Preconception counseling and contraception after gestational diabetes

Area of Science:

• Endocrinology
• Reproductive Health
• Public Health

Background:

• Women diagnosed with gestational diabetes mellitus (GDM) have an increased risk of developing pre-existing diabetes mellitus.
• Long-term follow-up indicates a significant percentage of women with prior GDM will develop diabetes later.

Purpose of the Study:

• To assess the safety and efficacy of various contraceptive methods for women with a history of GDM.
• To provide guidance on family planning and contraception for women with previous GDM.

Main Methods:

• A cohort of women diagnosed with GDM between 1978-1984 was followed for an average of 6 years.
• Assessed glucose tolerance, lipoprotein levels, and insulin response in women using low-dose hormonal contraceptives.
• Surveyed contraceptive choices postpartum among women with a history of GDM.

Main Results:

• Thirty percent of women with previous GDM developed diabetes at follow-up; at least a third more were projected to develop it later.
• Low-dose oral contraceptives (ethinyl estradiol and levonorgestrel) did not alter glucose tolerance or lipoprotein levels but increased insulin response.
• A triphasic preparation showed a lower insulin response compared to a low-dose monophasic preparation.
• No increased risk of diabetes was observed in women with previous GDM who used oral contraception.
• Intrauterine devices (IUDs) were considered safe and effective, with 33% of women choosing them postpartum.

Conclusions:

• Family planning and contraceptive counseling are crucial for women with a history of GDM.
• Low-dose oral contraceptives may be safe for short-term use in women with previous GDM.
• Intrauterine devices (IUDs) represent a safe and effective contraceptive option for this population.