Autoimmune disease incidence among women prenatally exposed to diethylstilbestrol.
OBJECTIVE
Animal studies have suggested that prenatal diethylstilbestrol (DES) exposure may alter immune system development and function including antigen self-recognition. A cohort study was conducted to investigate whether prenatal DES exposure might influence the incidence of at least some specific autoimmune diseases in women.


METHODS
A group of women who were and were not prenatally exposed to DES have been followed for more than 25 years for numerous health outcomes including autoimmune disease. To verify diagnoses, medical records or physician abstracts were requested for all women who reported a diagnosis of rheumatoid arthritis (RA), systemic lupus erythematosus (SLE), optic neuritis (ON), and idiopathic thrombocytopenic purpura (ITP). Incidence rates of these autoimmune diseases were compared between women who were and who were not prenatally DES-exposed.


RESULTS
Overall, there was no increase in verified autoimmune disease among DES-exposed women relative to those who were not exposed (RR 1.2; 95% CI 0.7, 2.1). There was, however, a positive association between prenatal DES exposure and RA among women younger than 45 years (RR 4.9; 95% CI 1.1, 21.6) and an inverse association among women who were 45 years and older (RR 0.1; 95% CI 0.01, 0.7).


CONCLUSIONS
Overall, these data provide little support for an association between prenatal DES exposure and development of autoimmune disease. The implication that such exposure may be related to RA in an unusual age-related manner is based on small numbers of cases and warrants further study.
Strohsnitter
William C
WC
Department of Obstetrics and Gynecology, Tufts Medical Center, Boston, Massachusetts 02111, USA. wstrohsnitter@tuftsmedicalcenter.org
Noller
Kenneth L
KL
Troisi
Rebecca
R
Robboy
Stanley J
SJ
Hatch
Elizabeth E
EE
Titus-Ernstoff
Linda
L
Kaufman
Raymond H
RH
Palmer
Julie R
JR
Anderson
Diane
D
Hoover
Robert N
RN
D000328:Adult; D000818:Animals; D001172:Arthritis, Rheumatoid / Q000209:etiology; D001327:Autoimmune Diseases / Q000209:etiology*; D015331:Cohort Studies; D004054:Diethylstilbestrol / Q000009:adverse effects*; D004968:Estrogens, Non-Steroidal / Q000009:adverse effects*; D005260:Female; D006801:Humans; D008875:Middle Aged; D011247:Pregnancy; D011297:Prenatal Exposure Delayed Effects; D012307:Risk Factors; D011795:Surveys and Questionnaires; D055815:Young Adult
D004968:Estrogens, Non-Steroidal; D004054:Diethylstilbestrol