CitationBritton, Laura E.; Hussey, Jon M.; Berry, Diane C.; Crandell, Jamie L.; Brooks, Jada L.; & Bryant, Amy G. (2018). Contraceptive use among women with prediabetes and diabetes in a US national sample. 2018 Add Health Users Conference. Bethesda, MD.
AbstractFor women with pre-existing Type 1 or Type 2 diabetes mellitus, elevated blood glucose in pregnancy is associated with increased risks of fetal malformations, preterm birth, macrosomia, preeclampsia, and perinatal loss. The American Diabetes Association recommends that contraception be used until blood glucose is well-controlled, but evidence suggests that family planning services are not well-integrated into diabetes management. Using a population-based sample, we evaluated the relationship between contraceptive use and diabetes status. This cross-sectional study used data from 5,548 sexually active, non-pregnant women ages 24-32 in the nationally representative National Longitudinal Study of Adolescent to Adult Health (Add Health) from 2007-2008. Prediabetes and diabetes were identified by A1C from blood specimens. Diagnosis was identified by self-report or anti-hyperglycemic medication use. The primary outcome was most effective contraception used in the past year: highly effective (sterilization, intrauterine device, implant, pills, patch, ring, or injectable), moderately effective (condoms, diaphragms, spermicides, natural family planning, or withdrawal), or none. Multinomial regression models were adjusted for education, insurance, healthcare access, race/ethnicity, and body mass index. Unless otherwise indicated, women with normoglycemia were the referent, and highly effective contraceptive use was the base outcome. We tested the hypothesis that women with diabetes had greater odds of using no contraception compared to normoglycemic women. We estimated that 20.8% of sexually active, non-pregnant women aged 24-32 had prediabetes and 5.9% had diabetes. Among women with diabetes, 28.8% used no contraception, 33.6% used moderately effective contraception, and 37.6% used highly effective contraception. Our hypothesis that women with diabetes had greater odds of using no contraception than normoglycemic women was supported (OR 1.90, 95% CI 1.25-2.87). Among women with diabetes, those who were undiagnosed had greater odds of using moderately effective contraception than those who were diagnosed (OR 3.39, 95% CI 1.44-7.96). Use of less effective contraceptive methods was common among women with diabetes. Since this population is at elevated risk of adverse obstetrical outcomes, family planning service delivery must be improved to help women at risk of diabetes-related pregnancy complications to achieve their childbearing goals.
Reference TypeConference proceeding
Book Title2018 Add Health Users Conference
Author(s)Britton, Laura E.
Hussey, Jon M.
Berry, Diane C.
Crandell, Jamie L.
Brooks, Jada L.
Bryant, Amy G.