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The expected complication associated with diethylstilbestrol (DES) exposure in utero is vaginal epithelial changes. DES is a synthetic estrogen that was prescribed to pregnant women between the 1940s and 1970s to prevent pregnancy complications. However, it was later discovered that exposure to DES during fetal development could lead to several anomalies, particularly in the reproductive system.

One significant consequence of DES exposure is the development of abnormal vaginal epithelium, which can present as clear cell adenocarcinoma of the vagina and cervix in some cases. The vaginal walls may also show structural changes, such as a looped and ridged appearance, which are associated with the abnormal development driven by in utero estrogen exposure. These epithelial changes highlight the profound impact of hormonal exposure during critical periods of development and underscore the necessity for monitoring and follow-up care for those exposed to DES.

The other options listed—high blood pressure, diabetes mellitus, and cardiovascular defects—are not directly linked to in utero DES exposure and have different etiologies or risk factors associated with them. Understanding the specific complications arising from DES exposure helps midwives and healthcare professionals provide appropriate care and counsel for individuals potentially affected.