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Diabetes Mellitus and Contraception

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Comprehensive Clinical Approach to Diabetes During Pregnancy

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Abstract

Diabetes mellitus constitutes a common health problem affecting, amongst others, women of reproductive age. Contraception counseling in these patients is important in planning pregnancies when serum glucose concentrations are normalized. Nevertheless, limited information and access issues are prevalent among patients with diabetes. As far as the effects of contraception on glucose metabolism are concerned, evidence remains ambivalent. In some studies, healthy women receiving contraception demonstrated clinically insignificant changes in glucose metabolism parameters. In women with diabetes, the effects of contraception on glucose metabolism were small and depended on the extent of the disease. Specifically, for gestational diabetes mellitus, the risk of developing type 2 diabetes was not increased. The World Health Organization medical eligibility criteria for contraception in patients with medical conditions provide evidence regarding the safety of various contraceptive regimens in patients with diabetes and can be used in clinical practice. Besides contraceptive benefits, progestin-containing regimens decrease the risk of endometrial carcinoma and provide control over other gynecological pathologies, such as abnormal uterine bleeding.

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References

  1. Centers for Disease Control and Prevention. National Diabetes Statistics Report, 2020. Atlanta, GA; 2020.

    Google Scholar 

  2. Robinson A, Nwolise C, Shawe J. Contraception for women with diabetes: challenges and solutions. Open Access J Contracept. 2016;7:11–8. https://pubmed.ncbi.nlm.nih.gov/29386933.

    Article  PubMed  PubMed Central  Google Scholar 

  3. World Health Organization. Contraception: evidence brief. 2019. https://apps.who.int/iris/handle/10665/329884.

    Google Scholar 

  4. Association AD. Management of diabetes in pregnancy: Standards of medical care in diabetes-2020. Diabetes Care. 2020;43(supplement 1):S183–92. https://doi.org/10.2337/dc20-S014.

    Article  Google Scholar 

  5. De Wolff MG, Johansen M, Rom AL, Midtgaard J, Tabor A, Hegaard HK. Degree of pregnancy planning and recommended pregnancy planning behavior among women with and without chronic medical conditions—a large hospital-based cross-sectional study. Acta Obstet Gynecol Scand. 2020. https://pubmed.ncbi.nlm.nih.gov/33368141/. Accessed 31 Jan 2021.

  6. Vahratian A, Barber JS, Lawrence JM, Kim C. Family-planning practices among women with diabetes and overweight and obese women in the 2002 National Survey for Family Growth. Diabetes Care. 2009;32(6):1026–31. https://pubmed.ncbi.nlm.nih.gov/19279299/. Accessed 20 Jan 2021.

    Article  PubMed  PubMed Central  Google Scholar 

  7. Britton LE, Hussey JM, Berry DC, Crandell JL, Brooks JL, Bryant AG. Contraceptive use among women with prediabetes and diabetes in a US National Sample. J Midwifery Womens Health. 2019;64(1):36–45. /pmc/articles/PMC6351213/?report=abstract. Accessed 20 Jan 2021.

    PubMed  Google Scholar 

  8. Earle S, Tariq A, Komaromy C, Lloyd CE, Ali Karamat M, Webb J, et al. Preconception care for women with type 1 or type 2 diabetes mellitus: a mixed-methods study exploring uptake of preconception care. In: Health technology assessment, vol. 21. NIHR Journals Library; 2017. p. 1–127. https://pubmed.ncbi.nlm.nih.gov/28398196/. Accessed 31 Jan 2021.

    Google Scholar 

  9. Shawe J, Smith P, Stephenson J. Use of contraception by women with type 1 or type 2 diabetes mellitus: “It’s funny that nobody really spoke to me about it.”. Eur J Contracept Reprod Health Care. 2011;16(5):350–8. https://pubmed.ncbi.nlm.nih.gov/21777049/. Accessed 22 Jan 2021

    Article  PubMed  Google Scholar 

  10. Nwolise CH, Carey N, Shawe J. Preconception care education for women with diabetes: a systematic review of conventional and digital health interventions. J Med Internet Res. 2016;18:e291. http://www.jmir.org/2016/11/e291/. Accessed 31 Jan 2021.

    Article  PubMed  PubMed Central  Google Scholar 

  11. Gourdy P. Diabetes and oral contraception. Best Pract Res Clin Endocrinol Metab. 2013;27:67–76. https://pubmed.ncbi.nlm.nih.gov/23384747/. Accessed 7 Feb 2021.

    Article  CAS  PubMed  Google Scholar 

  12. Lopez LM, Grimes DA, Schulz KF. Steroidal contraceptives: effect on carbohydrate metabolism in women without diabetes mellitus. Cochrane Database Syst Rev. 2019;(4):CD006133. http://www.ncbi.nlm.nih.gov/pubmed/24788670. Accessed 7 Feb 2021.

  13. Godsland IF, Crook D, Simpson R, Proudly T, Felton C, Lees B, et al. The effects of different formulations of oral contraceptive agents on lipid and carbohydrate metabolism. N Engl J Med. 1990;323(20):1375–81. Accessed 7 Feb 2021. https://doi.org/10.1056/NEJM199011153232003.

    Article  CAS  PubMed  Google Scholar 

  14. Oelkers W, Foidart JM, Dombrovicz N, Welter A, Heithecker R. Effects of a new oral contraceptive containing an antimineralocorticoid progestogen, drospirenone, on the renin-aldosterone system, body weight, blood pressure, glucose tolerance, and lipid metabolism. J Clin Endocrinol Metab. 1995;80(6):1816–21. https://pubmed.ncbi.nlm.nih.gov/7775629/. Accessed 7 Feb 2021.

    CAS  PubMed  Google Scholar 

  15. Deleskog A, Hilding A, Östenson C-G. Oral contraceptive use and abnormal glucose regulation in Swedish middle-aged women. Diabetes Res Clin Pract. 2011;92(2):288–92. https://www.sciencedirect.com/science/article/pii/S0168822711000635.

    Article  CAS  PubMed  Google Scholar 

  16. Haverinen A, Kangasniemi M, Lucero K, Peltonen T, Heikinheimo O, Tapanainen JS. Ethinyl estradiol vs estradiol valerate in combined oral contraceptives—effect on glucose tolerance: a randomized, controlled clinical trial. Contraception. 2021;103(1):53–9. https://www.sciencedirect.com/science/article/pii/S001078242030384X.

    Article  CAS  PubMed  Google Scholar 

  17. Porkka KVK, Erkkola R, Taimela S, Raitakari OT, Dahlen GH, Viikari JSA. Influence of oral contraceptive use on lipoprotein (a) and other coronary heart disease risk factors. Ann Med. 1995;27(2):193–8. https://pubmed.ncbi.nlm.nih.gov/7632413/. Accessed 8 Feb 2021.

    Article  CAS  PubMed  Google Scholar 

  18. Kim C, Siscovick DS, Sidney S, Lewis CE, Kiefe CI, Koepsell TD. Oral contraceptive use and association with glucose, insulin, and diabetes in young adult women: the CARDIA study. Diabetes Care. 2002;25(6):1027–32. https://care.diabetesjournals.org/content/25/6/1027. Accessed 8 Feb 2021.

    Article  CAS  PubMed  Google Scholar 

  19. Peltonen T, Puurunen J, Hedberg P, Ruokonen A, Mutt SJ, Herzig KH, et al. Oral, transdermal and vaginal combined contraceptives induce an increase in markers of chronic inflammation and impair insulin sensitivity in young healthy normal-weight women: a randomized study. Hum Reprod. 2012;27(10):3046–56. Accessed 8 Feb 2021.

    Article  Google Scholar 

  20. Mosorin M-E, Haverinen A, Ollila M-M, Nordström T, Jokelainen J, Keinänen-Kiukaanniemi S, et al. Current use of combined hormonal contraception is associated with glucose metabolism disorders in perimenopausal women. Eur J Endocrinol. 183(6):619–26. https://eje.bioscientifica.com/view/journals/eje/183/6/EJE-20-0406.xml.

  21. Amiri M, Ramezani Tehrani F, Nahidi F, Kabir A, Azizi F, Carmina E. Effects of oral contraceptives on metabolic profile in women with polycystic ovary syndrome: a meta-analysis comparing products containing cyproterone acetate with third-generation progestins. Metab Clin Exp. 2017;73:22–35. https://pubmed.ncbi.nlm.nih.gov/28732568/. Accessed 9 Feb 2021.

    Article  CAS  PubMed  Google Scholar 

  22. Brache V, Payán LJ, Fagundes A. Current status of contraceptive vaginal rings. Contraception. 2013;87(3):264–72. https://www.sciencedirect.com/science/article/pii/S0010782412008037.

    Article  CAS  PubMed  Google Scholar 

  23. Wagner M-S, Black A. The combined contraceptive vaginal ring: an update. Curr Obstet Gynecol Rep. 2016;5(1):1–12. https://doi.org/10.1007/s13669-016-0141-7.

    Article  Google Scholar 

  24. Elkind-Hirsch KE, Darensbourg C, Ogden B, Ogden LF, Hindelang P. Contraceptive vaginal ring use for women has less adverse metabolic effects than an oral contraceptive. Contraception. 2007;76(5):348–56. https://www.sciencedirect.com/science/article/pii/S0010782407003502.

    Article  CAS  PubMed  Google Scholar 

  25. Guazzelli CAF, Barreiros FA, Torloni MR, Barbieri M. Effects of extended regimens of the contraceptive vaginal ring on carbohydrate metabolism. Contraception. 2012;85(3):253–6.

    Article  CAS  PubMed  Google Scholar 

  26. Morin-Papunen L, Martikainen H, McCarthy MI, Franks S, Sovio U, Hartikainen A-L, et al. Comparison of metabolic and inflammatory outcomes in women who used oral contraceptives and the levonorgestrel-releasing intrauterine device in a general population. Am J Obstet Gynecol. 2008;199(5):529.e1–529.e10. https://www.sciencedirect.com/science/article/pii/S0002937808004043.

    Article  Google Scholar 

  27. Oderich CL, Wender MCO, Lubianca JN, Santos LM, de Mello GC. Impact of etonogestrel-releasing implant and copper intrauterine device on carbohydrate metabolism: a comparative study. Contraception. 2012;85(2):173–6. https://www.sciencedirect.com/science/article/pii/S001078241100254X.

    Article  CAS  PubMed  Google Scholar 

  28. Kim S-W, Jeon J-H, Lee W-K, Lee S, Kim J-G, Lee I-K, et al. Long-term effects of oral contraceptives on the prevalence of diabetes in postmenopausal women: 2007–2012 KNHANES. Endocrine. 2016 Sep;53(3):816–22.

    Article  CAS  PubMed  Google Scholar 

  29. Rosenthal AD, Shu X-O, Jin F, Yang G, Easy TA, Li Q, et al. Oral contraceptive use and risk of diabetes among Chinese women. Contraception. 2004;69(3):251–7.

    Article  PubMed  Google Scholar 

  30. Rimm EB, Manson JE, Stampfer MJ, Colditz GA, Willett WC, Rosner B, et al. Oral contraceptive use and the risk of type 2 (non-insulin-dependent) diabetes mellitus in a large prospective study of women. Diabetologia. 1992;35(10):967–72. https://doi.org/10.1007/BF00401427.

    Article  CAS  PubMed  Google Scholar 

  31. Visser J, Snel M, Van Vliet HAAM. Hormonal versus non-hormonal contraceptives in women with diabetes mellitus type 1 and 2. Cochrane Database Syst Rev. 2013;2013(3):CD003990. https://pubmed.ncbi.nlm.nih.gov/23543528.

    PubMed Central  Google Scholar 

  32. Skouby SO, Mølsted-Pedersen L, Kühl C, Bennet P. Oral contraceptives in diabetic women: metabolic effects of four compounds with different estrogen/progestogen profiles. Fertil Steril. 1986;46(5):858–64.

    Article  CAS  PubMed  Google Scholar 

  33. Rogovskaya S, Rivera R, Grimes DA, Chen P-L, Pierre-Louis B, Prilepskaya V, et al. Effect of a levonorgestrel intrauterine system on women with type 1 diabetes: a randomized trial. Obstet Gynecol. 2005;105(4):811–5.

    Article  CAS  PubMed  Google Scholar 

  34. Vicente L, Mendonça D, Dingle M, Duarte R, Boavida JM. Etonogestrel implant in women with diabetes mellitus. Eur J Contracept Reprod Health Care. 2008;13(4):387–95.

    Article  CAS  PubMed  Google Scholar 

  35. Diab KM, Zaki MM. Contraception in diabetic women: comparative metabolic study of Norplant, depot medroxyprogesterone acetate, low dose oral contraceptive pill and CuT380A. J Obstet Gynaecol Res. 2000;26(1):17–26.

    Article  CAS  PubMed  Google Scholar 

  36. Grodnitskaya EE, Grigoryan OR, Klinyshkova EV, Andreeva EN, Melnichenko GA, Dedov II. Effect on carbohydrate metabolism and analysis of acceptability (menstrual cycle control) of extended regimens of the vaginally inserted hormone-releasing system “NuvaRing” as compared with the standard 21/7 regime in reproductive-age women with type 1 diabetes mellitus. Gynecol Endocrinol. 2010;26(9):663–8.

    Article  CAS  PubMed  Google Scholar 

  37. Grigoryan OR, Grodnitskaya EE, Andreeva EN, Chebotnikova TV, Melnichenko GA. Use of the NuvaRing hormone-releasing system in late reproductive-age women with type 1 diabetes mellitus. Gynecol Endocrinol. 2008;24(2):99–104.

    Article  CAS  PubMed  Google Scholar 

  38. Ahmed SB, Hovind P, Parving H-H, Rossing P, Price DA, Laffel LM, et al. Oral contraceptives, angiotensin-dependent renal vasoconstriction, and risk of diabetic nephropathy. Diabetes Care. 2005;28(8):1988–94.

    Article  CAS  PubMed  Google Scholar 

  39. Garg SK, Chase HP, Marshall G, Hoops SL, Holmes DL, Jackson WE. Oral contraceptives and renal and retinal complications in young women with insulin-dependent diabetes mellitus. JAMA. 1994;271(14):1099–102.

    Article  CAS  PubMed  Google Scholar 

  40. Klein BE, Klein R, Moss SE. Exogenous estrogen exposures and changes in diabetic retinopathy. The Wisconsin epidemiologic study of diabetic retinopathy. Diabetes Care. 1999;22(12):1984–7.

    Article  CAS  PubMed  Google Scholar 

  41. World Health Organization. Global report on diabetes. 2016. WHO: Geneva.

    Google Scholar 

  42. Bellamy L, Casas J-P, Hingorani AD, Williams D. Type 2 diabetes mellitus after gestational diabetes: a systematic review and meta-analysis. Lancet. 2009;373(9677):1773–9.

    Article  CAS  PubMed  Google Scholar 

  43. Peters RK, Kjos SL, Xiang A, Buchanan TA. Long-term diabetogenic effect of single pregnancy in women with previous gestational diabetes mellitus. Lancet. 1996;347(8996):227–30.

    Article  CAS  PubMed  Google Scholar 

  44. Damm P, Mathiesen ER, Petersen KR, Kjos S. Contraception after gestational diabetes. Diabetes Care. 2007;30(Supplement 2):S236 LP–S241. http://care.diabetesjournals.org/content/30/Supplement_2/S236.abstract.

    Article  Google Scholar 

  45. Kjos SL, Peters RK, Xiang A, Thomas D, Schaefer U, Buchanan TA. Contraception and the risk of type 2 diabetes mellitus in Latina women with prior gestational diabetes mellitus. JAMA. 1998;280(6):533–8.

    Article  CAS  PubMed  Google Scholar 

  46. Baptiste-Roberts K, Barone BB, Gary TL, Golden SH, Wilson LM, Bass EB, et al. Risk factors for type 2 diabetes among women with gestational diabetes: a systematic review. Am J Med. 2009;122(3):207–214.e4.

    Article  PubMed  PubMed Central  Google Scholar 

  47. Xiang AH, Kawakubo M, Kjos SL, Buchanan TA. Long-acting injectable progestin contraception and risk of type 2 diabetes in latino women with prior gestational diabetes mellitus. Diabetes Care. 2006;29(3):613 LP–617. http://care.diabetesjournals.org/content/29/3/613.abstract.

    Article  Google Scholar 

  48. World Health Organisation. Medical eligibility criteria for contraceptive use. 5th ed; 2015. https://apps.who.int/iris/bitstream/handle/10665/181468/9789241549158_eng.pdf.

    Google Scholar 

  49. Salinas A, Merino PM, Giraudo F, Codner E. Long-acting contraception in adolescents and young women with type 1 and type 2 diabetes. Pediatr Diabetes. 2020;21:1074–82.

    Article  PubMed  Google Scholar 

  50. Bahamondes L, Brache V, Ali M, Habib N. A multicenter randomized clinical trial of etonogestrel and levonorgestrel contraceptive implants with nonrandomized copper intrauterine device controls: effect on weight variations up to 3 years after placement. Contraception. 2018;98(3):181–7.

    Article  CAS  PubMed  Google Scholar 

  51. Lopez LM, Ramesh S, Chen M, Edelman A, Otterness C, Trussell J, et al. Progestin-only contraceptives: effects on weight. Cochrane Database Syst Rev. 2016;2016(8):CD008815.

    PubMed Central  Google Scholar 

  52. Shaw KA, Edelman AB. Obesity and oral contraceptives: a clinician’s guide. Best Pract Res Clin Endocrinol Metab. 2013;27(1):55–65. https://www.sciencedirect.com/science/article/pii/S1521690X12000978.

    Article  CAS  PubMed  Google Scholar 

  53. Jamieson DJ, Hillis SD, Duerr A, Marchbanks PA, Costello C, Peterson HB. Complications of interval laparoscopic tubal sterilization: findings from the United States collaborative review of sterilization. Obstet Gynecol. 2000;96(6):997–1002.

    CAS  PubMed  Google Scholar 

  54. Laforce R, Rosa-Neto P, Soucy J-P, Rabinovici GD, Dubois B, Gauthier S. Canadian consensus guidelines on use of amyloid imaging in Canada: update and future directions from the specialized task force on amyloid imaging in Canada. Can J Neurol Sci. 2016;43(4):503–12. https://www.ncbi.nlm.nih.gov/pubmed/26916179.

    Article  PubMed  Google Scholar 

  55. Lu KH, Broaddus RR. Endometrial cancer. N Engl J Med. 2020;383(21):2053–64. https://doi.org/10.1056/NEJMra1514010.

    Article  CAS  PubMed  Google Scholar 

  56. Thong EP, Codner E, Laven JSE, Teede H. Diabetes: a metabolic and reproductive disorder in women. Lancet Diabetes Endocrinol. 2020;8(2):134–49.

    Article  CAS  PubMed  Google Scholar 

  57. Saed L, Verse F, Baradaran HR, Moradi Y, Khatri S, Friberg E, et al. The effect of diabetes on the risk of endometrial cancer: an updated a systematic review and meta-analysis. BMC Cancer. 2019;19(1):527. https://doi.org/10.1186/s12885-019-5748-4.

    Article  PubMed  PubMed Central  Google Scholar 

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Authors and Affiliations

  1. Unit of Reproductive Endocrinology, 1st Department of Obstetrics and Gynecology, Medical School, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece

    Meletios P. Nigdelis

  2. Unit of Reproductive Endocrinology, 1st Department of Reproductive Endocrinology, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece

    Dimitrios G. Goulis

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  1. Meletios P. Nigdelis
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Correspondence to Dimitrios G. Goulis .

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  1. Unit of Reproductive Endocrinology, 1st Department of Reproductive Endocrinology, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece

    Dimitrios G. Goulis

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Nigdelis, M.P., Goulis, D.G. (2022). Diabetes Mellitus and Contraception. In: Goulis, D.G. (eds) Comprehensive Clinical Approach to Diabetes During Pregnancy. Springer, Cham. https://doi.org/10.1007/978-3-030-89243-2_21

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  • DOI: https://doi.org/10.1007/978-3-030-89243-2_21

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