Contraception for women with diabetes: challenges and solutions

Figures & data

Table 1 Prevalence of diabetes

Prevalence of diabetes (2014)^Citation2,Citation4
Adults aged 20–79 years worldwide	387 million people were affected in 2014. This figure was calculated to rise to 592 million by 2035^Citation2
Undiagnosed type 2 diabetes	179 million people were calculated to have undiagnosed type 2 Diabetes^Citation4
Type 1 and type 2 diabetes	Type 1 diabetes – 10% of those affected Type 2 diabetes – 90% of those affected^Citation4
Global estimations	The International Diabetes Federation (IDF) documents the countries with the highest number of diabetic patients: People’s Republic of China, India, USA, Russia, Brazil^Citation2

Table 2 WHO Medical Eligibility Criteria for Contraceptive Use (2015)

Category	With clinical judgment
1	Use method in any circumstance
2	Generally use method
3	Use of method not usually recommended unless other more appropriate methods are not available or not acceptable
4	Method not to be used

Note: Reprinted from WHO. WHO Medical Eligibility Criteria for Contraceptive Use; Geneva: 2015. Available from: http://www.who.int/reproductivehealth/publications/family_planning/mec-wheel-5th/en/. Accessed August 19, 2015.¹⁸ Copyright © 2015.

Table 3 Contraceptive methods and diabetes

Condition	CHC	POP	DMPA/NET-EN	IMP	Cu IUD	IUS
History of gestational diabetes	1	1	1	1	1	1
Nonvascular disease
i. Noninsulin dependent	2	2	2	2	1	2
ii. Insulin dependent	2	2	2	2	1	2
Neuropathy/retinopathy/neuropathy	3/4	2	3	2	1	2
Other vascular disease	3/4	2	3	2	1	2

Abbreviations: CHC, combined hormonal contraception; Cu IUD, copper intrauterine device; DMPA/NET-EN, medroxyprogesterone acetate/Norethisterone enanthate; IMP, implants; POP, progestogen-only pill; IUS, intrauterine system.

Note: Reprinted from WHO. WHO Medical Eligibility Criteria for Contraceptive Use; Geneva: 2015. Available from: http://www.who.int/reproductivehealth/publications/family_planning/mec-wheel-5th/en/. Accessed August 19, 2015.¹⁸ Copyright © 2015.

Table 4 Summary of recommendations

Individualized, specialist contraceptive advice

Contraceptive guidance needs to be offered holistically; a trusting relationship between practitioner and client is advocated.^Citation17

Practitioners need to make reference to the WHO Medical Eligibility Criteria for Contraceptive Use.^Citation18

Women should be informed of all methods available including LARC methods which have higher efficacy.^Citation26

Contraceptive choices for women with diabetes

Recent data highlight the safety of hormonal contraception in relation to women with DM without complications of cardiovascular or microvascular risk factors.^Citation18

The copper IUD and IUS are suitable for women with type 1 and type 2 DM (MEC 1/2).^Citation18

Injectable contraceptives (medroxyprogesterone acetate) are not contraindicated for healthy diabetic women (MEC 2).^Citation26 Women at risk are recommended that they seek specialist advice (MEC 3).^Citation18

Contraceptive implants are suitable for women with diabetes (MEC 2).^Citation18

Natural and barrier methods of contraception are not contraindicated for women looking for a nonhormonal method of birth control.

Male and female sterilization remains an option; however, infection control is paramount^Citation32 and specialist referral is recommended.

Emergency contraceptive pills and the copper IUD are suitable for all women with DM to prevent unintended pregnancy.^Citation18

Preconception care

Effective contraception is paramount for women exhibiting poor glycemic control.^Citation6

Women with diabetes have increased risks of adverse pregnancy outcomes: Fivefold increased risk of stillbirth, threefold increased risk of perinatal mortality, and twofold increased risk of fetal congenital anomaly.^Citation7

Contraceptive care prior to pregnancy can benefit optimal pre-pregnancy weight, stabilize glycemic control, ensure safety of medication, and provide baseline levels for monitoring retinal and renal functions.^Citation9

Contraception is advised until HbA1c is below 6.5%.^Citation9 Women whose HbA1c level is above 86 mmol/mol (10%) are advised not to get pregnant.^Citation9

Women with DM need to be made aware of fertility advice services available within both acute and primary care.^Citation9

Abbreviations: LARC, long-acting reversible contraceptives; DM, diabetes mellitus; IUD, intrauterine device; IUS, intrauterine system; MEC, Medical Eligibility Criteria; WHO, World Health Organization.

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