Researchers Observe Disparities in Contraception Use Between Women With, Without Diabetes

New research from the Boston University School of Medicine suggests that women with diabetes are less likely to use contraception after their diagnosis, a finding that could have significant implications for maternal and fetal risks during pregnancy.

Uncontrolled diabetes poses significant risks to both maternal and fetal health during pregnancy, according to the study authors. Because of these risks, the American Diabetes Association (ADA) recommends that family planning should be discussed, and effective contraception should be available to reproductive-age women with diabetes.

“Efforts are needed to ensure that women with diabetes receive the counseling and clinical services needed to carefully plan their pregnancies,” said corresponding author Mara Murray Horwitz, MD, in a press release.

The investigators used claims data from a large national insurance provider to identify reproductive-age women, who they divided into 2 groups: those who received a new diabetes diagnosis and those who did not receive a diabetes diagnosis. They then matched individuals in each group on important other variables and measured contraception use in the 2 groups during the year before and the year after their diagnosis. Finally, they compared the change in contraception use from the year before the diagnosis to the year after diagnosis.

The study findings indicate that being diagnosed with diabetes does not make a person more likely to use effective contraception and may actually lead to a drop in the use of certain types of effective contraception, especially short-acting hormonal methods such as pills or injections, according to the authors.

Women with diabetes do have the same contraception options and recommendations as women without diabetes, according to the ADA, and the risks of an unplanned pregnancy in this population outweigh the risks of most contraception options.

“Nonetheless, many patients and clinicians report concerns about the need for an safety of contraception in the setting of diabetes,” Horwitz said in the press release. “It is conceivable that—as our study suggests—a diabetes diagnosis leads to less, instead of more, contraception counseling, prescribing, and use.”

The investigators said they hope that their findings lead to more comprehensive care, including family planning, for people with diabetes who may become pregnant.

“Ultimately we 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,” Horwitz concluded.

REFERENCE

Disparities in Contraception Use Between Women with and Without Diabetes Persist, Sometimes Worsen After the Diagnosis of Diabetes [news release]. Boston University School of Medicine; March 18, 2021. https://www.bumc.bu.edu/busm/2021/03/18/disparities-in-contraception-use-between-women-with-and-without-diabetes-persist-sometimes-worsen-after-the-diagnosis-of-diabetes/. Accessed March 26, 2021.