Prescrire Int. 2011 Nov;20(121):264-6.
Between the 1950s and the late 1970s, millions of women worldwide took diethylstilbestrol (DES) during pregnancy. It was claimed that DES prevented miscarriage, even though a clinical trial was interrupted in 1953 when an interim analysis showed no beneficial effect in the prevention of miscarriage. In 1971, it emerged that DES exposure in utero was associated with somatic effects in adulthood, including female genital abnormalities with obstetric consequences, vaginal cancer, and male urogenital disorders. This article examines the psychological effects of exposure to DES in utero, based on a review of the literature using the standard Prescrire methodology. In two experimental studies, mice exposed to DES during gestation were found to be more aggressive than unexposed mice. A randomised clinical trial and epidemiological studies have pointed to a risk of psychological disorders during adolescence and adulthood after DES exposure in utero. A placebo-controlled randomised trial of DES was conducted in London in the 1950s but was never published. In the 1980s, a research team recovered some of the original data and obtained information on the adult health status of the persons exposed in utero. Compared to the placebo group, psychological disorders were twice as frequent in the adults who were likely to have been exposed to DES in utero. Three large epidemiological studies were also conducted. One study showed that major depressive episodes were about 1.5 times more frequent in women exposed to DES in utero than in unexposed women; the second showed that exposed women had an episode of major weight loss more often than unexposed women; while the third showed no significant difference between the groups in terms of depressive episodes. Smaller studies also suggest that depressive episodes tend to be more frequent after DES exposure in utero. In practice, these data suggest that persons exposed to DES in utero have an increased risk of experiencing psychological disorders and should be monitored accordingly.
在20世纪50年代至70年代末期间，全球数百万名女性在孕期服用了己烯雌酚（DES）。据称，DES可预防流产，尽管在1953年一项临床试验因中期分析显示其对预防流产无有益效果而中断。1971年，有研究表明子宫内接触DES与成年后的躯体影响有关，包括具有产科后果的女性生殖器异常、阴道癌和男性泌尿生殖系统疾病。本文基于使用标准Prescrire方法对文献的综述，探讨子宫内接触DES的心理影响。在两项实验研究中，发现孕期接触DES的小鼠比未接触的小鼠更具攻击性。一项随机临床试验和多项流行病学研究指出，子宫内接触DES后在青春期和成年期有患心理障碍的风险。20世纪50年代在伦敦进行了一项DES的安慰剂对照随机试验，但从未发表。20世纪80年代，一个研究团队找回了一些原始数据，并获取了子宫内接触者的成年健康状况信息。与安慰剂组相比，子宫内可能接触过DES的成年人患心理障碍的频率是其两倍。还进行了三项大型流行病学研究。一项研究表明，子宫内接触DES的女性发生重度抑郁发作的频率比未接触者高约1.5倍；第二项研究表明，接触DES的女性发生重大体重减轻发作的频率高于未接触者；而第三项研究表明两组在抑郁发作方面无显著差异。规模较小的研究也表明，子宫内接触DES后抑郁发作往往更频繁。实际上，这些数据表明子宫内接触DES的人患心理障碍的风险增加，应据此进行监测。
