Mini-Pill Increases Risk Of Chronic Diabetes In Women With History Of Diabetes During Pregnancy

August 12, 1998

USC Researchers Urge Caution In Prescribing Progestin-Only Oral Contraceptives For High-Risk Women

LOS ANGELES, August 12, 1998 -- Women who develop diabetes during pregnancy face an increased risk of later developing type-2 diabetes. Now, USC researchers say that using the mini-pill -- progestin-only birth control pills -- may put these women at an even higher risk of developing the chronic form of the disease.

"It appears that progestin-only oral contraceptives increase risk by nearly three-fold and should not be widely prescribed in this group of women," says Siri Kjos, M.D., associate professor of obstetrics and gynecology at the University of Southern California School of Medicine.

That caution, however, is tempered by good news, Kjos (pronounced KEY-hos) says. "The most important finding is that low-dose combination oral contraceptives appear to be a relatively safe method of contraception for these very high-risk women." The combination birth control pills are the most commonly used ones and contain a mix of estrogen and progestin.

Kjos and colleagues report their results in the August 12 issue of the Journal of the American Medical Association.

In the study, USC researchers followed 904 Latina women who had developed gestational diabetes mellitus (GDM) during a recent pregnancy, but whose ability to process sugars had returned to normal after delivery.

During their initial post-partum visits to the High Risk Family Planning Clinic at LAC+USC Women's and Children's Hospital, about half chose to use hormonal oral contraceptives and half chose a non-hormonal contraceptives. Of the women opting to take birth control pills, 383 were prescribed low-dose combination birth control pills and the 78 women who were breast-feeding received the progestin-only contraceptives.

For women who wish to breast-feed and take hormonal contraceptives, doctors usually prescribe progestin-only oral contraceptives because they do not interfere with milk production. In the present study, women were switched to the low-dose combination pills once they stopped breast-feeding.

The research team found that 169 women developed chronic diabetes during the study and that the risk was influenced by the type of contraception they had used. Of the women taking the progestin-only mini-pill, an average of 26.5% per year developed type-2 diabetes, compared to a rate of only 8.7% per year of women using non-hormonal contraceptives and 11.7% per year of those choosing a low-dose combination oral contraceptive.

"We found that the longer a woman used the progestin-only oral contraceptives, the higher her risk of later getting diabetes," Kjos says.

Type-2 or adult-onset diabetes strikes more than 14 million Americans, according to estimates from the American Medical Association. Since it can be asymptomatic in its early stages, many are only diagnosed with a blood test. Most develop the disease in middle age. Obesity, having a close relative with the disease and being a member of certain ethnic groups (including African-American, Latino and Native American) are known risk factors. Without treatment, type-2 diabetes can lead to serious complications including heart disease, stroke, nerve disease, vision problems and kidney failure. Lifestyle changes (such as dietary changes and increasing exercise) and oral medications prove effective in controlling diabetes for most people.

"Family planning is extremely important for women with a history of gestational diabetes," says study co-author Thomas Buchanan, M.D., USC associate professor of medicine and obstetrics and gynecology. In earlier studies, the same team had found that women with a history of GDM who have a subsequent pregnancy face two-to-three-fold the risk of later developing type-2 diabetes. Contraception is also important for the health of the woman's future children -- if a woman gets pregnant and has uncontrolled diabetes, her fetus faces an increased risk of birth defects, and she is more likely to miscarry or suffer other potentially fatal complications.

"When we started the study we were more interested in finding out whether oral contraceptives in general were safe in these women," says Ruth Peters, Sc.D., USC professor of preventive medicine who also helped lead the study. "We found that it's OK to use oral contraceptives even if you have had gestational diabetes. But if you're breast feeding, and so would be prescribed a progestin-only pill, you may want to choose non-hormonal contraceptives instead," Peters says.

This study was supported in part by grants from the National Institutes of Health and the National Institute of Diabetes and Digestive Kidney Diseases.
-end-
Editor's Note: To set up an interview with Dr. Ruth Peters, please call Eva Emerson at 323-442-2830.
-end-


University of Southern California

Related Diabetes Articles from Brightsurf:

New diabetes medication reduced heart event risk in those with diabetes and kidney disease
Sotagliflozin - a type of medication known as an SGLT2 inhibitor primarily prescribed for Type 2 diabetes - reduces the risk of adverse cardiovascular events for patients with diabetes and kidney disease.

Diabetes drug boosts survival in patients with type 2 diabetes and COVID-19 pneumonia
Sitagliptin, a drug to lower blood sugar in type 2 diabetes, also improves survival in diabetic patients hospitalized with COVID-19, suggests a multicenter observational study in Italy.

Making sense of diabetes
Throughout her 38-year nursing career, Laurel Despins has progressed from a bedside nurse to a clinical nurse specialist and has worked in medical, surgical and cardiac intensive care units.

Helping teens with type 1 diabetes improve diabetes control with MyDiaText
Adolescence is a difficult period of development, made more complex for those with Type 1 diabetes mellitus (T1DM).

Diabetes-in-a-dish model uncovers new insights into the cause of type 2 diabetes
Researchers have developed a novel 'disease-in-a-dish' model to study the basic molecular factors that lead to the development of type 2 diabetes, uncovering the potential existence of major signaling defects both inside and outside of the classical insulin signaling cascade, and providing new perspectives on the mechanisms behind insulin resistance in type 2 diabetes and possibly opportunities for the development of novel therapeutics for the disease.

Tele-diabetes to manage new-onset diabetes during COVID-19 pandemic
Two new case studies highlight the use of tele-diabetes to manage new-onset type 1 diabetes in an adult and an infant during the COVID-19 pandemic.

Genetic profile may predict type 2 diabetes risk among women with gestational diabetes
Women who go on to develop type 2 diabetes after having gestational, or pregnancy-related, diabetes are more likely to have particular genetic profiles, suggests an analysis by researchers at the National Institutes of Health and other institutions.

Maternal gestational diabetes linked to diabetes in children
Children and youth of mothers who had gestational diabetes during pregnancy are at increased risk of diabetes themselves, according to new research published in CMAJ (Canadian Medical Association Journal).

Two diabetes medications don't slow progression of type 2 diabetes in youth
In youth with impaired glucose tolerance or recent-onset type 2 diabetes, neither initial treatment with long-acting insulin followed by the drug metformin, nor metformin alone preserved the body's ability to make insulin, according to results published online June 25 in Diabetes Care.

People with diabetes visit the dentist less frequently despite link between diabetes, oral health
Adults with diabetes are less likely to visit the dentist than people with prediabetes or without diabetes, finds a new study led by researchers at NYU Rory Meyers College of Nursing and East Carolina University's Brody School of Medicine.

Read More: Diabetes News and Diabetes Current Events
Brightsurf.com is a participant in the Amazon Services LLC Associates Program, an affiliate advertising program designed to provide a means for sites to earn advertising fees by advertising and linking to Amazon.com.