December 15, 2016

Strokes, MIs Are Rare for Women With Diabetes Who Use Hormonal Contraception

SACRAMENTO, Calif -- December 15, 2016 -- Strokes and myocardial infarctions (MIs) are rare for women with diabetes who use hormonal contraception, with the safest options being intrauterine devices (IUDs) and under-the-skin implants, according to a study published in the journal Diabetes Care.

The study, one of the first to evaluate hormonal contraception and health outcomes in women with a chronic condition, should encourage physicians to include implants and IUDs in birth control discussions among patients with diabetes.

“Clinicians need to get beyond the idea that birth control just means ‘the pill,’” said senior author Eleanor Bimla Schwarz, UC Davis Health System, Sacramento, California. “There are options that are safe and effective for all women, including those with diabetes.”

Physicians have been reluctant to prescribe hormonal birth control to women with diabetes, as adults with diabetes are 2 to 4 times more likely to die from heart disease than adults who do not have diabetes.

Schwarz and colleagues wanted to know to what extent the risks of cardiovascular events for diabetic women differed with various types of hormonal birth control. Using data from Clinformatics, a health claims database encompassing 15 million commercially-insured people throughout the United States, they examined information from 2002 to 2011 on reproductive-aged females with type 1 or type 2 diabetes. The records of nearly 150,000 women were evaluated for hormonal birth control prescriptions and the occurrence of strokes, MIs or thromboembolism.

The outcomes showed that the vast majority of women with diabetes (72%) did not receive prescription contraception of any kind, even though pregnancy planning is critical for this population.

“This was alarming, since women with diabetes become pregnant as often as other women,” said lead author Sarah O’Brien, MD, Nationwide Children's Hospital, Columbus, Ohio. “Pregnancy timing is critical for women with diabetes. It's best to carefully plan pregnancies and ensure that the diabetes is under good control, because high sugars can cause an increased chance of birth defects.”

Overall, thromboembolic events among women in the study were low, with 6.3 events per 1,000 women each year. The contraceptives least likely to be associated with thrombosis were IUDs and subdermal implants. Oestrogen patches and progestin-only injections were both associated with slightly increased risks of thromboembolism.

“The next step is to understand the best ways to share this information with women who have diabetes and make sure they are consistently offered a full range of contraceptive options,” said Schwarz.

SOURCE: University of California - Davis Health System

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