Women who receive a diagnosis of diabetes are less, not more, likely to use contraception after their diagnosis, according to a new study from researchers at the Boston University School of Medicine.
This report could have important implications for the health of mothers ─ and also of their babies, according to the authors. Diabetes that is not managed well can be risky for both mother and child, they say, and it’s estimated that about 3% of women in the United States who are of reproductive age have diabetes. According to Mara Murray Horwitz, MD, assistant professor of medicine at Boston University School of Medicine and lead author of the study, “Public health data tell us that patients with diabetes have lower levels of family planning, including lower levels of effective contraception use and more unintended pregnancies. As a primary care physician, I know that it is a constant struggle to balance care for patients’ active medical issues and their preventive care needs.”
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The researchers collected data from the years 2000 to 2014 from a large national private insurance company. The subjects were women aged 15 to 49 who were not pregnant. They divided the women into two groups: about 75,000 who received a new diabetes diagnosis and some 7.5 million who did not. The researchers used pharmacy procedure and fill codes, along with medical diagnosis, to measure contraception usage both before and after the women’s diabetes diagnoses. The final step in the research process was to compare any changes in contraceptive use from the year before the diabetes diagnosis to the year after it.
The researchers found that overall rates of the use of contraceptives did not increase after a diagnosis diabetes, and, in fact, when the researchers looked into contraceptive methods, they discovered a decline in the use of both estrogen-containing contraceptives (sometimes called “the pill”) and injectable contraceptives (sometimes called the “birth control shot”).
Why the decline? The authors believe it might stem from the belief that estrogen, a key component of contraceptive pills and injections, carries cardiovascular risks. The authors, however, cited a statement from the American Diabetes Association: “Women with diabetes have the same contraceptive options and recommendations as women without diabetes. The risk of an unplanned pregnancy outweighs the risk of any given contraception option.”
As Dr. Murray Horwitz summed it up, “Our finding was disappointing, but not surprising, because it can take years, even decades, to translate healthcare policy into practice…. Currently, on a population level, and contrary to clinical practice recommendations, a diabetes diagnosis is not triggering an increase in family planning or contraception use.” This might mean, she said, that such a diagnosis is “a missed opportunity to help patients plan healthy pregnancies.” What needs to happen now, she advised, is to determine why some women with diabetes might not be getting the needed advice and access to family planning. “Are services not being offered because of a lack of time, information, priority or bandwidth; or, most likely, some combination of them?” she asked. “Ultimately, I want everyone to be able to choose when and if they become pregnant, and to have the information, tools, and support as needed to optimize their pregnancy outcomes.”
Want to learn more about managing diabetes during pregnancy? Read “Pregnancy and Type 1 Diabetes,” “Treatment for Gestational Diabetes: Once You’re Diagnosed” and “Gestational Diabetes: More Treatment Approaches.”
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