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Provision of Contraceptive Services to Women with Diabetes Mellitus

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ABSTRACT

BACKGROUND

Women with diabetes mellitus who delay pregnancy until glycemic control is achieved experience lower rates of adverse pregnancy outcomes.

OBJECTIVE

To compare rates of provision of contraceptive services among women with diabetes mellitus and women without chronic medical conditions.

DESIGN

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.

RESULTS

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.

CONCLUSIONS

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.

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Acknowledgements and Funding

Eleanor Bimla Schwarz participated in the study design, interpretation of results, and manuscript writing; her time was supported by NICHD K23 HD051585. Debbie Postlethwaite participated in the study design, supervision of data collection, interpretation of results, and manuscript writing. Yun-Yi Hung participated in study design, data collection, conducted analyses, interpretation of results, and manuscript editing. Mary Anne Armstrong participated in study design, provided biostatistical expertise, interpretation of results, and manuscript editing. Eric Lantzman participated in study design, data collection, manuscript editing, and contributed to the discussion. Michael A. Horberg participated in interpretation of results, manuscript editing, and contributed to the discussion.

Conflict of Interest

None disclosed.

Sources of Funding

Dr. Schwarz was supported by NICHD grant K23 HD051585. The Kaiser Foundation Research Institute (KFRI) administered research funding provided by Bayer HealthCare Pharmaceutical Inc. for the study conducted by the Division of Research, Kaiser Permanente Northern California.

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Authors and Affiliations

  1. Departments of Medicine, Epidemiology, Obstetrics, Gynecology, and Reproductive Sciences, University of Pittsburgh, Center for Research on Health Care, 230 McKee Place, Suite 600, Pittsburgh, PA, 15213, USA

    Eleanor Bimla Schwarz MD, MS

  2. Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA

    Debbie Postlethwaite RNP, MPH, Yun-Yi Hung PhD, MPH & Mary Anne Armstrong MA

  3. Department of Obstetrics and Gynecology, Southcentral Foundation, Anchorage, AK, USA

    Eric Lantzman MD

  4. Mid-Atlantic Permanente Research Institute, Rockville, MD, USA

    Michael A. Horberg MD, MAS

Authors
  1. Eleanor Bimla Schwarz MD, MS
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  2. Debbie Postlethwaite RNP, MPH
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  3. Yun-Yi Hung PhD, MPH
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  4. Eric Lantzman MD
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  5. Mary Anne Armstrong MA
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  6. Michael A. Horberg MD, MAS
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Corresponding author

Correspondence to Eleanor Bimla Schwarz MD, MS.

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Schwarz, E.B., Postlethwaite, D., Hung, YY. et al. Provision of Contraceptive Services to Women with Diabetes Mellitus. J GEN INTERN MED 27, 196–201 (2012). https://doi.org/10.1007/s11606-011-1875-6

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  • DOI: https://doi.org/10.1007/s11606-011-1875-6

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