Research
Urogenital abnormalities in men exposed to diethylstilbestrol in utero: a cohort study
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* Corresponding author: Julie R Palmer jpalmer@bu.edu
1 Slone Epidemiology Center of Boston University, Boston, MA, USA
2 Department of Obstetrics and Gynecology, University of Chicago, Chicago, IL, USA
3 Department of Obstetrics and Gynecology, New England Medical Center, Boston, MA, USA
4 Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD, USA
5 Departments of Community and Family Medicine and of Pediatrics, Dartmouth Medical School, Lebanon, NH, USA
6 Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA
Environmental Health 2009, 8:37 doi:10.1186/1476-069X-8-37
Published: 18 August 2009Abstract
Background
Diethylstilbestrol (DES), a synthetic estrogen widely prescribed to pregnant women during the 1940s-70s, has been shown to cause reproductive problems in the daughters. Studies of prenatally-exposed males have yielded conflicting results.
Methods
In data from a collaborative follow-up of three U.S. cohorts of DES-exposed sons, we examined the relation of prenatal DES exposure to occurrence of male urogenital abnormalities. Exposure status was determined through review of prenatal records. Mailed questionnaires (1994, 1997, 2001) asked about specified abnormalities of the urogenital tract. Risk ratios (RR) were estimated by Cox regression with constant time at risk and control for year of birth.
Results
Prenatal DES exposure was not associated with varicocele, structural abnormalities of the penis, urethral stenosis, benign prostatic hypertrophy, or inflammation/infection of the prostate, urethra, or epididymus. However, RRs were 1.9 (95% confidence interval 1.1-3.4) for cryptorchidism, 2.5 (1.5-4.3) for epididymal cyst, and 2.4 (1.5-4.4) for testicular inflammation/infection. Stronger associations were observed for DES exposure that began before the 11th week of pregnancy: RRs were 2.9 (1.6-5.2) for cryptorchidism, 3.5 (2.0-6.0) for epididymal cyst, and 3.0 (1.7-5.4) for inflammation/infection of testes.
Conclusion
These results indicate that prenatal exposure to DES increases risk of male urogenital abnormalities and that the association is strongest for exposure that occurs early in gestation. The findings support the hypothesis that endocrine disrupting chemicals may be a cause of the increased prevalence of cryptorchidism that has been seen in recent years.