Morris Jerrine R, Tepper Naomi K
Department of Gynecology and Obstetrics, Emory University School of Medicine, Atlanta, GA, United States.
Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, United States.
Contraception. 2019 Dec;100(6):474-479. doi: 10.1016/j.contraception.2019.08.008. Epub 2019 Sep 1.
As diabetes is increasing among women of reproductive age in the United States, access to effective contraception is important to allow time for optimal glycemic control which may mitigate complications in future pregnancies. This study sought to describe contraceptive use and compare the effectiveness of contraceptive methods among postpartum women with and without diabetes.
This study used data from the Pregnancy Risk Assessment Monitoring System and included women with recent live births during 2012-2015 (N = 93,574). Women were asked about pre-gestational or recent gestational diabetes and their postpartum contraceptive method. Chi-square and multivariate logistic regression analyses were used to compare contraceptive methods between women with and without diabetes.
Contraceptive prevalence was similar between women with (82%) and without (83%) diabetes; women with diabetes were more likely to use the most effective methods. This was driven by higher use of female sterilization among women with diabetes (15%) compared to women without diabetes (9%) (p < 0.001). In multivariate analysis, odds of use of female sterilization versus reversible prescription methods was higher among women with diabetes than women without diabetes (adjusted odds ratio 1.29, 95% confidence interval 1.19-1.39).
Although overall postpartum contraceptive use was high, only 1/3 of women with or without diabetes were using the most effective methods. Furthermore, women with diabetes were more likely to use female sterilization than women without diabetes. It is important all postpartum women, particularly those with high risk pregnancies such as women with diabetes, receive counseling about and access to all contraceptive methods.
It is important for clinicians to counsel women with pregnancies affected by diabetes that reversible contraceptives such as implants and IUDs are as effective as female permanent contraception.
鉴于美国育龄女性中的糖尿病发病率不断上升，获得有效的避孕措施对于争取时间实现最佳血糖控制十分重要，这可能会降低未来妊娠的并发症风险。本研究旨在描述产后女性的避孕措施使用情况，并比较患糖尿病和未患糖尿病的产后女性避孕方法的有效性。
本研究使用了妊娠风险评估监测系统的数据，纳入了2012 - 2015年期间有近期活产经历的女性（N = 93,574）。询问女性孕前或近期孕期糖尿病情况以及她们的产后避孕方法。采用卡方检验和多因素逻辑回归分析比较患糖尿病和未患糖尿病女性的避孕方法。
患糖尿病女性（82%）和未患糖尿病女性（83%）的避孕普及率相似；患糖尿病的女性更有可能采用最有效的避孕方法。这是由于患糖尿病女性中接受绝育手术的比例（15%）高于未患糖尿病女性（9%）（p < 0.001）。在多因素分析中，患糖尿病女性采用绝育手术而非可逆性处方避孕方法的几率高于未患糖尿病女性（调整后的优势比为1.29，95%置信区间为1.19 - 1.39）。
尽管产后避孕措施的总体使用率较高，但患糖尿病和未患糖尿病的女性中只有三分之一采用了最有效的避孕方法。此外，患糖尿病的女性比未患糖尿病的女性更有可能接受绝育手术。所有产后女性，尤其是那些有高危妊娠情况的女性，如患糖尿病的女性，接受关于所有避孕方法的咨询并能够获得这些方法，这一点很重要。
临床医生向患有糖尿病妊娠的女性提供咨询时，告知她们诸如植入式避孕器和宫内节育器等可逆性避孕方法与女性永久性避孕方法一样有效，这一点很重要。
