Departments of Medicine, Epidemiology, Obstetrics, Gynecology, and Reproductive Sciences, University of Pittsburgh, Center for Research on Health Care, 230 McKee Place, Suite 600, Pittsburgh, PA 15213, USA.
J Gen Intern Med. 2012 Feb;27(2):196-201. doi: 10.1007/s11606-011-1875-6. Epub 2011 Sep 16.
Women with diabetes mellitus who delay pregnancy until glycemic control is achieved experience lower rates of adverse pregnancy outcomes.
To compare rates of provision of contraceptive services among women with diabetes mellitus and women without chronic medical conditions.
A retrospective cohort study of 459,181 women aged 15-44 who had continuous membership and pharmacy benefits in a managed care organization in Northern California between January 2006 and June 2007. Rates of documented provision of contraceptive counseling, prescriptions, and services were compared between women with diabetes and women without chronic medical conditions.
Among 8,182 women with diabetes and 122,921 women without any chronic conditions, women with diabetes were less likely than women without a chronic condition to have documented receipt of any contraceptive counseling, prescriptions, or services (47.8% vs 62.0%, p < 0.001). After controlling for age and race, women with diabetes were more likely to have undergone tubal sterilization compared to women without a chronic condition (OR = 1.41, 95% CI 1.30-1.54), but less likely to have received highly effective, reversible methods of contraception such as intrauterine contraception (OR = 0.68, 95% CI 0.61-0.75). In addition, more women with diabetes had undergone hysterectomy, which is rarely performed solely for contraceptive purposes.
Women with diabetes were less likely to receive highly effective reversible contraception and more likely to undergo sterilization procedures. Increasing the use of highly effective reversible contraceptives may help diabetic women who want to retain their fertility to delay pregnancy until glycemic control is achieved.
患有糖尿病的女性在血糖控制达标后再怀孕，可降低不良妊娠结局的发生率。
比较患有糖尿病和无慢性疾病的女性获得避孕服务的情况。
回顾性队列研究，纳入 2006 年 1 月至 2007 年 6 月期间在加利福尼亚北部一家管理式医疗组织中连续参保且享受药房福利的年龄在 15-44 岁之间的 459181 名女性。比较了患有糖尿病和无慢性疾病的女性获得避孕咨询、处方和服务的情况。
在 8182 名患有糖尿病的女性和 122921 名无任何慢性疾病的女性中，患有糖尿病的女性获得任何避孕咨询、处方或服务的记录比例低于无慢性疾病的女性（47.8%比 62.0%，p < 0.001）。在调整年龄和种族后，与无慢性疾病的女性相比，患有糖尿病的女性更有可能接受输卵管绝育术（OR = 1.41，95% CI 1.30-1.54），但更不可能使用宫内节育器等高效、可逆的避孕方法（OR = 0.68，95% CI 0.61-0.75）。此外，更多的糖尿病女性接受了子宫切除术，而这种手术很少仅用于避孕目的。
患有糖尿病的女性更不可能获得高效、可逆的避孕措施，而更有可能接受绝育手术。增加高效、可逆避孕方法的使用可能有助于希望保留生育能力并等到血糖控制达标后再怀孕的糖尿病女性。
