对己烯雌酚暴露后代妊娠结局的持续随访。

Continued follow-up of pregnancy outcomes in diethylstilbestrol-exposed offspring.

作者信息

Kaufman R H, Adam E, Hatch E E, Noller K, Herbst A L, Palmer J R, Hoover R N

机构信息

Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, Texas 77030, USA.

出版信息

Obstet Gynecol. 2000 Oct;96(4):483-9. doi: 10.1016/s0029-7844(00)00959-5.

DOI:10.1016/s0029-7844(00)00959-5

PMID:11004345

Abstract

OBJECTIVE

To evaluate long-term pregnancy experiences of women exposed to diethylstilbestrol (DES) in utero compared with unexposed women.

METHODS

This study was based on diethylstilbestrol-exposed daughters, the National Collaborative Diethylstylbistrol Adenosis cohort and the Chicago cohort, and their respective nonexposed comparison groups. Subjects who could be traced were sent a detailed questionnaire in 1994 that contained questions on health history, including information on pregnancies and their outcomes. We reviewed 3373 questionnaires from exposed daughters and 1036 questionnaires from unexposed women.

RESULTS

The response rate was 88% among exposed and unexposed women. Diethylstilbestrol-exposed women were less likely than unexposed women to have had full-term live births and more likely to have had premature births, spontaneous pregnancy losses, or ectopic pregnancies. Full-term infants were delivered in the first pregnancies of 84.5% of unexposed women compared with 64. 1% of exposed women identified by record review (relative risk [RR] 0.76, confidence interval [CI] 0.72, 0.80). Preterm delivery of first births occurred in 4.1% of unexposed compared with 11.5% of exposed women, and ectopic pregnancies in 0.77% of unexposed compared with 4.2% of exposed women. Spontaneous abortion was reported in 19.2% of DES-exposed women compared with 10.3% in control women (RR 2.00, CI 1.54, 2.60). According to complete pregnancy histories (many women had more than one pregnancy), preterm births were more common in DES-exposed women (19.4% exposed versus 7.5% unexposed (RR 2.93 CI 2.23, 3.86). Second-trimester spontaneous pregnancy losses were more common in DES-exposed women (6.3% versus 1.6%; RR 4.25, CI 2.36, 7.66). More first-trimester spontaneous abortions occurred in DES-exposed women than in controls (RR 1.31, CI 1.13, 1.53), and DES-exposed women had at least one ectopic pregnancy more often than unexposed women (RR 3.84, CI 2.26, 6.54).

CONCLUSION

Pregnancy outcomes in DES-exposed women were worse than those in unexposed women.

摘要

目的

评估子宫内接触己烯雌酚（DES）的女性与未接触该物质的女性相比的长期妊娠经历。

方法

本研究基于接触己烯雌酚的女儿们、全国己烯雌酚腺病协作队列和芝加哥队列，以及各自未接触的对照组。1994年，向能够追踪到的受试者发送了一份详细问卷，其中包含关于健康史的问题，包括妊娠及其结局的信息。我们审查了3373份来自接触DES女儿的问卷和1036份来自未接触女性的问卷。

结果

接触组和未接触组女性的回复率均为88%。与未接触己烯雌酚的女性相比，接触己烯雌酚的女性足月活产的可能性较小，早产、自然流产或异位妊娠的可能性较大。经记录审查确定，84.5%未接触DES的女性在首次妊娠时足月分娩，而接触DES的女性这一比例为64.1%（相对风险[RR]0.76，置信区间[CI]0.72，0.80）。未接触DES的女性首次分娩早产率为4.1%，而接触DES的女性为11.5%；未接触DES的女性异位妊娠率为0.77%，而接触DES的女性为4.2%。报告显示，接触DES的女性自然流产率为19.2%，而对照组女性为10.3%（RR 2.00，CI 1.54，2.60）。根据完整的妊娠史（许多女性有不止一次妊娠），接触DES的女性早产更为常见（接触组为19.4%，未接触组为7.5%；RR 2.93，CI 2.23，3.86）。接触DES的女性孕中期自然流产更为常见（6.3%对1.6%；RR 4.25，CI 2.36，7.66）。接触DES的女性孕早期自然流产比对照组更多（RR 1.31，CI 1.13，1.53），且接触DES的女性发生至少一次异位妊娠的情况比未接触的女性更频繁（RR 3.84，CI 2.26，6.54）。