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Pregestational exposure to hormonal combined contraceptives and risk of gestational diabetes: an observational retrospective population study

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Abstract

Aims

To investigate whether pregestational exposure to oral combined hormonal contraception (CHC) is associated with a rise in the risk of gestational diabetes (GDM).

Methods

Prevailing GDM was assessed for all pregnancies that occurred in Tuscany, Italy, from years 2010 to 2018, using administrative data coupled with information about CHC prescriptions in the year prior to pregnancy retrieved from the regional registry of drug prescription claims. The relation between exposure to CHC and risk of GDM, expressed as Odds Ratio: OR (95% Confidence Intervals, CI), was calculated separately based on citizenship of mothers using multiple logistic regression analysis models, after adjusting for confounders.

Results

Among 210,791 pregnancies from 170,126 mothers, GDM was present in 22,166 (10.5%) pregnancies. CHC prescription within 12 months before the index pregnancy was present in 9065 (4.3%) mothers. The risk of GDM was weakly but significantly higher in pregnancies exposed to pregestational CHC only in pregnancies of mothers of Italian citizenship: OR:1.11 (95% CI 1.02–1.21); p = 0.02, after adjusting for age, parity, calendar year and pregestational body-mass index. The CHC-mediated effect was no longer present in pregnancies of mothers at higher risk of GDM, such as pregestational obesity, migrating from countries at higher GDM risk or after adjusting for the entire panel of confounders including employment status, prior spontaneous abortions, and education degree.

Conclusions

CHC had a modest effect on GDM risk, which became insignificant when added to basal prevailing risk factors for impaired glucose metabolism in pregnancy, such as pregestational obesity or originating from countries at high GDM risk.

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Authors and Affiliations

  1. Epidemiology Unit, Regional Health Agency of Tuscany, Via Pietro Dazzi 1, 50141, Florence, Italy

    Giuseppe Seghieri, Elisa Gualdani & Paolo Francesconi

  2. Department of Experimental and Clinical Medicine, Faculty of Physiatry, University of Florence, Florence, Italy

    Giuseppe Seghieri

  3. National Laboratory of Sex Gender Medicine, National Institute of Biostructures and Biosystems, Sassari, Italy

    Flavia Franconi & Ilaria Campesi

  4. Department of Biomedical Science, University of Sassari, Sassari, Italy

    Ilaria Campesi

  5. Diabetes and Metabolic Diseases Unit, Health Local Unit North-West Tuscany, Livorno, Italy

    Graziano Di Cianni

Authors
  1. Giuseppe Seghieri
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  2. Elisa Gualdani
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  3. Flavia Franconi
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  4. Ilaria Campesi
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  5. Graziano Di Cianni
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  6. Paolo Francesconi
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Contributions

No potential conflicts of interest relevant to this article were reported. EG and GS conducted the data analysis, GDC, FF and PF developed the study protocol and contributed to discussion. GS, IC and FF wrote and edited the final manuscript.

Corresponding author

Correspondence to Giuseppe Seghieri.

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Conflict of interest

The authors declare that there is no conflict of interest that could be perceived as prejudicing the impartiality of the research reported.

Human and animal rights

All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2008.

Informed consent

Each patient was assigned a unique identifier that was the same for all administrative.databases. This identifier does not allow to disclose the patient’s identity and othersensitive data, and therefore, no informed consent was required from all patients for being included in the study.

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This article belongs to the topical collection Pregnancy and Diabetes, managed by Antonio Secchi and Marina Scavini.

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Seghieri, G., Gualdani, E., Franconi, F. et al. Pregestational exposure to hormonal combined contraceptives and risk of gestational diabetes: an observational retrospective population study. Acta Diabetol 60, 1505–1511 (2023). https://doi.org/10.1007/s00592-023-02143-7

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