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MS WordPerinatologist Corner - C.E.U/C.M.E. Modules
Diabetes In Pregnancy Series
Sponsored by The Indian Health Service Clinical Support Center
PART 2: Management, delivery, and postpartum
12. Contraception
All contraceptive modalities are appropriate for the woman who has had GDM. Caveats include:
- estrogen containing combination oral contraceptive agents may increase insulin requirements in the overt diabetic
- injectable depot medroxyprogesterone acetate (Depo-Provera) may result in undesirable weight gain (Espey et al)
- very limited retrospective data suggests progestin only contraceptive pills may increase the incidence of glucose intolerance (Kjos et al 1998)
Espey et al studied a cohort of 172 Navajo women who had used DMPA continuously for one or 2 years comprised the study group. A cohort of 134 Navajo women who used a non-progestin method or no method over 1 or 2 years comprised the comparison group. Study subjects gained a mean of 6 pounds over one year and 11 pounds over 2 years relative to the comparison group (p < 0.001) after controlling for possible confounding variables including age, parity and initial weight.
Kjos et al 1998 reported a retrospective cohort study of 904 Latinas with GDM who gave birth between January 1987 and March 1994, in whom postpartum diabetes was excluded at 4 to 16 weeks post partum. The report is limited because the patients with progestin only OCs were significantly heavier, significantly higher parity, and significantly higher weight gain in follow-up compared to patients on combination agents.
