The odds of developing gestational diabetes mellitus (GDM) were 40% higher among women with a history of hormonal contraceptive use than in women who never used contraception, according to a study published July 17 in Preventing Chronic Disease.
Brittney A. Kramer, Project Specialist, Missouri Department of Health and Senior Services, Jefferson City, and colleagues analyzed data from 2741 pregnancies to determine whether the type of contraceptive used affected risk for GDM. The data came from surveys conducted in 2007 and 2008 by the Missouri Pregnancy Risk Assessment Monitoring System (PRAMS). PRAMS data represent a sample of women whose names are drawn from recent birth certificates. The average weighted response rate in 2007 and 2008 was 63.9%.
Women who had used hormonal birth control had a 43% increased risk of gestational diabetes compared with women who did not use contraception (adjusted odds ratio [AOR], 1.43; 95% confidence interval [CI], 1.32 - 1.55; P < .001). The investigators adjusted the analysis for maternal age, race, education and income levels, marital status, Medicaid status at delivery, and type of prenatal care.
In addition, women 30 years of age or older had an increased risk of GDM compared with those younger than 20 years (AOR, 1.50; 95% CI, 1.34 - 1.67; P < .001). Other factors associated with increased risk include adequate prenatal care compared with inadequate or intermediate prenatal care (AOR 2.36; 95% CI, 2.16 - 2.58), Medicaid enrollment at delivery compared with nonenrollment (AOR, 2.58; 95% CI, 2.36 - 2.81), nonwhite or nonblack race compared with white race (AOR, 5.54; 95% CI, 4.90 - 6.25), and overweight or obese before pregnancy compared with normal body mass index (AOR, 3.04; 95% CI, 2.84 -3.24). Having a high school education or more was also linked with higher odds of GDM (AOR, 1.38; 95% CI, 1.27 - 1.50).
Conversely, women who used barrier methods of contraception had a lower risk for GDM compared with women who used no contraception (AOR, 0.79; 95% CI, 0.72 - 0.86), as did women with an unintended pregnancy compared with intended pregnancy (AOR, 0.39; 95% CI, 0.37 - .042).
Of the women surveyed, 8.3% reported a diagnosis of GDM in their most recent pregnancy. Hormonal contraception was the most prevalent form of contraception (17.9%), followed by barrier methods (17.2%), fertility awareness/rhythm (6.8%), and other (2.3%). More than half of the women, 56%, reported using no contraception.
The research follows earlier studies that showed a relationship between oral, hormonal contraception and increased serum glucose and insulin, as well as altered lipid levels. However, the long-term effects of hormonal contraceptives on GDM risk have not been established.
GDM affects 2% to 10% of all pregnancies. In the United States, its prevalence has been on the increase since the 1980s and has more than doubled since 1990.
"The prevalence of GDM continues to increase worldwide, and definitive screening and preventive measures are needed to deter its chronic lifelong complications," the authors write. "Although researchers have not established a causal relationship between hormonal contraception use and GDM, results of our study suggest there may be an underlying correlating mechanism."
The authors have disclosed no relevant financial relationships.
Prev Chronic Dis. 2014;11:140059. Full text
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Cite this: Hormonal Contraceptives Raise Odds of Gestational Diabetes - Medscape - Jul 17, 2014.
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