Customize your JAMA Network experience by selecting one or more topics from the list below.
Kjos SL, Peters RK, Xiang A, Thomas D, Schaefer U, Buchanan TA. Contraception and the Risk of Type 2 Diabetes Mellitus in Latina Women With Prior Gestational Diabetes Mellitus. JAMA. 1998;280(6):533–538. doi:10.1001/jama.280.6.533
From the Departments of Obstetrics and Gynecology (Drs Kjos, Schaefer, and Buchanan), Preventive Medicine (Drs Peters, Xiang, and Thomas), and Medicine (Dr Buchanan), University of Southern California School of Medicine, Los Angeles.
Context.— Effective contraception is essential in women with prior gestational
diabetes mellitus (GDM) but should not increase their already substantial
risk of developing type 2 diabetes.
Objective.— To determine whether exposure to low-dose oral contraceptives increases
the risk of developing type 2 diabetes mellitus in women with recent GDM.
Design.— Retrospective cohort study of 904 Latinas with GDM who gave birth between
January 1987 and March 1994, in whom postpartum diabetes was excluded at 4
to 16 weeks post partum.
Interventions.— At their initial postpartum visit, 443 women selected a nonhormonal
form of contraception, 383 received a low-dose, estrogen-progestin combination
oral contraceptive (OC), and 78 breast-feeding women received the progestin-only
OC. When breast-feeding ended, patients initially taking progestin-only OCs
were switched to combination OCs. Patients were followed up periodically with
oral glucose tolerance tests for up to 712 years.
Main Outcome Measures.— Person time was used to compute unadjusted average annual incidence
rates of developing diabetes mellitus, as defined by the National Diabetes
Data Group Criteria. Survival analysis was used to compute the unadjusted
cumulative incidence rates and adjusted relative risks of diabetes mellitus.
Results.— The unadjusted average annual incidence rates of type 2 diabetes mellitus
were 8.7%, 10.4%, and 26.5%, respectively, for patients using nonhormonal
forms of contraception, combination OCs, and progestin-only OCs. Cumulative
incidence rates were virtually identical for patients with uninterrupted use
of combination OCs and nonhormonal forms of contraception, but patients using
progestin-only OCs developed diabetes mellitus more rapidly during the first
2 years of use. After adjustment for potential confounding factors, the use
of progestin-only OCs almost tripled the risk of type 2 diabetes mellitus
compared with equivalent use of low-dose combination OCs (adjusted relative
risk, 2.87; 95% confidence interval, 1.57-5.27). The magnitude of this risk
increased with duration of uninterrupted use.
Conclusion.— Progestin-only OCs were associated with an increased risk of diabetes
in breast-feeding Latinas with recent GDM and probably should be prescribed
with caution, if at all, in these women. Long-term use of low-dose combination
OCs did not increase the risk of type 2 diabetes compared with use of nonhormonal
contraception. Thus, combination OCs do not appear to increase the risk of
diabetes in non–breast-feeding women with recent GDM.