Contraception in the Postpartum Care of Patients With Gestational Diabetes [319

Abstract

INTRODUCTION: Effective contraception allows women with gestational diabetes mellitus (GDM) time to optimize their health before future pregnancies. We therefore sought to evaluate use of long-acting reversible contraception (LARC) in women with GDM compared with women with preexisting DM. METHODS: We identified 404 pregnancies with GDM and 232 with preexisting DM cared for at Brigham and Womens Hospital between 2006 and 2011. We compared the likelihood of receiving LARC in women with GDM compared with women with preexisting DM with bivariate analyses using Fishers exact test or t tests as appropriate. We performed multivariate logistic regression to identify factors associated with LARC uptake. RESULTS: Women with GDM were less likely to have had a planned pregnancy than women with preexisting DM (P=.04). Of 404 pregnancies with GDM 21.5% with A1GDM and 21.6% with A2GDM received LARC. Of 232 pregnancies with preexisting DM 24.4% with type 1 DM and 18.5% with type 2 DM received LARC. There was no significant difference among the groups (P=.79). Women who had received contraception during their postpartum hospitalization were less likely to attend their postpartum visit (odds ratio 0.58 95% confidence interval 0.39-0.86). CONCLUSION: Although women with GDM were as likely as women with preexisting DM to receive LARC postpartum they were more likely to have an unplanned pregnancy highlighting the need for effective contraception in this population. Our findings suggest that further study is needed to understand how best to provide contraception while still engaging women in postpartum care.