May 2023 Update
Overview
Since the publication in 1971 by Dr. Arthur Herbst documenting vaginal cancer among women exposed prenatally to the drug diethylstilbestrol (DES) (see Herbst, “Adenocarcimona of the Vagina: Association of Maternal Stilbestrol Therapy with Tumor Appearance in Young Women (1971), published in the New England Journal of Medicine), an extensive body of investigative research has been published revealing the widening scope of reported adverse health effects for DES daughters (i.e. women exposed prenatally to DES).
An estimated 5 to 10 million women (mothers and daughters) in the U.S. were exposed to DES between the 1940s and early 1970s. This site documents links to published research emphasizing DES Daughters that was published between 1990 and 2023, with references to historical literature published as early as the 1940s.
Major topics addressed in these journals include:
- Cancers, especially risk of clear cell adenocarcinoma of the vagina and cervix, squamous cell neoplasia of the genital tract, breast cancer
- Endometriosis and infertility
- Structural changes of the genital tract including T-shaped uterus with a small cavity, T-shaped uterus with a constriction ring, and constriction rings alone; abnormalities of the uterine corpus and fallopian tube; cervical ectropion
- Cardiovascular effects, including coronary artery disease (CAD) and myocardial infarction
- Pancreatic disorders and pancreatitis
- Early natural menopause
- Reproductive tract abnormalities, including menstrual irregularities and urinary tract irregularities
- Autoimmune disease
- Poor pregnancy outcomes
- Mental health effects, especially depression and neurobehavioral effects
- Psychosexual/gender identity outcomes
- Other reported adverse effects that may have been noted in individual medical case studies of DES Daughters
A summary of the most commonly reported adverse health effects in DES Daughters is available from DES Action USA.
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>> How to Review Research Publications Included on this Page <<
* Keep in mind that this is a comprehensive directory of published research with each individual article listed by title, year of publication, name of journal, and indication of whether the article is available as an abstract (summary only) or full-text version
* Journal articles published most recently (i.e. 2010 or later) tend to have the most comprehensive overview of long-term trends in research findings, but may not always contain complete summaries of every major condition experienced by DES Daughters. When examining an issue, it is wise to review earlier published research to get a full picture of the epidemiological trends.
* Take your time in reviewing these references! There is a huge amount of information included, and it is easy to become totally overwhelmed when you begin to read this material. When possible, it is worthwhile to focus on articles that serve as “systematic reviews”, as they function as comprehensive overviews of the history of published research on a particular topic.
* Recommendation: For help on the best ways to review a journal article, I encourage you to read “How to Read and Understand a Scientific Paper: A Guide for Non-Scientists“, by Jennifer Raff.
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Journal References 1988-2023*
[* Note regarding the timeline of research publications: Initial research about the human health effects of exposure to diethylstilbestrol began as early as the 1950s and significantly evolved during the 1970s and 1980s. Most publications from the 1990s and forward cite the studies from those early years where considered relevant.]
A comprehensive guide to the full directory of DES-related publications on all topics is available at Diethylstilbestrol (DES): Multigenerational Research Trends 1939-2023.
2019-2023
- Postmenopausal Vaginal and Cervical Cancer Risk Related to in utero Diethylstilbestrol Exposure (2023), by B W Wamakima, et. al, published in the Journal of Lower Genital Tract Disease (abstract only)
- Environmental Impact on Female Fertility and Pregnancy (2023), by Anastasia-Konstantina Sakali, et. al, published in the textbook Environmental Endocrinology and Endocrine Disruptors (eds: Rosario Pivonello & Evanthia Diamanti-Kandarakis)
- Like Mother, Like Daughter, Like Granddaughter… Transgenerational Ignorance Engendered by a Defective Reproductive Health Technology (2022), by Emmanuelle Fillion & Didier Torny, published in the journal Reproductive Medicine & Society Online
- ** Risk of Clear-cell Adenocarcinoma of the Vagina and Cervix among U.S. Women with Potential Exposure to Diethylstilbestrol in utero (2022), by Mary C. White, et. al, published in the journal Cancer Causes & Control (abstract only)
- Association of in utero Exposures with Risk of Early Natural Menopause (2022), by Christine R. Langton, et. al, published in the American Journal of Epidemiology (Full-text)
- Diethylstilbestrol (DES) Exposure and Cancer (2021), published summary from the National Cancer Institute (full-text with links)
- A Rare Case of Clear Cell Cervical Carcinoma to a Woman, 50 Years After Diethylstilbestrol Exposure for Lactation Suppression (2021), by Konstantinos Palailogos, et. al, published in the journal Cureus (full-text)
- Screening for Cancers of the Cervix and Vagina for Women Exposed to Diethylstilbestrol (DES) in utero (2021), by Michael Tournaire, et al, published in the Journal of Gynecology Obstetrics and Human Reproduction (full-text)
- Multigenerational Endometriosis: Consequence of Fetal Exposure to Diethylstilbestrol? (2021) by Laura Gaspari, et. al, published in the journal Environmental Health (full-text)
- Prenatal Diethylstilbestrol Exposure and Risk of Diabetes, Gallbladder Disease, and Pancreatic Disorders and Malignancies (2020), by Rebecca Troisi, et. al, published in the Journal of Developmental Origins of Health and Disease (full-text)
- Definition, Prevalence, Clinical Relevance and Treatment of T-Shaped Uterus: Systematic Review (2020), by M. A. Coelho Neto, et. al, published in the journal Ultrasound in Obtetrics & Gynecology (full-text)
- Prenatal Diethylstilbestrol Exposure and Cancer Risk in Women (2019), by Rebecca Troisi, et. al, published in the journal Environmental and Molecular Mutagenesis (abstract)
- Case Report: POLE-Mutated Clear Cell Cervical Cancer Associated with in-utero Diethylstilbestrol Exposure (2019), by Elizabeth K. Lee, et. al, published in the journal Gynecologic Oncology Reports (2019), by Elizabeth K. Lee, et. al, published in the journal Gynecologic Oncology Reports (abstract only)
- Prenatal Diethylstilbestrol Exposure and Risk of Depression in Women and Men (2019), by Linda Titus, et. al, published in the journal Epidemiology (full-text)
2014-2018 - Prenatal Diethylstilbestrol Exposure and Mammographic Density (2018), by William C. Strohsnitter, et. al, published in the International Journal of Cancer (full-text)
- Estrogen Metabolism in Postmenopausal Women Exposed in utero to Diethylstilbestrol (2018), by Rebecca Troisi, et. al, published in the journal Cancer Epidemiology, Biomarkers & Prevention (full-text)
- Diethylstilbestrol: Potential Health Risks for Women Exposed in utero and their Offspring (2017), published in the Journal of the American Academy of Physician Assistants/JAAPA (abstract only)
- Impact of Prenatal Exposure to Diethylstilbestrol (DES) on Psychological Outcome: A National Survey of DES Daughters and Unexposed Controls (2017), by Helene Verdoux, et. al, published in the journal Archives of Women’s Mental Health (abstract only)
- Risk of Cervical Intra-Epithelial Neoplasia and Invasive Cancer of the Cervix in DES Daughters (2017), by J. Verloop, et. al, published in the journal Gynecologic Oncology (full-text)
- Incidence Rates and Risks of Diethylstilbestrol-related Clear-cell Adenocarcinoma of the Vagina and Cervix: Update After 40-year Follow-up (2017), by Dezheng Huo, et. al, published in the journal Gynecologic Oncology (abstract only)
- Current Perspective of Diethylstilbestrol (DES) Exposure in Mothers and Offspring (2017), by Taher Al Jishi & Consolato Sergi, published in the journal Reproductive Toxicology (partial text)
- A Prospective Cohort Study of Prenatal Diethylstilbestrol Exposure and Cardiovascular Disease Risk (2017), by Rebecca Troisi, et. al, published in The Journal of Clinical Endocrinology & Metabolism (full-text)
- Potential Health Risks for Women Exposed in utero and their Offspring (2017), by J. Leocadia Conlon, published in the journal JAAPA (abstract only)
- Diethylstilbestrol (DES) Pregnancy Treatment: A Promising Widely Used Therapy with Unintended Adverse Consequences (2015), by Arthur L. Herbst, published in the AMA Journal of Ethics (full-text)
- Cancer Risk in Women Exposed to Diethylstilbestrol in Utero (2015), by Michel Tournaire, et. al, published in the French journal Thérapie (abstract only)
- Prenatal Diethylstilbestrol Exposure and Risk of Obesity in Adult Women (2015), by E.E. Hatch, et. al, published in the Journal of Developmental Origins of Health and Disease (abstract only)
- Prenatal Diethylstilbestrol Exposure and Reproductive Hormones in Premenopausal Women (2015), by L.A. Wise, et. al, published in the Journal of Developmental Origins of Health and Disease (Abstract only)
- Menarche, Menopause, Years of Menstruation, and the Incidence of Osteoporosis: The Influence of Prenatal Exposure to Diethylstilbestrol (2014), by Samantha E. Parker, et. al, published in The Journal of Clinical Encocrinology & Metabolism (full-text)
- Maternal Exposure to Diethylstilbestrol during Pregnancy and Increased Breast Cancer Risk in Daughters (2014), by Leena Hilakivi-Clarke, published in the journal Breast Cancer Research (full-text)
- Prenatal Diethylstilbestrol Exposure and Risk of Uterine Leiomyomata in the Nurses’ Health Study II (2014), by Shruthi Mahalingaiah, et. al, published in the American Journal of Epidemiology (full-text)
- DES Daughters in France: Experts’ Points of View on the Various Genital, Uterine and Obstetric Pathologies, and in utero DES Exposure (2014), by R. Clement, et. al, published in the journal Medicine, Science and the Law (Abstract only)
2008-2013 - Exposure to Diethylstilbestrol during Sensitive Life Stages: A Legacy of Heritable Health Effects (2013), by Casey Reed & Suzanne E. Fenton, published in the journal Birth Defects Res C Embryo Today (full-text)
- Medical Conditions Among Adult Offspring Prenatally Exposed to Diethylstilbestrol (2013), by Rebecca Troisi, et. al, published in the journal Epidemiology (full-text)
- Breast Cancer Following Diethylstilbestrol Exposure in Utero: Insights from a Tragedy (2012), by Hans-Olov Adami, et. al, published in the European Journal of Epidemiology (abstract only)
- The Development of Cervical and Vaginal Adenosis as a Result of Diethylstilbestrol Exposure in utero (2012), by Monica M. Laronda, et. al, published in the journal Differentiation (abstract only)
- The Long-Term Effects of in utero Exposures–The DES Story (2011), by Annekathryn Goodman, John Schorge, & Michael F. Greene, published in the New England Journal of Medicine (full-text)
- Preterm Birth, Fetal Growth, and Age at Menarche Among Women Exposed Prenatally to Diethylstilbestrol (DES) (2011), by Elizabeth E. Hatch, et. al, published in the journal Reproductive Toxicology (full-text)
- Adverse Health Outcomes in Women Exposed in Utero to Diethylstilbestrol (2011), by Robert N. Hoover, et. al, published in the New England Journal of Medicine (full-text)
- Intrauterine Exposure to Diethylstilbestrol: Long-term Effects in Humans (2011), by S. H. Swan, published in the Journal of Pathology, Microbiology and Immunology (abstract only)
- Birth Defects in the Sons and Daughters of Women who were Exposed in utero to Diethylstilbestrol (DES) (2010), by Linda Titus-Ernstoff, et. al, published in the International Journal of Andrology (full-text)
- Cancer Risk in DES Daughters (2010), by Janneke Verloop, et. al, published in the journal Cancer Causes & Control (full-text)
- Autoimmune Disease Incidence Among Women Prenatally Exposed to Diethylstilbestrol (2010), by William C. Strohsnitter, et. al, published in The Journal of Rheumatology (full-text)
- Diethylstilbestrol Exposure in utero and Depression in Women (2010), by Eilis O’ Reilly, et. al, published in the American Journal of Epidemiology (abstract only)
- Breast Cancer Screening in Women Exposed in utero to Diethylstilbestrol (2009), by Elizabeth A. Camp, et. al, published in the Journal of Women’s Health (abstract only)
- Cervical Screening and General Physical Examination Behaviors of Women Exposed in utero to Diethylstilbestrol (abstract only) (2008), by Elizabeth A. Camp, et. al, published in the Journal of Lower Genital Tract Disease (abstract only)
- Prenatal Exposure to Diethylstilbestrol (DES) (2008) by Retha R. Newbold, published in the journal Fertility and Sterility (full-text)
2000-2007 - Cancer Risk in Women Prenatally Exposed to Diethylstilbestrol (2007), by Rebecca Troisi, et. al, published in the International Journal of Cancer (full-text)
- Preeclampsia Risk in Women Exposed in Utero to Diethylstilbestrol (2007), by Rebecca Troisi, et. al, published in the journal Obstetrics & Gynecology (abstract only)
- Antenatal Exposure to DES: Lessons Learned, Future Concerns (2007), by Mary M. Rubin, published in the journal Obstetrical & Gynecological Survey (abstract only)
- Age at Natural Menopause in Women Exposed to Diethylstilbestrol in utero (2006), by Elizabeth E. Hatch, et. al, published in the American Journal of Epidemiology (full-text)
- Prenatal Diethylstilbestrol Exposure and Risk of Breast Cancer (2006), by Julie R. Palmer, et. al, published in the journal Cancer Epidemiology Biomarkers & Prevention (full-text)
- Management of Breast Cancer in Patients Prenatally Exposed to Diethylstilbestrol: Are we Prepared? (2005), by MS Mano, et. al, published in the journal The Breast (abstract only)
- Obstetrical Outcome in 454 Women Exposed to Diethylstilbestrol During their Fetal Life: A Case-control Analysis (2005) by E Papiernik, et. al, published in the Journal de Gynecologie, Obstetrique et Biologie de la Reproduction (France) (abstract only)
- Risk of Benign Gynecologic Tumors in Relation to Prenatal Diethylstilbestrol Exposure (2005), by LA Wise, et. al, published in the journal Obstetrics & Gynecology (abstract only)
- Diethylstilbestrol (DES) Update: Recommendations for the Identification and Management of DES-exposed Individuals (2003), published in the Journal of Midwifery & Women’s Health (full-text)
- Immunomodulatory Effects of Diethylstilbestrol During Prenatal and Adult Life (2003), by Jillian Beth Fenaux, unpublished Master’s degree thesis, Virginia Tech
- Risk of Breast Cancer in Women Exposed to Diethylstilbestrol in utero: Preliminary Results (United States) (2002), by Julie R. Palmer, et. al, published in the journal Cancer Causes & Control (abstract only)
- Infertility among Women Exposed Prenatally to Diethylstilbestrol (2001), by Julie R. Palmer, et. al, published in the American Journal of Epidemiology (full-text)
- Incidence of Squamous Neoplasia of the Cervix and Vagina in Women Exposed Prenatally to Diethylstilbestrol (2001), by E. E. Hatch, et. al, published in the journal Cancer Causes & Control (abstract only)
- Altered Immune Response in Adult Women Exposed to Diethylstilbestrol in utero (2001), by Louis Burke, et. al, published in the American Journal of Obstetrics and Gynecology (abstract only)
- Intrauterine Exposure to Diethylstilbestrol: Long-term Effects in Humans (2001), by S H Swan, published in the Journal of Pathology, Microbiology, and Immunology–APMIS (full-text)
- Continued Follow-up of Pregnancy Outcomes in Diethylstilbestrol-exposed Offspring (2000), by Raymond H. Kaufman, et. al, published in the journal Obstetrics & Gynecology (abstract only)
- A Focus Group Study of DES Daughters: Implications for Health Care Providers (2000), by Suzanne S. Duke, et. al, published in the journal Psycho-Oncology (abstract only)
- Language Lateralization and Handedness in Women Prenatally Exposed to Diethylstilbestrol (DES), (2000), by Laurel L. Smith and Melissa Hines, published in the journal Psychoneuroendocrinology (full-text)
- Prevalence of Gynecologic Cancer in Women Exposed to Diethylstilbestrol in Utero (2000), from the New England Journal of Medicine (full-text)
1988-1999 - New Approaches for Estimating Risk from Exposure to Diethylstilbestrol (1999), by Gerald R. Cunha, et. al, published in the journal Environmental Health Perspectives (full-text)
- Effect of Diethylstilbestrol on Reproductive Function (1999), by Jeffrey M. Goldberg & Tommaso Falcone, published in the journal Fertility and Sterility (full-text)
- Prenatal Diethylstilbestrol Exposure and Self-Reported Immune-related Diseases (1998), by AJJM Vingerhoets, et. al, published in the European Journal of Obstetrics & Gynecology and Reproductive Biology (full-text)
- Diethylstilbestrol and Risk of Fatal Breast Cancer in a Prospective Cohort of U.S. Women (1996), by Eugenia E. Calle, et. al, published in the American Journal of Epidemiology (full-text)
- Self-reported Allergy, Infection, and Autoimmune Diseases among Men and Women Exposed in utero to Diethylstilbestrol (1996), by Donna Day Baird, Allen Wilcox & Arthur L. Herbst, published in the Journal of Clinical Epidemiology (abstract only)
- Sexual Differentiation of Cognitive Abilities in Women Exposed to Diethylstilbestrol (DES) Prenatally (1996), by Melissa Hines & Eugene Sandberg, published in the journal Hormones and Behavior (abstract only)
- Gender-Identity, Body-Experience, Sexuality, and the Wish for Having Children in DES-Daughters (1996), by Marrie Bekker, et. al, published in the journal Women & Health (abstract only)
- Prenatal Estrogens and the Development of Homosexual Orientation (1995), by HFL Meyer-Bahlburg, et. al, published in the journal Developmental Psychology (abstract only)
- Diethylstilbestrol Revisited: A Review of the Long-term Health Effects (1995), by Ruthann Giusti, et. al, published in the journal Annals of Internal Medicine (abstract only)
- Teratogen Update: Carcinogenesis and Teratogenesis Associated with Exposure to Diethylstilbestrol (DES) in utero (1995), by Robert Mittendorf, published in the journal Teratology (abstract only)
- Effects on the Menstrual Cycle of in utero Exposure to Diethylstilbestrol (1994), by Paige P. Hornsby, et. al, published in the American Journal of Obstetrics and Gynecology (abstract only)
- Gender-related Behavior in Women Exposed Prenatally to Diethylstilbestrol (1993), by R. R. Newbold, published in the journal Environmental Health
- Breast Cancer in Mothers Prescribed Diethylstilbestrol in Pregnancy: Further Follow-up (1993), by Theodore Colton, et. al, published in the Journal of the American Medical Association (JAMA) (abstract only)
- Prenatal Exposure to Diethylstilbestrol (DES): Childhood Play Behavior and Adult Gender-role Behavior in Women (1992), by Jennifer D. Lish, et. al, published in the journal Archives of Sexual Behavior
- Menstrual Cycle Functioning in Women with a History of Prenatal Diethylstilbestrol Exposure (1991), by D. Schechter, et. al, published in the Journal of Psychosomatic Obstetrics & Gynecology (full-text)
- Gender-related Behavior Development in Females Exposed to Diethylstilbestrol (DES) in Utero: An Attempted Replication (1991), by Jennifer D. Lish, et. al, published in the Journal of the American Academy of Child & Adolescent Psychiatry (abstract only)
- Diethylstilbestrol, Teratogenesis, and Carcinogenesis: Medical/legal Implications of its Long-term Sequelae, including Third Generation Effects (1990), by Henry T. Lynch, et. al, published in the International Journal of Risk and Safety in Medicine (abstract only)
- Abortion and Pregnancy Loss Among Diethylstilbestrol-exposed Women (1989), by Arthur L. Herbst, Elizabeth K. Senekjian, & Keith W. Frey, published in the Journal of Reproductive Medicine (abstract only)
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