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Diabetes Standards of Care & Clinical Practice Resources

Contraception

Optimally, pregnancies in women with diabetes of all ages are planned for, including achieving preconception glycemic control and switching to medications that are safe to use in pregnancy. While this goal is not always achieved in adult women, it is even less likely to occur in adolescent girls. Hyperglycemia, as well as certain diabetes-related medications (e.g., statins, ACE inhibitors, ARBs), are potentially toxic to the developing fetus. As such, providers need to be proactive in regard to contraception and to anticipate the possibility of unplanned pregnancies. Women with diabetes often have comorbid issues that affect the selection of an optimal contraceptive method.

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Clinical Practice Recommendations

Recommendations for Contraception

  • Beginning at puberty, discuss sexual activity, the need for pregnancy prevention or planning, and contraception as part of routine diabetes care for women.
  • Providers need to assess each woman’s situation:
    • Women with diabetes should be considered for contraception, preferably a form that is long-acting such as an intrauterine device (IUD) or Contraceptive Implant since these methods have much lower failure rates.
    • For women not on a long-acting form of contraception, consider prescribing only those diabetes-related medications that are safe in the event of an unplanned pregnancy.
  • Discuss with patients the increased risk of pregnancy with medications such as metformin and thiazolidinediones (TZDs) that may increase fertility:
    • Offer contraception when starting these medications.

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