title: Medical conditions among adult offspring prenatally exposed to diethylstilbestrol.
abstract: BACKGROUND
  Diethylstilbestrol (DES), a synthetic estrogen that was used in pregnancy, is a prototype endocrine-disrupting chemical. Although prenatal exposure to DES is known to increase risks of vaginal/cervical adenocarcinoma and adverse reproductive outcomes in women, and urogenital anomalies in men, data on nonreproductive medical conditions are lacking.
  
  
  METHODS
  We estimated hazard ratios and their associated 95% confidence intervals for the associations between prenatal DES exposure and the occurrence of cardiovascular disease, diabetes, osteoporosis, and related conditions among 5590 female and 2657 male offspring followed from 1994 through 2006, adjusted for birth year, cohort, sex, body mass index, smoking status, alcohol use, education, and number of general physical examinations in the past 5 years.
  
  
  RESULTS
  Comparing persons exposed prenatally to DES with those who were not exposed, the hazard ratios were 1.21 (95% confidence interval = 0.96-1.54) for diabetes, 1.27 (1.00-1.62) for all cardiovascular disease, 1.18 (0.88-1.59) for coronary artery disease, 1.28 (0.88-1.86) for myocardial infarction, 1.12 (1.02-1.22) for high cholesterol, 1.14 (1.02-1.28) for hypertension, 1.24 (0.99-1.54) for osteoporosis, and 1.30 (0.95-1.79) for fractures. The associations did not differ by dose and timing of DES exposure, nor, in the women, by the presence or absence of vaginal epithelial changes (a marker of DES host susceptibility).
  
  
  CONCLUSIONS
  These data raise the possibility that prenatal exposure to DES is associated with several common medical conditions in adulthood, although differential reporting by DES status and residual confounding cannot be ruled out. Further follow-up should assess these findings with validated outcomes and seek to understand the biological mechanisms.
authors.affiliation: Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Department of Health and Human Services, Bethesda, MD, USA. troisir@mail.nih.gov
authors.forename: Rebecca
authors.initials: R
authors.lastname: Troisi
authors.forename: Marianne
authors.initials: M
authors.lastname: Hyer
authors.forename: Elizabeth E
authors.initials: EE
authors.lastname: Hatch
authors.forename: Linda
authors.initials: L
authors.lastname: Titus-Ernstoff
authors.forename: Julie R
authors.initials: JR
authors.lastname: Palmer
authors.forename: William C
authors.initials: WC
authors.lastname: Strohsnitter
authors.forename: Arthur L
authors.initials: AL
authors.lastname: Herbst
authors.forename: Ervin
authors.initials: E
authors.lastname: Adam
authors.forename: Robert N
authors.initials: RN
authors.lastname: Hoover
mesh_terms: D000328:Adult; D000368:Aged; D002318:Cardiovascular Diseases / Q000139:chemically induced*; D003920:Diabetes Mellitus / Q000139:chemically induced*; D004054:Diethylstilbestrol / Q000009:adverse effects*; D004968:Estrogens, Non-Steroidal / Q000009:adverse effects*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D010024:Osteoporosis / Q000139:chemically induced*; D011247:Pregnancy; D011297:Prenatal Exposure Delayed Effects / Q000139:chemically induced*; D016016:Proportional Hazards Models; D011795:Surveys and Questionnaires
chemical_list: D004968:Estrogens, Non-Steroidal; D004054:Diethylstilbestrol