Magazine article Drug Topics

Hormonal Contraception and Diabetes: Select Carefully

Magazine article Drug Topics

Hormonal Contraception and Diabetes: Select Carefully

Article excerpt

Women who have had gestational diabetes during a previous pregnancy or who have a family history of diabetes should not take certain hormone contraceptives, some medical researchers maintain. However, that may not hold true in every case.

"Unfortunately, many women who have diabetes have been told that they cannot use certain birth control methods, such as oral contraceptives, when that may not be true," contended Siri Linda Kjos, M.D., of the University of Southern California School of Medicine, speaking at the recent American Diabetes Association (ADA) meeting in San Francisco.

Rather, research conducted by Kjos and co-workers at USC showed that women with diabetes or those who had gestational diabetes during a prior pregnancy must carefully select which oral contraceptive to use. Kjos advised women who want to use oral contraceptives as their birth control method to use the birth control pill with the lowest dose and potency of progestin in order to avoid increasing their risk of Type II diabetes.

Gestational diabetes can occur during pregnancy and then disappear following delivery. In many women who experience gestational diabetes, this condition may reappear years later as Type II diabetes. Gestational diabetes can occur in anyone but is most common in people over the age of 30, those who are obese, and those with a family history of Type II disease.

In one study reported at the ADA meeting, Kjos and colleagues assessed the impact of hormonal contraception on the risk of Latino women for developing noninsulindependent diabetes (NIDDM). The 943 women did not have NIDDM four to 16 weeks after the index pregnancy, and they returned for at least one glucose tolerance test during the seven-year follow-up. Among the women, 10% overall developed NIDDM, with 56% of these later diabetes patients having used hormonal contraception. The researchers found that the greatest risk for developing NIDDM was six to 12 weeks after delivery of the index pregnancy. Each type of hormonal contraceptivecombination estrogen/progestin oral tablet, progestin-only oral tablet, and Depo-Provera injection-produced a significant risk of diabetes (1.8, 13.5, and 3.8 relative risk, respectively).

Interestingly, the risk for diabetes occurred when the combination oral pill contained the progestin levonorgestrel, but it did not occur when the progestin included was the synthetic hormone norethindrone. The higher relative risk of diabetes development disappeared 12 weeks after delivery but continued when a progestin-only oral contraceptive was used. …

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