Contraception After Gestational Diabetes

Abstract

Women with prior gestational diabetes mellitus (GDM) are at risk of developing overt diabetes, predominantly type 2 diabetes, after pregnancy, often during their reproductive years (1–4). Type 2 diabetes will often be present without symptoms years before the clinical diagnosis is made. Women with type 2 diabetes often do not plan their pregnancy (5) or enter pregnancy with unrecognized diabetes. In both cases, an increased risk of congenital malformations in the offspring has been found (5–7). Similar to type 1 diabetes, this risk has been shown to increase with increasing maternal hyperglycemia (8). Although intervention trials are lacking in type 2 diabetic women, studies in type 1 diabetic women have shown that the proportion of congenital malformations can be reduced to a background population value by prepregnancy planning, including optimization of metabolic control (8). Contraception is an essential component to be able to plan pregnancy when glucose status is normalized and may also confer protection from developing diabetes by preventing a subsequent pregnancy (9). Recent studies show that women with previous GDM exhibit a markedly increased prevalence of the metabolic syndrome, even when glucose tolerance is normal (10,11). Metabolic syndrome is associated with an increased risk of cardiovascular disease and mortality (12). For both maternal and future offspring, women with prior GDM need safe, efficient, and acceptable choices for contraceptive methods that do not enhance their already substantial risk to develop either overt diabetes or metabolic syndrome and associated sequelae. Studies on contraception in women with prior GDM are limited, especially new studies published since the Fourth International Workshop-Conference on GDM (13). The present article provides a condensed review of contraceptive methods available for women with prior GDM, focusing on recent studies. When data in women with prior GDM are unavailable, extrapolations will …