Provision of Contraceptive Services to Women with Diabetes Mellitus
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Women with diabetes mellitus who delay pregnancy until glycemic control is achieved experience lower rates of adverse pregnancy outcomes.
To compare rates of provision of contraceptive services among women with diabetes mellitus and women without chronic medical conditions.
A retrospective cohort study of 459,181 women aged 15–44 who had continuous membership and pharmacy benefits in a managed care organization in Northern California between January 2006 and June 2007. Rates of documented provision of contraceptive counseling, prescriptions, and services were compared between women with diabetes and women without chronic medical conditions.
Among 8,182 women with diabetes and 122,921 women without any chronic conditions, women with diabetes were less likely than women without a chronic condition to have documented receipt of any contraceptive counseling, prescriptions, or services (47.8% vs 62.0%, p < 0.001). After controlling for age and race, women with diabetes were more likely to have undergone tubal sterilization compared to women without a chronic condition (OR = 1.41, 95% CI 1.30–1.54), but less likely to have received highly effective, reversible methods of contraception such as intrauterine contraception (OR = 0.68, 95% CI 0.61–0.75). In addition, more women with diabetes had undergone hysterectomy, which is rarely performed solely for contraceptive purposes.
Women with diabetes were less likely to receive highly effective reversible contraception and more likely to undergo sterilization procedures. Increasing the use of highly effective reversible contraceptives may help diabetic women who want to retain their fertility to delay pregnancy until glycemic control is achieved.
KEY WORDSdiabetes mellitus pregnancy contraception preconception counseling women
- 6.Cyganek K, Hebda-Szydlo A, Katra B, Skupien J, Klupa T, Janas I, et al. Glycemic control and selected pregnancy outcomes in type 1 diabetes women on continuous subcutaneous insulin infusion and multiple daily injections: the significance of pregnancy planning. Diabetes Technol Ther. 2010;12(1):41–7.PubMedCrossRefGoogle Scholar
- 8.Centers for Disease Control and Prevention. Update on overall prevalence of major birth defects—Atlanta, Georgia, 1978–2005. MMWR Morb Mortal Wkly Rep. 2008;11(57(1)):1–5..Google Scholar
- 9.Johnson K, Posner SF, Biermann J, Cordero JF, Atrash HK, Parker CS, et al. Recommendations to improve preconception health and health care—United States. A report of the CDC/ATSDR Preconception Care Work Group and the Select Panel on Preconception Care. MMWR Recomm Rep. 2006;55(RR-6):1–23.PubMedGoogle Scholar
- 11.D'Angelo D, Williams L, Morrow B, Cox S, Harris N, Harrison L, et al. Preconception and interconception health status of women who recently gave birth to a live-born infant—Pregnancy Risk Assessment Monitoring System (PRAMS), United States, 26 reporting areas, 2004. MMWR Surveill Summ. 2007;56(10):1–35.PubMedGoogle Scholar
- 14.World Health Organization. Medical Eligibility Criteria for Contraceptive Use [Book]. Geneva 2009. Available from: http://whqlibdoc.who.int/publications/2010/9789241563888_eng.pdf <accessed Aug 26, 2011>
- 26.Lidegaard O, Lokkegaard E, Svendsen AL, Agger C. Hormonal contraception and risk of venous thromboembolism: national follow-up study. BMJ. 2009;339:b2890.Google Scholar
- 27.Hatcher R, Trussell J, Stewart F, Nelson A, Cates W, Guest F, et al. Contraceptive Technology. 18th ed. New York: Ardent Media; 2004.Google Scholar