Mølsted-Pedersen L, Skouby S O, Damm P
Department of Obstetrics and Gynaecology, Rigshospitalet, University of Copenhagen, Denmark.
Diabetes. 1991 Dec;40 Suppl 2:147-50. doi: 10.2337/diab.40.2.s147.
Women with gestational diabetes mellitus (GDM) diagnosed in the period 1978-1984 were followed for on average 6 yr after the index pregnancy. Thirty percent had diabetes mellitus at the follow-up examination, and preliminary results indicate that at least another third will develop diabetes during a subsequent pregnancy. Therefore, family planning and contraceptive guidance should follow the lines for women with pregestational diabetes. When low-dose hormonal contraceptives containing ethinyl estradiol and levonorgestrel were given to women with previous GDM, glucose tolerance and lipoprotein levels remained unchanged during a 6-mo treatment. However, insulin response to oral glucose increased significantly after hormonal intake for 6 mo. A triphasic preparation resulted in a significantly lower insulin response than a low-dose monophasic preparation. However, the results indicate that low-dose oral-contraceptive compounds appear to be safe for women with previous GDM when administered for limited periods. At the follow-up examination, we found no increased risk of developing diabetes in women with previous GDM who used oral contraception. We consider the intrauterine contraceptives (IUD) a safe and effective alternative for women with previous GDM. Of 154 women with GDM, 33% chose IUD, 22% a combination-type oral contraceptive, and 16% barrier methods as their first choice of contraception 2 mo postpartum. We conclude that family planning and qualified contraceptive advice are important in women with previous GDM.
对1978年至1984年期间诊断为妊娠期糖尿病（GDM）的女性在本次妊娠后平均随访6年。30%的女性在随访检查时患有糖尿病，初步结果表明，至少另有三分之一的女性在随后的妊娠期间会发展为糖尿病。因此，计划生育和避孕指导应遵循孕前糖尿病女性的指导原则。当给既往患有GDM的女性服用含炔雌醇和左炔诺孕酮的低剂量激素避孕药时，在6个月的治疗期间，葡萄糖耐量和脂蛋白水平保持不变。然而，激素摄入6个月后，口服葡萄糖的胰岛素反应显著增加。三相制剂导致的胰岛素反应明显低于低剂量单相制剂。然而，结果表明，低剂量口服避孕药化合物在有限时间内给药时，对既往患有GDM的女性似乎是安全的。在随访检查中，我们发现既往患有GDM且使用口服避孕药的女性患糖尿病的风险没有增加。我们认为宫内节育器（IUD）对既往患有GDM的女性是一种安全有效的避孕选择。在154名患有GDM的女性中，33%选择IUD，22%选择复方口服避孕药，16%选择屏障避孕法作为产后2个月的首选避孕方法。我们得出结论，计划生育和专业的避孕建议对既往患有GDM的女性很重要。
