SAT-206 Contemporary Risk of Menstrual and Reproductive Dysfunction in Women with Type 1 Diabetes: A Population-Based Study

Abstract

Background: Type 1 diabetes mellitus (T1D) is historically associated with perturbations of the hypothalamic-pituitary ovarian axis, leading to hypogonadism, amenorrhea and infertility. Given modern therapies and aims for tighter glycaemic control, such reproductive disturbances may be ameliorated; however, few studies have evaluated this in women with T1D in a contemporary setting. Aims: To assess menstrual disturbance, contraceptive use, and reproductive outcomes in women of reproductive age with T1D, compared to age-matched women without T1D. Methods: A cross-sectional analysis was performed using data from the Australian Longitudinal Study on Women’s Health, a large community-based study. Women from two cohorts were included in this study: those aged 18-23 years old who participated in Survey 1 (2013) from the cohort born between 1989-1995, and those aged 34-39 years old who responded to Survey 6 (2012) from the cohort born between 1973-1978. Univariate analyses were performed to explore associations with menstrual disturbance, followed by multivariable logistic regression analyses adjusting for significant and clinically relevant covariates. Results: A total of 23,752 women were included, comprising 162 women with self-reported T1D and 23,590 non-diabetic, age-matched controls. There were no differences in mean age (25.3±7.7 vs. 25.8±7.8 years, p=0.37), body mass index (BMI) [25.9±6.3 vs. 25.0±5.9 kg/m2, p=0.06], although a significant proportion of women in both groups had a BMI ≥ 25.0 kg/m2 (43.0% vs 38.3%, p=0.25). Delay in menarche was not observed (12.8±1.9 vs. 12.8±1.5 years, p=0.59), however menstrual irregularity (47.2% vs. 34.6%, p=0.001) and polycystic ovarian syndrome (PCOS) [14.2% vs. 5.2%, p<0.001] was significantly increased in women with T1D. T1D, PCOS, thyroid dysfunction, younger age, increased BMI and hypertension were independently associated with menstrual irregularity, after adjustment. In women with prior pregnancies, those with T1D experienced significantly more miscarriages (45.9% vs 32.7%, p=0.04) and stillbirths (6.6% vs. 1.4%, p=0.01), despite no difference in pregnancy rates. Conclusions: Despite therapeutic advances in diabetes management, young women with T1D have persistently higher risk of menstrual and reproductive dysfunction compared to age-matched controls. Further evaluation of the aetiology of menstrual irregularity in this group, particularly distinguishing between oestrogen deficiency and PCOS, is necessary to guide management. Pre-conception optimization of care and counselling in reproductive-aged women with T1D is imperative to minimize complications in pregnancy.