Abstract
Objective
As diabetes is increasing among women of reproductive age in the United States, access
to effective contraception is important to allow time for optimal glycemic control
which may mitigate complications in future pregnancies. This study sought to describe
contraceptive use and compare the effectiveness of contraceptive methods among postpartum
women with and without diabetes.
Study design
This study used data from the Pregnancy Risk Assessment Monitoring System and included
women with recent live births during 2012–2015 (N = 93,574). Women were asked about pre-gestational or recent gestational diabetes
and their postpartum contraceptive method. Chi-square and multivariate logistic regression
analyses were used to compare contraceptive methods between women with and without
diabetes.
Results
Contraceptive prevalence was similar between women with (82%) and without (83%) diabetes;
women with diabetes were more likely to use the most effective methods. This was driven
by higher use of female sterilization among women with diabetes (15%) compared to
women without diabetes (9%) (p < 0.001). In multivariate analysis, odds of use of female sterilization versus reversible
prescription methods was higher among women with diabetes than women without diabetes
(adjusted odds ratio 1.29, 95% confidence interval 1.19–1.39).
Conclusions
Although overall postpartum contraceptive use was high, only 1/3 of women with or
without diabetes were using the most effective methods. Furthermore, women with diabetes
were more likely to use female sterilization than women without diabetes. It is important
all postpartum women, particularly those with high risk pregnancies such as women
with diabetes, receive counseling about and access to all contraceptive methods.
Implications
It is important for clinicians to counsel women with pregnancies affected by diabetes
that reversible contraceptives such as implants and IUDs are as effective as female
permanent contraception.
Keywords
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Article Info
Publication History
Published online: September 01, 2019
Accepted:
August 26,
2019
Received in revised form:
August 21,
2019
Received:
May 17,
2019
Footnotes
☆Declaration of Competing Interest: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.
☆☆Paper presentations: This research was presented in part as a poster at the American Society for Reproductive Medicine Annual Conference, Denver, CO, October 10, 2018.
★Disclaimer: The findings and conclusions in this article are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention.
★★Funding: This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors
Identification
Copyright
Published by Elsevier Inc.
