Troisi Rebecca, Titus-Ernstoff Linda, Hyer Marianne, Hatch Elizabeth E, Robboy Stanley J, Strohsnitter William, Palmer Julie R, Øglaend Bjørn, Adam Ervin, Kaufman Raymond, Herbst Arthur L, Hoover Robert N
Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Department of Health and Human Services, Bethesda, Maryland, USA.
Obstet Gynecol. 2007 Jul;110(1):113-20. doi: 10.1097/01.AOG.0000268796.75591.02.
To assess whether preeclampsia risk is elevated in pregnancies of diethylstilbestrol (DES)-exposed daughters.
This study used data from the National Cancer Institute DES Combined Cohorts Follow-up Study. A total of 285 preeclampsia cases (210 exposed and 75 unexposed) occurred in 7,313 live births (4,759 DES exposed and 2,554 unexposed). Poisson regression analysis estimated relative risks and 95% confidence intervals (CI) for preeclampsia adjusted for age at the index pregnancy, parity, education, smoking, body mass index, year of diagnosis, and cohort.
In utero DES exposure was associated with nearly a 50% elevation in preeclampsia risk. Adjustment for preeclampsia risk factors attenuated the relative risk slightly (1.42, 95% CI 1.04-1.94). The excess risk with DES was concentrated among women who developed preeclampsia in their first pregnancies (relative risk 1.81, 95% CI 1.17-2.79), who were exposed before 15 weeks of gestation (relative risk 1.57, 95% CI 1.11-2.23), and who were treated with magnesium sulfate (relative risk 2.10, 95% CI 0.82-5.42). Among DES-exposed women who had a prior hysterosalpingogram, preeclampsia prevalence was higher in those with uterine abnormalities (12.4%) than in those without (7.7%).
These data suggest that in utero exposure to DES is associated with a slightly elevated risk of preeclampsia, and that one possible biological mechanism involves uterine abnormalities.
评估己烯雌酚（DES）暴露女性子代妊娠时子痫前期风险是否升高。
本研究使用了美国国立癌症研究所DES联合队列随访研究的数据。在7313例活产中（4759例DES暴露和2554例未暴露），共发生285例子痫前期病例（210例暴露和75例未暴露）。采用泊松回归分析估计子痫前期的相对风险和95%置信区间（CI），并对索引妊娠年龄、产次、教育程度、吸烟、体重指数、诊断年份和队列进行了校正。
子宫内DES暴露与子痫前期风险升高近50%相关。对子痫前期风险因素进行校正后，相对风险略有降低（1.42，95%CI 1.04 - 1.94）。DES导致的额外风险集中在首次妊娠时发生子痫前期的女性中（相对风险1.81，95%CI 1.17 - 2.79）、妊娠15周前暴露的女性中（相对风险1.57，95%CI 1.11 - 2.23）以及接受硫酸镁治疗的女性中（相对风险2.10，95%CI 0.82 - 5.42）。在曾接受子宫输卵管造影的DES暴露女性中，有子宫异常者的子痫前期患病率（12.4%）高于无子宫异常者（7.7%）。
这些数据表明，子宫内暴露于DES与子痫前期风险略有升高相关，一种可能的生物学机制涉及子宫异常。
