Reliable Contraception for Diabetic Women

April 2, 2014
Jeannette Y. Wick, RPh, MBA, FASCP

For women with diabetes, family planning is both a personal decision and a medical necessity, as unintended pregnancy can threaten a diabetic woman's health.

Studies have found long-acting, reversible contraceptive (LARC) methods are the most efficient and cost-effective birth control options, making them an ideal choice for many women. For women with diabetes, family planning is both a personal decision and a medical necessity, as unintended pregnancy can threaten a diabetic woman’s health.

Historically, women with diabetes have had limited choices for contraception. In the 1970s, many questions were raised about intrauterine devices (IUDs), specifically in diabetic women. While some studies suggested that IUDs were less effective or increased risk of intrauterine infection among diabetics, they reported conflicting results overall.

Recently, 2 South African researchers conducted an analysis of inert (plain plastic), copper-bearing, and hormone-releasing IUDs in women with type 1 and type 2 diabetes. Their results, which were published in ISRN Obstetrics and Gynecology, also examined biochemical changes in copper IUD and levonorgestrel-releasing intrauterine system (IUS) users and compared them to those observed in combined oral contraceptives (COC) or hormonal injection or hormonal-releasing implants.

One strength of the review is its 52-year duration of literature scrutiny. The researchers looked for studies concerning IUD efficacy in diabetic women and potential IUD-related changes in laboratory parameters, though they omitted studies that included fewer than 30 subjects or were conducted for less than 6 months. They were especially interested in studies that compared pregnancy rates in diabetics and non-diabetic controls.

Of the 7 studies included in the review, 6 reported acceptable IUD efficacy in diabetic women. Three studies evaluated the IUD’s effect on laboratory parameters, and all of them found the copper IUD and levonorgestrel-releasing IUS do not affect the diabetic state.

With diabetes increasing in prevalence among younger women of reproductive age, having reasonable, safe, and effective contraception options is critical. The researchers concluded that copper-bearing and levonorgestrel-releasing IUDs are safe and effective options for women with type 1 and type 2 diabetes.