CONTRACEPTIVE METHODS FOR DIABETIC WOMEN

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Studies conducted in the last decade have shown that the rise in the incidence of congenital anomalies in children of diabetic women is due to the lack of metabolic control at the time of conception. With stringent metabolic control, the rate of congenital anomalies decreases to levels close to those in the general population. To properly plan her pregnancy, the diabetic woman must have access to effective contraceptive methods. Thanks to advances in contraceptive technology, clinicians can now offer their patients a relatively large range of options that meet medical criteria such as effectiveness and efficiency and satisfy individual preferences.

5.1. Women with GDM:

Women who had GDM and have normal findings on 75 g glucose loading after pregnancy can use any kind of contraceptive method, with the same considerations as healthy women. Regular metabolic follow-up is required with oral contraceptive use, even though oral contraceptives with low oestrogenic and low androgenic characteristics are generally considered not to adversely affect metabolic balance.

5.2 Women with PreDM and Normal Target Organs:

Women with diabetes before pregnancy are at the highest risk of congenital anomalies if glucose is not controlled at the time of conception. In the past, these patients were not considered candidates for oral contraceptives because of their side effects. This approach changed, however, with the development of oral contraceptives with a low oestrogen component (<30 mcg ethanyl estradiol) and progesterone with weak androgenic characteristics. Studies have shown that these new pills do not adversely affect the metabolic balance and often even improve it because of better patient compliance with treatment and follow-up. They also do not affect the blood lipid profile, and unlike the older type, do not lead to blood coagulation. Thus, the new oral contraceptives offer a good and safe solution for diabetic women who are under regular doctor’s care. 

Another possibility that suits this patient group is the intrauterine device (IUD). Because it is not hormonal, the IUD does not have a metabolic effect. Research has proven it safe and effective in preventing pregnancy. The rate of side effects associated with the IUD in diabetic women does not exceed the rate and the rate in the general population.

5.3 Women with PreDM and Affected Target Organs:

Diabetic women in whom a microvascular disorder (nephropathy, retinopathy) has already developed are at higher risk of visual loss and renal dysfunction because of the diabetes. The safety of oral contraceptives, even the newer ones with lower hormone levels, has not been definitively proven in this patient group.

There are a few studies with some promising results regarding side effects, but further research is needed to evaluate long-term use. When no other means of contraception are available, clinicians may opt for oral contraceptives with low hormone doses in combination with meticulous follow-up in a multidisciplinary setting that includes experts in nephrology and ophthalmology, so that any worsening of the underlying disease is immediately detected and treated. As in women with PreDM and no vascular complications, the IUD is a feasible and safe solution.

In conclusion, clinicians have no problem today in suiting a contraceptive method to women with GDM. However, women with PreDM require close surveillance by a team with expertise in all the metabolic aspects of this disorder.