Diethylstilbestrol (DES) Update: Recommendations for the Identification and Management of DES-Exposed Individuals

Barbara Hammes, CNM, MS, Cynthia J. Laitman, PhD

Disclosures

J Midwifery Womens Health. 2003;48(1) 

In This Article

Evaluation and Management of Women Exposed to DES

Since 1995, health care practitioners have depended on the National Cancer Institute document, "Recommendations for the identification and management of persons exposed to diethylstilbestrol (DES)," edited by Raymond Kaufman, for use in clinical practice. This document serves as a leading reference by the National Cancer Institute and CDC and is the key resource for the following guidelines.[15]

 

Although many DES mothers and DES daughters know of their exposure, it is not uncommon for clinicians to make the initial diagnosis secondary to either components of a client's prior medical history, obstetric history, or signs noted on physical examination. DES was given to pregnant women in the United States between 1938 and 1971. However, it was not banned in other countries until the late 1970s or early 1980s.[55] Elements within an obstetric history that should alert clinicians to the possibility that DES was prescribed during pregnancy are listed in Table 2

If past records are not available from the woman's health provider, a complete review of a woman's past obstetric and medical records is needed to identify mothers who have forgotten or were unaware that they received DES. Because a history of DES may not be volunteered, routine medical histories should include the following questions:

  • Did you or your mother take DES? (Show them the various names for DES.)

  • Did you or your mother have problems carrying a pregnancy to term?

  • Do you or did your mother have a history of miscarriages for which medication was prescribed? (If any pills were taken during pregnancy, every effort to locate and check obstetric records should be made to determine the name of the drug.)

  • Do you have a history of ectopic pregnancy?

  • Just as DES mothers may be unaware of prior DES exposure, women exposed in utero, DES daughters, may not be aware of their exposure. Clinical signs that are suspicious for DES exposure, which may be noted on physical examination, are listed in Table 2 Women with these suspicious abnormalities should be considered to have been exposed to DES, despite unclear DES history.

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