | vauthors = Hoover RN, Hyer M, Pfeiffer RM, Adam E, Bond B, Cheville AL, Colton T, Hartge P, Hatch EE, Herbst AL, Karlan BY, Kaufman R, Noller KL, Palmer JR, Robboy SJ, Saal RC, Strohsnitter W, Titus-Ernstoff L, Troisi R | title = Adverse health outcomes in women exposed in utero to diethylstilbestrol | journal = The New England Journal of Medicine | volume = 365 | issue = 14 | pages = 1304–14 | date = October 2011 | pmid = 21991952 | doi = 10.1056/NEJMoa1013961 }}
8. ^{{cite web | url = http://orwh.od.nih.gov/health/fibroidsrevisedmarch2006.pdf | title = Status of Research on Uterine Fibroids (leiomyomata uteri) at the National Institutes of Health | author = Office of Research on Women’s Health, NIH, DHHS | date = March 2006 | publisher = United States National Institutes of Health | access-date = 2018-07-21 | archive-url = https://web.archive.org/web/20100527231045/http://orwh.od.nih.gov/health/fibroidsrevisedmarch2006.pdf | archive-date = 2010-05-27 | dead-url = yes | df = }}
9. ^{{cite journal | vauthors = Strohsnitter WC, Noller KL, Troisi R, Robboy SJ, Hatch EE, Titus-Ernstoff L, Kaufman RH, Palmer JR, Anderson D, Hoover RN | title = Autoimmune disease incidence among women prenatally exposed to diethylstilbestrol | journal = The Journal of Rheumatology | volume = 37 | issue = 10 | pages = 2167–73 | date = October 2010 | pmid = 20634240 | pmc = 2988471 | doi = 10.3899/jrheum.091092 }}
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11. ^{{cite journal | vauthors = Newbold RR, Padilla-Banks E, Snyder RJ, Phillips TM, Jefferson WN | title = Developmental exposure to endocrine disruptors and the obesity epidemic | journal = Reproductive Toxicology | volume = 23 | issue = 3 | pages = 290–6 | year = 2007 | pmid = 17321108 | pmc = 1931509 | doi = 10.1016/j.reprotox.2006.12.010 }}
12. ^{{cite journal | vauthors = Henderson BE, Benton B, Cosgrove M, Baptista J, Aldrich J, Townsend D, Hart W, Mack TM | title = Urogenital tract abnormalities in sons of women treated with diethylstilbestrol | journal = Pediatrics | volume = 58 | issue = 4 | pages = 505–7 | date = October 1976 | pmid = 972792 }}
13. ^{{cite journal | vauthors = Gill WB, Schumacher GF, Bibbo M, Straus FH, Schoenberg HW | title = Association of diethylstilbestrol exposure in utero with cryptorchidism, testicular hypoplasia and semen abnormalities | journal = The Journal of Urology | volume = 122 | issue = 1 | pages = 36–9 | date = July 1979 | pmid = 37351 | doi = 10.1016/s0022-5347(17)56240-0 }}
14. ^{{cite journal | vauthors = Palmer JR, Herbst AL, Noller KL, Boggs DA, Troisi R, Titus-Ernstoff L, Hatch EE, Wise LA, Strohsnitter WC, Hoover RN | title = Urogenital abnormalities in men exposed to diethylstilbestrol in utero: a cohort study | journal = Environmental Health | volume = 8 | pages = 37 | date = August 2009 | pmid = 19689815 | pmc = 2739506 | doi = 10.1186/1476-069X-8-37 }}
15. ^{{cite journal | vauthors = Virtanen HE, Adamsson A | title = Cryptorchidism and endocrine disrupting chemicals | journal = Molecular and Cellular Endocrinology | volume = 355 | issue = 2 | pages = 208–20 | date = May 2012 | pmid = 22127307 | doi = 10.1016/j.mce.2011.11.015 }}
16. ^{{cite web | url = https://www.cdc.gov/des/consumers/about/effects_sons.html | title = Known Health Effects for DES Sons | publisher = United States Department of Health and Human Services: Centers for Disease Control and Prevention |accessdate=2011-06-30 }}
17. ^{{cite web | url = https://www.aace.com/files/hypo-gonadism.pdf| title = American Association of Clinical Endocrinologists Medical Guidelines for Clinical Practice for the Evaluation and Treatment of Hypogonadism in Adult-Male Patients--2002 Update| publisher = American Association of Clinical Endocrinologists }}
18. ^¹{{cite journal | vauthors = Yalom ID, Green R, Fisk N | title = Prenatal exposure to female hormones. Effect on psychosexual development in boys | journal = Archives of General Psychiatry | volume = 28 | issue = 4 | pages = 554–61 | date = April 1973 | pmid = 4734959 | doi=10.1001/archpsyc.1973.01750340080013}}
19. ^{{cite journal | vauthors = Hines M | title = Prenatal endocrine influences on sexual orientation and on sexually differentiated childhood behavior | journal = Frontiers in Neuroendocrinology | volume = 32 | issue = 2 | pages = 170–82 | date = April 2011 | pmid = 21333673 | pmc = 3296090 | doi = 10.1016/j.yfrne.2011.02.006 }}
20. ^{{cite journal | vauthors = Kaplan NM | title = Male pseudohermaphrodism: report of a case, with observations on pathogenesis | journal = The New England Journal of Medicine | volume = 261 | issue = 13 | pages = 641–4 | date = September 1959 | pmid = 14404413 | doi = 10.1056/NEJM195909242611303 }}
21. ^{{cite book | vauthors = Buckingham J, and MacDonald F | title = Dictionary of Organic Compounds, 6th edition | year = 1995 | publisher= Chapman and Hall/CRC | pages= 2175–76 | isbn = 9780849300073 }}
22. ^{{cite journal | vauthors = Michel A, Mormont C, Legros JJ | title = A psycho-endocrinological overview of transsexualism | journal = European Journal of Endocrinology | volume = 145 | issue = 4 | pages = 365–76 | date = October 2001 | pmid = 11580991 | doi = 10.1530/eje.0.1450365 }}
23. ^{{cite journal | vauthors = Selvaggi G, Ceulemans P, De Cuypere G, VanLanduyt K, Blondeel P, Hamdi M, Bowman C, Monstrey S | title = Gender identity disorder: general overview and surgical treatment for vaginoplasty in male-to-female transsexuals | journal = Plastic and Reconstructive Surgery | volume = 116 | issue = 6 | pages = 135e–145e | date = November 2005 | pmid = 16267416 | doi = 10.1097/01.prs.0000185999.71439.06 | url = http://www.shb-info.org/sitebuildercontent/sitebuilderfiles/vaginoplasty2005doc.pdf | access-date = 2018-07-21 | archive-url = https://web.archive.org/web/20131014195725/http://www.shb-info.org/sitebuildercontent/sitebuilderfiles/vaginoplasty2005doc.pdf | archive-date = 2013-10-14 | dead-url = yes | df = }}
24. ^{{cite journal|year=2004|title=Gender Bender: New Research Suggests Genes and Prenatal Hormones Could Have More Sway in Gender Identity than Previously Thought|url=http://www.apa.org/monitor/apr04/gender.aspx|journal=APA Monitor on Psychology|volume=35|issue=4|page=48|vauthors=Dingfelder S}}
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26. ^{{cite journal | vauthors = Reinisch JM, Ziemba-Davis M, Sanders SA | title = Hormonal contributions to sexually dimorphic behavioral development in humans | journal = Psychoneuroendocrinology | volume = 16 | issue = 1–3 | pages = 213–78 | year = 1991 | pmid = 1961841 | doi = 10.1016/0306-4530(91)90080-D }}
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30. ^{{cite journal|last1=Titus-Ernstoff|first1=Linda|title=Psychosexual characteristics of men and women exposed prenatally to diethylstilbestrol|journal=Epidemiology|date=March 2003|volume=14|issue=2|pages=155–160|doi=10.1097/01.EDE.0000039059.38824.B2|pmid=12606880}}
31. ^{{cite web|title=Recent DES Research: Psychosexual Characteristics of Men and Women Exposed Prenatally to Diethylstilbestrol|url=https://www.cdc.gov/des/consumers/research/recent_psychosexual.html|publisher=CDC|accessdate=16 May 2017}}
32. ^{{cite journal | vauthors = Pillard RC, Rosen LR, Meyer-Bahlburg H, Weinrich JD, Feldman JF, Gruen R, Ehrhardt AA | title = Psychopathology and social functioning in men prenatally exposed to diethylstilbestrol (DES) | journal = Psychosomatic Medicine | volume = 55 | issue = 6 | pages = 485–91 | year = 1993 | pmid = 8310108 | doi = 10.1097/00006842-199311000-00003 }}
33. ^{{cite journal | vauthors = O'Reilly EJ, Mirzaei F, Forman MR, Ascherio A | title = Diethylstilbestrol exposure in utero and depression in women | journal = American Journal of Epidemiology | volume = 171 | issue = 8 | pages = 876–82 | date = April 2010 | pmid = 20332145 | pmc = 2877444 | doi = 10.1093/aje/kwq023 }}
34. ^{{cite journal | vauthors = Soyer-Gobillard MO, Paris F, Gaspari L, Courtet P, Sultan C | title = Association between fetal DES-exposure and psychiatric disorders in adolescence/adulthood: evidence from a French cohort of 1002 prenatally exposed children | journal = Gynecological Endocrinology | volume = 32 | issue = 1 | pages = 25–9 | date = 2016 | pmid = 26172930 | doi = 10.3109/09513590.2015.1063604 }}
35. ^{{cite journal | vauthors = Titus-Ernstoff L, Troisi R, Hatch EE, Wise LA, Palmer J, Hyer M, Kaufman R, Adam E, Strohsnitter W, Noller K, Herbst AL, Gibson-Chambers J, Hartge P, Hoover RN | title = Menstrual and reproductive characteristics of women whose mothers were exposed in utero to diethylstilbestrol (DES) | journal = International Journal of Epidemiology | volume = 35 | issue = 4 | pages = 862–8 | date = August 2006 | pmid = 16723367 | doi = 10.1093/ije/dyl106 | url = http://ije.oxfordjournals.org/content/35/4/862.full.pdf+html }}
36. ^{{cite journal | vauthors = Klip H, Verloop J, van Gool JD, Koster ME, Burger CW, van Leeuwen FE | title = Hypospadias in sons of women exposed to diethylstilbestrol in utero: a cohort study | journal = Lancet | volume = 359 | issue = 9312 | pages = 1102–7 | date = March 2002 | pmid = 11943257 | doi = 10.1016/S0140-6736(02)08152-7 }}
37. ^{{cite journal | vauthors = Kalfa N, Paris F, Soyer-Gobillard MO, Daures JP, Sultan C | title = Prevalence of hypospadias in grandsons of women exposed to diethylstilbestrol during pregnancy: a multigenerational national cohort study | journal = Fertility and Sterility | volume = 95 | issue = 8 | pages = 2574–7 | date = June 2011 | pmid = 21458804 | doi = 10.1016/j.fertnstert.2011.02.047 }}
38. ^{{cite journal | vauthors = Brouwers MM, Feitz WF, Roelofs LA, Kiemeney LA, de Gier RP, Roeleveld N | title = Hypospadias: a transgenerational effect of diethylstilbestrol? | journal = Human Reproduction | volume = 21 | issue = 3 | pages = 666–9 | date = March 2006 | pmid = 16293648 | doi = 10.1093/humrep/dei398 }}

First generation