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Pothongsangarun K, Li J, Naeowong W, Apirakviriya C, Phutrakool P, Juntamongkol T, Sae-Chueng T, Horpratraporn K, Jaisamrarn U, Santibenchakul S. Reproductive care in Thai women with diabetes mellitus: a descriptive cross-sectional study. Reprod Health 2023; 20:152. [PMID: 37828526 PMCID: PMC10571380 DOI: 10.1186/s12978-023-01694-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Accepted: 10/02/2023] [Indexed: 10/14/2023] Open
Abstract
BACKGROUND Pre-existing diabetes mellitus (DM) is a challenging pregnancy complication as poor glycemic control is associated with adverse maternal and fetal outcomes. In this study, we aimed to investigate DM-related knowledge, attitudes, preconception care practices, and contraceptive prevalence in women with DM. METHODS This descriptive cross-sectional survey was conducted among reproductive-aged Thai women receiving DM treatment at King Chulalongkorn Memorial Hospital between August 1, 2021, and June 30, 2022. Patients with DM who were not pregnant or trying to conceive and could be contacted via the phone were included and a validated self-administered questionnaire was distributed electronically. RESULTS A total of 238 participants were included in the final analysis, yielding 69.4% response rates. The mean (standard deviation) score for knowledge of pregnancy planning and pregnancy-related risks was 6.8 (3.5) out of 15. Only about half of the participants had discussed pregnancy planning with their physicians. Multivariable analysis showed that younger age at DM diagnosis, non-Buddhism, married, higher education, and medical personnel were significantly associated with higher knowledge scores. Women aged > 45 years and those with higher practice scores had significantly higher adjusted odds of using highly effective contraception; the most common methods included male condoms and combined oral contraceptive pills. There was an unmet need for contraception in 9.5% of women with DM. CONCLUSIONS Although highly effective contraception is safe for patients with DM, only about half of our participants used tier one or two contraceptives or had received consultation regarding preconception planning. There was a notable gap in care coordination among specialists; integrating reproductive healthcare into DM therapy would improve access to preconception care.
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Affiliation(s)
- Kritat Pothongsangarun
- Department of Obstetrics and Gynecology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Jiayu Li
- Department of Obstetrics and Gynecology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Witthawat Naeowong
- Department of Internal Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Chayanis Apirakviriya
- Department of Obstetrics and Gynecology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
- Department of Obstetrics and Gynecology, King Chulalongkorn Memorial Hospital, Bangkok, Thailand
| | - Phanupong Phutrakool
- Chula Data Management Center, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.
- Center of Excellence in Preventive & Integrative Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.
| | | | - Thita Sae-Chueng
- Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | | | - Unnop Jaisamrarn
- Department of Obstetrics and Gynecology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
- Center of Excellence in Menopause and Aging Women Health, Department of Obstetrics and Gynecology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Somsook Santibenchakul
- Department of Obstetrics and Gynecology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
- Department of Obstetrics and Gynecology, King Chulalongkorn Memorial Hospital, Bangkok, Thailand
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Nidhi, Kumari A, Tirkey S, Prakash J. Effectiveness of Levonorgestrel Releasing Intrauterine System in Perimenopausal Women with Heavy Menstrual Bleeding: A Prospective Study at a Teaching Hospital in India. J Menopausal Med 2022; 28:128-135. [PMID: 36647276 PMCID: PMC9843034 DOI: 10.6118/jmm.22025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Revised: 09/10/2022] [Accepted: 10/11/2022] [Indexed: 01/15/2023] Open
Abstract
OBJECTIVES To evaluate the effect of levonorgestrel-releasing intrauterine system (LNG-IUS) on heavy menstrual bleeding in perimenopausal women. METHODS This was a prospective, observational clinical study conducted on 42 perimenopausal women with heavy menstrual bleeding who met the study eligibility criteria. LNG-IUS was inserted in the postmenstrual phase following baseline evaluation. The patients were followed up at the 4, 12, and 24 weeks. Pictorial blood assessment chart (PBAC) score, hemoglobin and serum ferritin levels, and endometrial thickness were assessed before insertion and during the follow-up visits. RESULTS Two patients (4.8%) were lost to follow-up, three patients (7.1%) opted for hysterectomy, two women (4.8%) experienced spontaneous expulsion and 35 (83.3%) women continued the usage. Menstrual blood loss assessed using the median PBAC score (interquartile range) significantly reduced (P < 0.001) from the pre-insertion level of 280 (246-306) to 124 (60-200) at 4 weeks to 45 (34-76) at 12 weeks and further to 32 (20-50) at the end of 24 weeks. Simultaneously, a significant (P < 0.001) improvement in the mean hemoglobin and serum ferritin levels and a significant (P < 0.001) decrease in endometrial thickness were observed. The most common side effect was spotting (50.0%) and vaginal discharge (38.1%). CONCLUSIONS LNG-IUS causes a remarkable reduction in menstrual blood loss and marked improvement in dysmenorrhea. It also reduces anemia by improving the hemoglobin and ferritin levels. Thus, it can serve as an effective treatment option for heavy menstrual bleeding in perimenopausal women and prevent the need for a hysterectomy.
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Affiliation(s)
- Nidhi
- Department of Obstetrics and Gynecology, Rajendra Institute of Medical Sciences (RIMS), Ranchi, India
| | - Archana Kumari
- Department of Obstetrics and Gynecology, Rajendra Institute of Medical Sciences (RIMS), Ranchi, India
| | - Sarita Tirkey
- Department of Obstetrics and Gynecology, Rajendra Institute of Medical Sciences (RIMS), Ranchi, India
| | - Jay Prakash
- Department of Critical Care Medicine, Rajendra Institute of Medical Sciences, Ranchi, India
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Salinas A, Merino PM, Giraudo F, Codner E. Long-acting contraception in adolescents and young women with type 1 and type 2 diabetes. Pediatr Diabetes 2020; 21:1074-1082. [PMID: 32562346 DOI: 10.1111/pedi.13069] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Revised: 05/28/2020] [Accepted: 06/15/2020] [Indexed: 12/16/2022] Open
Abstract
Adolescent pregnancy is a major public health problem worldwide. Adolescents living with diabetes are not aware of the risks of unplanned pregnancy and the high rate of fetal and maternal complications when gestation occurs in women with significant hyperglycemia. These data highlight the significance of pregnancy prevention in young women with diabetes. Long-acting reversible contraceptives (LARCs), which include subdermal progestin implants and hormonal and nonhormonal intrauterine devices (IUDs), have been recommended by the American College of Obstetricians Gynecologists and the American Academy of Pediatrics as a first-line contraceptive option for adolescents and young women. This article reviews LARC options for adolescents and young women with type 1 (T1D) and type 2 (T2D) diabetes as well as the possible complications and side effects.
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Affiliation(s)
- Abril Salinas
- Institute of Maternal and Child Research, School of Medicine, University of Chile, Santiago, Chile.,Chilean Institute of Reproductive Medicine ICMER, Santiago, Chile
| | - Paulina M Merino
- Institute of Maternal and Child Research, School of Medicine, University of Chile, Santiago, Chile
| | - Franco Giraudo
- Institute of Maternal and Child Research, School of Medicine, University of Chile, Santiago, Chile.,Juvenile Diabetes Foundation of Chile FDJ, Santiago, Chile
| | - Ethel Codner
- Institute of Maternal and Child Research, School of Medicine, University of Chile, Santiago, Chile
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4
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Sandoval-Vivas P. [Safety and acceptability of the 52 mg levonorgestrel-releasing intrauterine system in women with abnormal uterine bleeding in an ambulatory care center in Bogotá, Colombia, 2012-2016]. REVISTA COLOMBIANA DE OBSTETRICIA Y GINECOLOGIA 2020; 71:247-256. [PMID: 33247888 DOI: 10.18597/rcog.3547] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/30/2020] [Accepted: 08/22/2020] [Indexed: 06/12/2023]
Abstract
OBJECTIVE To describe safety and acceptability with the use of the 52-mg levonorgestrel-releasing intrauterine system in women with abnormal uterine bleeding. METHODS Retrospective cohort of women 18 years of age and older diagnosed with abnormal uterine bleeding, ultrasound-reported uterine length between 6 and 10 cm and uniform endometrial cavity in its entire length, regardless of structural abnormality, who received treatment with 52-mg levonorgestrel-releasing intrauterine system between 2012 and 2016. Non-probabilistic convenience sampling was carried out. Sociodemographic and clinical baseline variables were measured, as well as patient perception of bleeding and the frequency of failure, amenorrhea, need for hysterectomy and adverse events, over a 12-month follow-up period. Descriptive statistics were applied. RESULTS Overall, 200 patients were assessed. A subjective perception of improvement in terms of bleeding volume and frequency of leave of absence or visits to the emergency department was found; 90 % of the patients had amenorrhea, and 6 % experienced adverse events. CONCLUSIONS The 52-mg levonorgestrel-releasing intrauterine system is a safe option for the management of abnormal uterine bleeding in women with normal uterine size and no submucosal endometrial abnormalities. Local randomized studies are required to assess effectiveness and efficiency in comparison with other management options.
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Feinberg T, Rougerie M, Dahan YS, Dahan MH. A review of the use of hormonal contraception in women with non-cardiovascular coexisting medical conditions. A comprehensive review. ACTA ACUST UNITED AC 2020; 72:82-89. [PMID: 32186166 DOI: 10.23736/s0026-4784.20.04509-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
INTRODUCTION Previously, the American College of Obstetrics and Gynecology (ACOG) had published an excellent practice bulletin addressing the use of hormone contraception in women with pre-existing medical conditions. This practice bulletin became out of date. The Centers for Disease Control and prevention (CDC) of the USA subsequently developed a point form guideline for the use of oral contraceptives in women with coexisting medical conditions. EVIDENCE ACQUISITION Although this acts as a guide, it leaves the clinician without an understanding of why they are doing what they are doing. This article is one of two related to women with coexisting medical conditions. EVIDENCE SYNTHESIS In this article we will provide an update of the scientific knowledge since the publication of the ACOG guideline (2006). It is to be used as a supplement for those who desire more information than that found in the CDC guidelines. CONCLUSIONS Although some recommendations have remained unchanged over the years, the development of lower dose contraceptive pills as well as the increased incidence of comorbid conditions, such as metabolic syndrome, in younger women seeking contraception has brought along new research and new evidence to guide clinicians in the prescription of these medications.
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Affiliation(s)
- Tehila Feinberg
- Faculty of Medicine, Technion Israel Institute of Technology, Haifa, Israel
| | - Michelle Rougerie
- Department of Obstetrics and Gynecology, McGill University Health Center, McGill University, Montréal, QC, Canada
| | | | - Michael H Dahan
- Department of Obstetrics and Gynecology, McGill University Health Center, McGill University, Montréal, QC, Canada -
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Turner AM, Donelan EA, Kiley JW. Contraceptive Options Following Gestational Diabetes: Current Perspectives. Open Access J Contracept 2019; 10:41-53. [PMID: 31749639 PMCID: PMC6817836 DOI: 10.2147/oajc.s184821] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2019] [Accepted: 09/04/2019] [Indexed: 01/11/2023] Open
Abstract
Gestational diabetes mellitus (GDM) complicates approximately 7% of pregnancies in the United States. Along with risk factors related to pregnancy, women with a history of GDM also have an increased risk of developing type 2 diabetes mellitus later in life. These women require special consideration when discussing contraception and other reproductive health issues. GDM carries a category 1 rating in the US Medical Eligibility Criteria for all contraceptive methods, which supports safety of the various methods but does not account for effectiveness. Contraceptive options differ in composition and mechanisms of action, and concerns have been raised about possible effects of contraception on metabolism. Clinical evidence is limited to suggest that hormonal contraception has significantly adverse effects on body weight, lipid, or glucose metabolism. In addition, the majority of evidence does not suggest a relationship between development of type 2 diabetes mellitus and use of hormonal contraception. Data are limited, so it is challenging to make a broad, general recommendation regarding contraception for women with a history of GDM. A woman’s history of GDM should be considered during contraceptive counseling. Discussion should focus on potential medical comorbidities and the implications of GDM on future health, with special consideration of issues including bone health, obesity, cardiovascular disease, and thrombosis risk. Providers must emphasize the importance of reliable, highly effective contraception for women with GDM, to optimize the timing of future pregnancies. This approach to comprehensive counseling will guide optimal decision-making on contraceptive use, lifestyle changes, and planning of subsequent pregnancies.
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Affiliation(s)
- Ashley M Turner
- Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Emily A Donelan
- Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Jessica W Kiley
- Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
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Cardiovascular risk markers among obese women using the levonorgestrel-releasing intrauterine system: A randomised controlled trial. Obes Res Clin Pract 2017; 11:687-693. [DOI: 10.1016/j.orcp.2017.06.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2016] [Revised: 05/28/2017] [Accepted: 06/02/2017] [Indexed: 11/21/2022]
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Dhamangaonkar PC, Anuradha K, Saxena A. Levonorgestrel intrauterine system (Mirena): An emerging tool for conservative treatment of abnormal uterine bleeding. J Midlife Health 2015; 6:26-30. [PMID: 25861205 PMCID: PMC4389381 DOI: 10.4103/0976-7800.153615] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Introduction: To study the efficacy of levonorgestrel intrauterine system (LNG-IUS; Mirena) in conservative management of abnormal uterine bleeding (AUB). Materials and Methods: Seventy women between 30 and 55 years with AUB were included in a study conducted over a period of 3 years. Response was assessed monthly for first 4 months and then yearly for maximum 2 years. Results: Mirena caused a 80% decrease in median menstrual blood loss (MBL) at 4 months, 95% decrease in MBL by 1 year, and 100% decrease (amenorrhea) by 2 years. Mean hemoglobin (Hb) % showed a significant rise of 7.8% from baseline 4 months post Mirena insertion. Mirena acted as an effective contraceptive in women not using any other form of contraception. Hysterectomy could be avoided in most of the women. Conclusion: Mirena provides an incredible nonsurgical alternative in treatment of menorrhagia. Its effects are reversible and it is an excellent fertility-sparing device. It is also an effective contraceptive.
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Affiliation(s)
- Pallavi C Dhamangaonkar
- Department of Obstetrics and Gynaecology, Dr. Babasaheb Ambedkar Memorial Hospital, Byculla, Mumbai, Maharashtra, India
| | - K Anuradha
- Department of Obstetrics and Gynaecology, Dr. Babasaheb Ambedkar Memorial Hospital, Byculla, Mumbai, Maharashtra, India
| | - Archana Saxena
- Department of Obstetrics and Gynaecology, Dr. Babasaheb Ambedkar Memorial Hospital, Byculla, Mumbai, Maharashtra, India
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S. Mukherjee M, Coppenrath VA, Dallinga BA. Pharmacologic Management of Types 1 and 2 Diabetes Mellitus and Their Complications in Women of Childbearing Age. Pharmacotherapy 2015; 35:158-74. [DOI: 10.1002/phar.1535] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Affiliation(s)
| | | | - Bree A. Dallinga
- Edward M. Kennedy Community Health Center; Framingham Massachusetts
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10
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Postpartum glucose tolerance in women with gestational diabetes using levonorgestrel intrauterine contraception. Contraception 2015; 91:67-70. [DOI: 10.1016/j.contraception.2014.08.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2014] [Revised: 08/04/2014] [Accepted: 08/06/2014] [Indexed: 11/19/2022]
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Luukkainen T, Pakarinen P. Medicated intrauterine devices for contraception and their therapeutic effects. ACTA ACUST UNITED AC 2014. [DOI: 10.1586/17474108.1.2.195] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Bahamondes L, Bahamondes MV, Monteiro I. Levonorgestrel-releasing intrauterine system: uses and controversies. Expert Rev Med Devices 2014; 5:437-45. [DOI: 10.1586/17434440.5.4.437] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Goldstuck ND, Steyn PS. The Intrauterine Device in Women with Diabetes Mellitus Type I and II: A Systematic Review. ISRN OBSTETRICS AND GYNECOLOGY 2013; 2013:814062. [PMID: 24396605 PMCID: PMC3874344 DOI: 10.1155/2013/814062] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/21/2013] [Accepted: 10/22/2013] [Indexed: 11/17/2022]
Abstract
Background. Women with diabetes mellitus type I and type II need effective contraception for personal and medical reasons. Long acting reversible contraceptive (LARC) methods are among the most efficient and cost-effective methods. Study Design. We searched the Popline, PubMed, and clinicaltrials.gov databases from 1961 to March 2013 for studies on the efficacy of the IUD in diabetic women and the possible changes it may produce in laboratory parameters. Studies of at least 30 subjects with DM1 or DM2 who were studied for 6 to 12 months depending on the method of analysis were eligible. Results. The search produced seven articles which gave event rate efficacy evaluable results and three which evaluated the effect of the IUD on laboratory parameters. One of the earlier efficacy studies showed an abnormally high pregnancy rate which sparked a controversy which is discussed in the Introduction section. The remaining 6 studies produced acceptable pregnancy rates. The three laboratory studies showed that the copper and levonorgestrel releasing IUD/IUS do not affect the diabetic state in any way. Conclusions. The copper bearing and levonorgestrel releasing IUDs are safe and effective in women with diabetes type I and diabetes type II although the evidence in the latter is limited.
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Affiliation(s)
- Norman D. Goldstuck
- Department of Obstetrics and Gynaecology, Tygerberg Hospital, Western Cape 7505, South Africa
| | - Petrus S. Steyn
- Reproductive Health and Fertility Regulation, Department of Obstetrics and Gynaecology, Groote Schuur Hospital and University of Cape Town, Cape Town 7925, South Africa
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Blumer I, Hadar E, Hadden DR, Jovanovič L, Mestman JH, Murad MH, Yogev Y. Diabetes and pregnancy: an endocrine society clinical practice guideline. J Clin Endocrinol Metab 2013; 98:4227-49. [PMID: 24194617 PMCID: PMC8998095 DOI: 10.1210/jc.2013-2465] [Citation(s) in RCA: 313] [Impact Index Per Article: 28.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVE Our objective was to formulate a clinical practice guideline for the management of the pregnant woman with diabetes. PARTICIPANTS The Task Force was composed of a chair, selected by the Clinical Guidelines Subcommittee of The Endocrine Society, 5 additional experts, a methodologist, and a medical writer. EVIDENCE This evidence-based guideline was developed using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) system to describe both the strength of recommendations and the quality of evidence. CONSENSUS PROCESS One group meeting, several conference calls, and innumerable e-mail communications enabled consensus for all recommendations save one with a majority decision being employed for this single exception. CONCLUSIONS Using an evidence-based approach, this Diabetes and Pregnancy Clinical Practice Guideline addresses important clinical issues in the contemporary management of women with type 1 or type 2 diabetes preconceptionally, during pregnancy, and in the postpartum setting and in the diagnosis and management of women with gestational diabetes during and after pregnancy.
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Affiliation(s)
- Ian Blumer
- 8401 Connecticut Avenue, Suite 900, Chevy Chase, Maryland 20815.
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Visser J, Snel M, Van Vliet HAAM. Hormonal versus non-hormonal contraceptives in women with diabetes mellitus type 1 and 2. Cochrane Database Syst Rev 2013; 2013:CD003990. [PMID: 23543528 PMCID: PMC6485821 DOI: 10.1002/14651858.cd003990.pub4] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND Adequate contraceptive advice is important in both women with diabetes mellitus type 1 and type 2 to reduce the risk of maternal and infant morbidity and mortality in unplanned pregnancies. A wide variety of contraceptives are available for these women. However, hormonal contraceptives might influence carbohydrate and lipid metabolism and increase micro- and macrovascular complications, so caution in selecting a contraceptive method is required. OBJECTIVES To investigate whether progestogen-only, combined estrogen and progestogen or non-hormonal contraceptives differ in terms of effectiveness in preventing pregnancy, in their side effects on carbohydrate and lipid metabolism, and in long-term complications such as micro- and macrovascular disease when used in women with diabetes mellitus. SEARCH METHODS The search was performed in CENTRAL, MEDLINE, EMBASE, POPLINE, CINAHL, WorldCat, ECO, ArticleFirst, the Science Citation Index, the British Library Inside, and reference lists of relevant articles. The last search was performed in January 2013. In addition, experts in the field and pharmaceutical companies marketing contraceptives were contacted to identify published, unpublished or ongoing studies. SELECTION CRITERIA Randomised and quasi-randomised controlled trials that studied women with diabetes mellitus comparing: 1. hormonal versus non-hormonal contraceptives; 2. progestogen-only versus estrogen and progestogen contraceptives; 3. contraceptives containing < 50 µg estrogen versus contraceptives containing ≥ 50 µg estrogen; and 4. contraceptives containing first-, second- and third-generation progestogens, drospirenone and cyproterone acetate. The principal outcomes were contraceptive effectiveness, diabetes control, lipid metabolism and micro- and macrovascular complications. DATA COLLECTION AND ANALYSIS Two investigators evaluated the titles and abstracts identified from the literature search. Quality assessment was performed independently with discrepancies resolved by discussion or consulting a third review author. Because the trials differed in studied contraceptives, participant characteristics and methodological quality, we could not combine the data in a meta-analysis. The trials were therefore examined on an individual basis and narrative summaries were provided. MAIN RESULTS Four randomised controlled trials were included. No unintended pregnancies were reported during the study periods. Only one trial was of good methodological quality. It compared the influence of a levonorgestrel-releasing intrauterine device (IUD) versus a copper IUD on carbohydrate metabolism in women with type 1 diabetes mellitus. No significant difference was found between the two groups. The other three trials were of limited methodological quality. Two compared progestogen-only pills with different estrogen and progestogen combinations, and one also included the levonorgestrel-releasing IUD and copper IUD. The trials reported that blood glucose levels remained stable during treatment with most regimens. Only high-dose combined oral contraceptives and 30 µg ethinylestradiol + 75 µg gestodene were identified as slightly impairing glucose homeostasis. The three studies found conflicting results regarding lipid metabolism. Some combined oral contraceptives appeared to have a minor adverse effect while others appeared to slightly improve lipid metabolism. The copper IUD and progestogen-only oral contraceptives also slightly improved lipid metabolism and no influence was seen while using the levonorgestel-releasing IUD. Only one study reported on micro- and macrovascular complications. It observed no signs or symptoms of thromboembolic incidents or visual disturbances, however study duration was short. Only minor adverse effects were reported in two studies. AUTHORS' CONCLUSIONS The four included randomised controlled trials in this systematic review provided insufficient evidence to assess whether progestogen-only and combined contraceptives differ from non-hormonal contraceptives in diabetes control, lipid metabolism and complications. Three of the four studies were of limited methodological quality, sponsored by pharmaceutical companies and described surrogate outcomes. Ideally, an adequately reported, high-quality randomised controlled trial analysing both intermediate outcomes (that is glucose and lipid metabolism) and true clinical endpoints (micro- and macrovascular disease) in users of combined, progestogen-only and non-hormonal contraceptives should be conducted. However, due to the low incidence of micro- and macrovascular disease and accordingly the large sample size and long follow-up period needed to observe differences in risk, a randomised controlled trial might not be the ideal design.
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Affiliation(s)
- Jantien Visser
- Department of Obstetrics and Gynaecology, Leiden University Medical Center, Leiden, Netherlands.
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Attia AM, Ibrahim MM, Abou-Setta AM. Role of the levonorgestrel intrauterine system in effective contraception. Patient Prefer Adherence 2013; 7:777-85. [PMID: 23990713 PMCID: PMC3749061 DOI: 10.2147/ppa.s36948] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Norgestrel, a synthetic progestin chemically derived from 19-nortestosterone, is six times more potent than progesterone, with variable binding affinity to various steroid receptors. The levonorgestrel-releasing intrauterine system (LNG IUS) provides a long-acting, highly effective, and reversible form of contraception, with a pearl index of 0.18 per 100 women-years. The locally released hormone leads to endometrial concentrations that are 200-800 times those found after daily oral use and a plasma level that is lower than that with other forms of levonorgestrel-containing contraception. The contraceptive effect of the LNG IUS is achieved mainly through its local suppressive effect on the endometrium, leading to endometrial thinning, glandular atrophy, and stromal decidualization without affecting ovulation. The LNG IUS is generally well tolerated. The main side effects are related to its androgenic activity, which is usually mild and transient, resolving after the first few months. Menstrual abnormalities are also common but well tolerated, and even become desirable (eg, amenorrhea, hypomenorrhea, and oligomenorrhea) with proper counseling of the patient during the choice of the method of contraception. The satisfaction rates after 3 years of insertion are high, reaching between 77% and 94%. The local effect of the LNG IUS on the endometrium and low rates of systemic adverse effects have led to its use in other conditions rather than contraception, as for the treatment of endometrial hyperplasia, benign menorrhagia, endometriosis, adenomyosis, and uterine fibroids.
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Affiliation(s)
| | - Magdy M Ibrahim
- Department of Obstetrics and Gynecology, Cairo University, Cairo, Egypt
| | - Ahmed M Abou-Setta
- George and Fay Yee Centre for Healthcare Innovation, University of Manitoba/Winnipeg Regional Health Authority, Winnipeg, MB, Canada
- Correspondence: Ahmed M Abou-Setta George and Fay Yee, Center for Healthcare Innovation, University of Manitoba/Winnipeg Regional Health Authority, GH-714–820 Sherbrook Street, Winnipeg, MB R3A 1R9, Canada, Tel +1 204 787 8707, Fax +1 204 787 7567, email
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Baird DT, Evers JLH, Gemzell-Danielsson K, Glasier A, Killick SR, Van Look PFA, Vercellini P, Yildiz BO, Benagiano G, Cibula D, Crosignani PG, Gianaroli L, La Vecchia C, Negri E, Volpe A. Family planning 2011: better use of existing methods, new strategies and more informed choices for female contraception. Hum Reprod Update 2012; 18:670-81. [DOI: 10.1093/humupd/dms021] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
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Pallardo L, Cano A, Cristobal I, Blanco M, Lozano M, Lete I. Hormonal Contraception and Diabetes. CLINICAL MEDICINE INSIGHTS. WOMEN'S HEALTH 2012. [DOI: 10.4137/cmwh.s9934] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Women with gestational diabetes mellitus are at increased risk for developing diabetes mellitus (DM), mainly type 2 DM, as well as metabolic syndrome. The presence of subsequent pregnancies increases the risk. In addition, pregnancy in patients with type 1 and type 2 DM also elevates the risk of morbidity and mortality for both mothers and offspring. Thus, all women with pre-existing type 1 or type 2 DM should receive preconception care to optimize glycemic control (HbA1c ≤ 6%). In those cases with macrovascular or microvascular complications, family planning is even more important in order to avoid the risk of aggravation of such complications associated with a new pregnancy. The present review analyzes the metabolic and cardiovascular repercussions of hormone contraception in non-diabetic women as well as in type 1 and type 2 DM patients with and without macrovascular and microvascular complications. Finally, the recommendations pertaining to hormonal contraceptive methods for women with diabetes are summarized.
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Affiliation(s)
| | - A Cano
- Hospital Pesset, valencia, Spain
| | | | | | - M Lozano
- Hospital Clinic, Barcelona, Spain
| | - I Lete
- Hospital Santiago Apostol, Vitoria, Spain
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GEMZELL-DANIELSSON KRISTINA, INKI PIRJO, HEIKINHEIMO OSKARI. Recent developments in the clinical use of the levonorgestrel-releasing intrauterine system. Acta Obstet Gynecol Scand 2011; 90:1177-88. [DOI: 10.1111/j.1600-0412.2011.01256.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Dispositifs intra-utérins. Contraception 2011. [DOI: 10.1016/b978-2-294-70921-0.00007-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Vilos GA, Marks J, Tureanu V, Abu-Rafea B, Vilos AG. The Levonorgestrel Intrauterine System Is an Effective Treatment in Selected Obese Women with Abnormal Uterine Bleeding. J Minim Invasive Gynecol 2011; 18:75-80. [PMID: 21195957 DOI: 10.1016/j.jmig.2010.09.013] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2010] [Revised: 09/02/2010] [Accepted: 09/09/2010] [Indexed: 10/18/2022]
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Abstract
Levonorgestrel-containing intrauterine contraceptive devices, marketed as Mirena (Bayer HealthCare Pharmaceuticals, Inc. Australia) are widely used in contemporary gynecology, primarily as an effective method for contraception and for control of menstrual disorders like menorrhagia and dysmenorrhea. In this article, the authors report 2 cases of Mirena migration following intrauterine insertion by general practitioners (family physicians). In the first case, the contraceptive device had moved to the patient's right iliac fossa just anterior to the cecum and, in the second, within the peritoneal cavity close to the left leaf of the diaphragm. Both patients underwent uneventful laparoscopic retrieval of the devices.
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Affiliation(s)
- Mark Erian
- High Doctorate of Medicine, University of Queensland, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia.
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Kerlan V. Post-partum et contraception chez les femmes ayant eu un diabète gestationnel. ACTA ACUST UNITED AC 2010; 39:S289-98. [DOI: 10.1016/s0368-2315(10)70055-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
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Kerlan V. Postpartum and contraception in women after gestational diabetes. DIABETES & METABOLISM 2010; 36:566-74. [DOI: 10.1016/j.diabet.2010.11.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
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Abstract
Gestational diabetes mellitus (GDM) is commonly defined as glucose intolerance first recognized during pregnancy. Diagnostic criteria for GDM have changed over the decades, and several definitions are currently used; recent recommendations may increase the prevalence of GDM to as high as one of five pregnancies. Perinatal complications associated with GDM include hypertensive disorders, preterm delivery, shoulder dystocia, stillbirths, clinical neonatal hypoglycemia, hyperbilirubinemia, and cesarean deliveries. Postpartum complications include obesity and impaired glucose tolerance in the offspring and diabetes and cardiovascular disease in the mothers. Management strategies increasingly emphasize optimal management of fetal growth and weight. Monitoring of glucose, fetal stress, and fetal weight through ultrasound combined with maternal weight management, medical nutritional therapy, physical activity, and pharmacotherapy can decrease comorbidities associated with GDM. Consensus is lacking on ideal glucose targets, degree of caloric restriction and content, algorithms for pharmacotherapy, and in particular, the use of oral medications and insulin analogs in lieu of human insulin. Postpartum glucose screening and initiation of healthy lifestyle behaviors, including exercise, adequate fruit and vegetable intake, breastfeeding, and contraception, are encouraged to decrease rates of future glucose intolerance in mothers and offspring.
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Affiliation(s)
- Catherine Kim
- Departments of Medicine and Obstetrics and Gynecology, University of Michigan, Ann Arbor, MI, USA.
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Verhaeghe J. Hormonal contraception in women with the metabolic syndrome: A narrative review. EUR J CONTRACEP REPR 2010; 15:305-13. [DOI: 10.3109/13625187.2010.502583] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Schwarz EB, Sobota M, Charron-Prochownik D. Perceived access to contraception among adolescents with diabetes: barriers to preventing pregnancy complications. DIABETES EDUCATOR 2010; 36:489-94. [PMID: 20332282 DOI: 10.1177/0145721710365171] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE The purpose of this study was to assess beliefs, perceived access to, and practices regarding contraception among adolescent women with type 1 diabetes. METHODS Eighty-nine females with type 1 diabetes between the ages of 13 and 19 years, who were recruited from 2 endocrinology practices as part of a larger study, completed a battery of questionnaires designed to assess variables relevant to discussions of sexuality, preconception counseling, contraception, and pregnancy. In addition, items were designed to explore adolescents' relationship with their health care provider and comfort requesting birth control. Baseline data were analyzed using descriptive statistics. RESULTS Half of the sexually active adolescents in this sample reported having had sex without birth control at a time they were trying to avoid pregnancy. A third (36%) of subjects felt that women with diabetes have very limited choices of birth control, and 43% incorrectly believe that all birth control methods are less effective when used by women with diabetes. Less than half (47%) reported that they had discussed birth control with a health care professional, and 29% of subjects reported they had not received formal instruction on birth control in any setting. Perhaps of greatest concern, only 69% stated they would feel comfortable asking a professional for birth control. CONCLUSION Many adolescent women with diabetes are at risk of unintended pregnancy and do not feel comfortable asking a health professional for birth control. Diabetes educators who initiate preconception counseling at puberty and discuss contraceptive options with adolescent women with diabetes may improve pregnancy outcomes.
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Affiliation(s)
- Eleanor B Schwarz
- The University of Pittsburgh, Pittsburgh, Pennsylvania (Dr Schwarz, Dr Charron-Prochownik)
| | - Mindy Sobota
- The Oregon Health and Science University, Portland, Oregon (Dr Sobota)
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Vilos GA, Tureanu V, Garcia M, Abu-Rafea B. The levonorgestrel intrauterine system is an effective treatment in women with abnormal uterine bleeding and anticoagulant therapy. J Minim Invasive Gynecol 2009; 16:480-4. [PMID: 19573825 DOI: 10.1016/j.jmig.2009.04.018] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2009] [Revised: 04/28/2009] [Accepted: 04/30/2009] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To evaluate the efficacy of levonorgestrel intrauterine systems (LNG-IUS) in obese women with AUB on anticoagulant therapy. DESIGN Prospective observational case series (Canadian Task Force Classification II-3). SETTING University affiliated teaching hospital. PATIENTS Premenopausal women on Warfarin therapy. INTERVENTIONS From January 2002 through January 2007, 10 women were identified from the senior author's clinical practice (G.A.V.). After clinical assessment, including Papanicolaou smear, endometrial biopsy, and pelvic sonography, the LNG-IUS was placed to treat their AUB. MEASUREMENTS AND MAIN RESULTS The median and range of age, parity, and body mass index were 45 years (34-49), 1 (0-4), and 38 kg/m(2) (26-52), respectively. All women were receiving warfarin therapy (4-12.5 mg/d) for previous venous thromboembolism. Some patients had additional comorbid conditions and were at high risk for traditional medical or surgical therapies. After placement of the LNG-IUS, all women reported menstrual reduction at 3 and 6 months. By 12 months, 1 woman with large fibroids expelled the LNG-IUS and was treated with transfemoral uterine artery embolization. Two women had amenorrhea, and 7 had hypomenorrhea. At 2 to 5 years, 1 woman expelled the LNG-IUS and hysterectomy indicated extensive adenomyosis in a 195-g uterus, and 1 woman had hysteroscopic endometrial ablation, 4 were menopausal, 2 had amenorrhea, and 1 had hypomenorrhea. In the 5 women with uterine fibroids measuring 4.2 to 147 cm(3), the fibroids were reduced in volume by approximately 75% in 2, were no longer detectable in 1, were subsequently shown to be adenomyoma in 1, and required uterine artery embolization in 1. CONCLUSION In properly assessed and selected obese, premenopausal women with AUB receiving warfarin therapy and at high risk for traditional therapies, the LNG-IUS was an effective treatment in 70% of patients.
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Affiliation(s)
- George A Vilos
- St. Joseph's Health Care, Department of Obstetrics and Gynecology, The University of Western Ontario, London, Ontario, Canada.
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Ng YW, Liang S, Singh K. Effects of Mirena (levonorgestrel-releasing intrauterine system) and Ortho Gynae T380 intrauterine copper device on lipid metabolism—a randomized comparative study. Contraception 2009; 79:24-8. [DOI: 10.1016/j.contraception.2008.07.012] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2008] [Revised: 07/21/2008] [Accepted: 07/25/2008] [Indexed: 10/21/2022]
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Beydoun HA, Beydoun MA, Tamim H. How does gestational diabetes affect postpartum contraception in nondiabetic primiparous women? Contraception 2008; 79:290-6. [PMID: 19272498 DOI: 10.1016/j.contraception.2008.10.013] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2008] [Revised: 10/24/2008] [Accepted: 10/25/2008] [Indexed: 10/21/2022]
Abstract
BACKGROUND The aim of the study is to explore the effect of gestational diabetes mellitus (GDM) on postpartum contraception among nondiabetic primiparous women. STUDY DESIGN Secondary analyses of 2004-2005 Pregnancy Risk Assessment Monitoring System data from Michigan and Oregon. METHODS Analyses were performed on 2332 women, taking complex survey design into consideration. Crude and adjusted odds ratios (cOR; aOR) and their 95% confidence intervals (CI) were obtained using logistic regression analyses. RESULTS Postpartum use of hormonal (aOR=1.12, 95% CI: 0.68-1.83) and nonhormonal (aOR=1.18, 95% CI: 0.73-1.92) contraception were not influenced by GDM after controlling for confounders. Female sterilization was more frequently adopted (cOR=4.99, 95% CI: 1.13-22.17) and depomedroxyprogesterone acetate (DMPA) (cOR=0.53, 95% CI: 0.23-1.18), diaphragm/cervical cap/sponge (cOR=0.13, 95% CI: 0.016-0.95) and cervical ring (cOR=0.13, 95% CI: 0.017-0.98) were less frequently adopted by women reporting GDM diagnosis. CONCLUSION With few exceptions, GDM does not appear to affect postpartum hormonal and nonhormonal contraception.
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Affiliation(s)
- Hind A Beydoun
- Graduate Program in Public Health, Eastern Virginia Medical School, Norfolk, VA 23501-1980, USA.
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Morin-Papunen L, Martikainen H, McCarthy MI, Franks S, Sovio U, Hartikainen AL, Ruokonen A, Leinonen M, Laitinen J, Järvelin MR, Pouta A. Comparison of metabolic and inflammatory outcomes in women who used oral contraceptives and the levonorgestrel-releasing intrauterine device in a general population. Am J Obstet Gynecol 2008; 199:529.e1-529.e10. [PMID: 18533124 DOI: 10.1016/j.ajog.2008.04.013] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2007] [Revised: 11/26/2007] [Accepted: 04/07/2008] [Indexed: 10/22/2022]
Abstract
OBJECTIVE We compared the metabolic and cardiovascular parameters of a reference group of women with those of women who used 2 contraceptive regimes that are used worldwide: the levonorgestrel-releasing intrauterine device and oral contraceptives. STUDY DESIGN We investigated a cohort of 2814 women at age 31 years from the general population-based Northern Finland Birth Cohort who were born in 1966. Women were classified as oral contraceptive users (n = 687 women), levonorgestrel-releasing intrauterine device users (n = 168 women), or no use of hormonal contraception (reference group; n = 1959 women). The analyses were adjusted for body mass index, current alcohol use, household income, and area of residence. RESULTS Compared with the reference group, oral contraceptive users had higher systolic and diastolic blood pressure, raised levels of inflammatory indices (C-reactive protein), and impaired insulin sensitivity. Levonorgestrel-releasing intrauterine device users displayed a lower high-density lipoprotein and total cholesterol, but a similar cholesterol/ high-density lipoprotein ratio, and higher leukocyte count compared with the reference group. Oral contraception users were insulin-resistant compared with levonorgestrel-releasing intrauterine device users with higher blood pressure, raised lipid levels (such as total cholesterol and triglycerides) and insulin levels, and lower homeostasis model assessment and insulin sensitivity, despite smaller waist and lower waist-hip ratio. CONCLUSION Oral contraception usage was associated with adverse findings in several metabolic, cardiovascular, and inflammatory parameters, which is consistent with an increased future risk of cardiovascular and metabolic disease. These findings should invite more criticism of recent trends that encourage the prescription of oral contraceptives for years during reproductive life and especially in premenopausal women. In contrast, levonorgestrel-releasing intrauterine device or progestin-only pills may offer long-term health benefits over oral contraceptives and should be preferred to oral contraceptives for women in their forties and/or with metabolic risk factors for cardiovascular diseases and type 2 diabetes mellitus.
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The Levonorgestrel-releasing Intrauterine System: An Updated Review of the Contraceptive and Noncontraceptive Uses. Clin Obstet Gynecol 2007; 50:886-97. [DOI: 10.1097/grf.0b013e318159c0d9] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Abstract
Intrauterine contraception is the most widely used method of reversible fertility regulation in the world. Finally, IUC is undergoing a renaissance in the US and it's role will expand as new devices and systems are developed and as old biases among clinicians and women are erased. Successful fertility regulation is a defining factor of the overall health of a population; the expanded use of IUC can help achieve that public health success.
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Affiliation(s)
- Laura MacIsaac
- Department of Obstetrics and Gynecology, Division of Family Planning, Albert Einstein College of Medicine of Yeshiva University, Bronx, NY 10461, USA.
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Affiliation(s)
- Peter Damm
- Obstetric Clinic, Center for Pregnant Women with Diabetes, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.
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Bernasko J. Intensive insulin therapy in pregnancy: strategies for successful implementation in pregestational diabetes mellitus. J Matern Fetal Neonatal Med 2007; 20:125-32. [PMID: 17437210 DOI: 10.1080/14767050601144727] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
The role of intensive insulin therapy (IIT) in the reduction of long-term diabetes-related complications is well established. Normal blood glucose level prior to and during pregnancy is critical in reducing both short- and long-term morbidity and mortality in mother and infant. IIT in pregnancy, though occasionally challenging, is necessary to achieve and maintain normal blood glucose level during pregnancy. Current knowledge and recent advances in insulin formulations and delivery systems have improved our ability to achieve glycemic targets in pregnancy while limiting maternal and fetal morbidity. The objective of this review is to discuss contemporary strategies for successful use of IIT in pregnancy.
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Affiliation(s)
- James Bernasko
- North Shore Center for Diabetes in Pregnancy, Division of Maternal-Fetal Medicine, North Shore-Long Island Jewish Health System, North Shore University Hospital, Manhasset, NY 11030, USA
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Abstract
Chronic medical conditions can complicate maternal and fetal health during pregnancy, making unintended or mistimed pregnancy problematic. The use of highly effective reversible contraceptives is important for women with health issues, yet sometimes those same illnesses make the contraceptives themselves less effective or less safe. We review the evidence surrounding contraceptive use by women with six common medical conditions: systemic lupus erythematosus, diabetes mellitus, anticonvulsant use for epilepsy or mood disorder, HIV infection, migraine headache, and obesity. In some instances it is not possible to make a risk-free contraceptive choice, yet pregnancy may be even riskier. Good clinical judgment and patient counseling must be exercised.
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Affiliation(s)
- Stephanie B Teal
- Department of Obstetrics and Gynecology, University of Colorado at Denver and Health Sciences Center, Denver, CO 80262, USA.
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Collinet P, Nayama M, Cosson M. [Acceptability of intrauterine levonorgestrel delivery system (Mirena 52mg) after estrogen-progesterone oral contraception: results of a prospective multicentric study of 211 patients aged 25-35 years]. ACTA ACUST UNITED AC 2006; 35:778-84. [PMID: 17151533 DOI: 10.1016/s0368-2315(06)76479-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Use of an intrauterine levonorgestrel (SIU-LNG) delivery system (Mirena 52mg has become popular in recent years, particularly among younger women. Mirena is currently the contraceptive method of choice used as an alternative to classical copper-containing intrauterine devices after oral contraception. The purpose of this study was to evaluate patient satisfaction among young women during the first year of use of the intrauterine hormonal system. MATERIAL AND METHODS This multicentric phase IV trial with a non-comparative methodology was conducted among 211 young women aged 25-35 years. The SIU-LNG was prescribed for women who wanted to change their contraception after oral estrogen progesterone taken for at least three months prior to inclusion in the study. A total of 211 patients were included and review was planned at one year: 197 patients (93.36%) were reviewed. RESULTS Mean patient age was 31.48+/-3.25 years. The SIU-LNG was inserted successfully at the first attempt in 99.05% of women. The continuation rate ws 85.65% at one year. Evaluation of cycle characteristics showed less voluminous blood loss and fewer dysmenorrheal phenomena as well as, in 40%, the development of amenorrhea. At the last visit, 85% of women were satisfied or very satisfied with this method of contraception. CONCLUSION As has been demonstrated in earlier studies, Mirena offers a contraception with a reliability equivalent to that of oral estrogen progesterone (IP: 0 - 0.2), with very few hormonal side effects due to the low plasma passage of levonorgestrel. Mirena is particularly well adapted for young women who desire a reliable long-term easty-to-use contraception after taking oral contraception.
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Affiliation(s)
- P Collinet
- Clinique de Gynécologie, Hôpital Jeanne-de-Flandre, CHRU de Lille, 2, avenue Oscar-Lambret, 59037 Lille Cedex.
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Visser J, Snel M, Van Vliet HAAM. Hormonal versus non-hormonal contraceptives in women with diabetes mellitus type 1 and 2. Cochrane Database Syst Rev 2006:CD003990. [PMID: 17054193 DOI: 10.1002/14651858.cd003990.pub3] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
BACKGROUND Adequate contraceptive advice is important in women with diabetes mellitus type 1 and 2 to reduce the risk of maternal and infant morbidity and mortality in unplanned pregnancies. A wide variety of contraceptives are available for these women. However hormonal contraceptives might influence carbohydrate and lipid metabolism and increase micro- and macrovascular complications. So caution in selecting a contraceptive method is required. OBJECTIVES To investigate whether progestogen-only, combined estrogen/progestogen or non-hormonal contraceptives differ in terms of effectiveness in preventing pregnancy, in their side effects on carbohydrate and lipid metabolism and in long-term complications such as micro- and macrovascular disease, when used in women with diabetes mellitus. SEARCH STRATEGY The search was performed in MEDLINE, EMBASE, CENTRAL/CCTR, POPLINE, CINAHL, WorldCat, ECO, ArticleFirst, the Science Citation Index, the British Library Inside, and reference lists of relevant articles. Last search was performed in May 2005. In addition, experts in the field and pharmaceutical companies marketing contraceptives were contacted to identify published, unpublished or ongoing studies. SELECTION CRITERIA Randomised and quasi-randomised controlled trials that studied women with diabetes mellitus comparing: 1. hormonal versus non-hormonal contraceptives. 2. progestogen-only versus estrogen/progestogen contraceptives. 3. contraceptives containing <50 microg estrogen versus contraceptives containing > or = 50 microg estrogen. 4. contraceptives containing 'first'-, 'second'- and 'third'-generation progestogens, drospirenone and cyproterone acetate. Principal outcomes were contraceptive effectiveness, diabetes control, lipid metabolism and micro- and macrovascular complications. DATA COLLECTION AND ANALYSIS Two investigators evaluated the titles and abstracts from the literature search. Quality assessment was performed independently with discrepancies resolved by discussion or consulting a third reviewer. Because the trials differed in studied contraceptives, participant characteristics and methodological quality, we could not combine the data in a meta-analysis. The trials were therefore examined on an individual basis and narrative summaries were provided. MAIN RESULTS Three randomised controlled trials were included. Only one was of good methodological quality. It compared the influence of levonorgestrel-releasing IUD versus copper-IUD on carbohydrate metabolism in women with type 1 diabetes mellitus. No difference was found in daily insulin requirement, glycosylated hemoglobin (HbA1c) or fasting blood sugar after twelve months. The other two trials were of limited methodological quality. Both compared progestogen-only pills with different estrogen/progestogen combinations. The trials reported blood glucose levels to remain stable during treatment with most regimens. Only high-dose combined oral contraceptives were found to slightly impair glucose homeostasis. Combined oral contraceptives also appeared to have a minor adverse effect on lipid metabolism whereas progestogen-only contraceptives slightly improved lipid-metabolism. Only one study reported on micro- and macrovascular complications. No signs or symptoms of thromboembolic incidents or visual disturbances were observed. However study duration was short. Minor adverse effects were reported in one study. The trial found progestogen-only pills to cause more bleeding irregularities when compared with combined oral contraceptives. Unintended pregnancies were not observed during any of the studies. AUTHORS' CONCLUSIONS The three included randomised controlled trials in this systematic review provided insufficient evidence to assess whether progestogen-only and combined contraceptives differ from non-hormonal contraceptives in diabetes control, lipid metabolism and complications. Two of the three studies were of limited methodological quality, sponsored by pharmaceutical companies and described surrogate outcomes. Ideally, an adequately reported, high-quality randomised controlled trial analysing both intermediate outcomes (i.e. glucose and lipid metabolism) and true clinical endpoints (micro- and macrovascular disease) in users of combined, progestogen-only and non-hormonal contraceptives should be conducted. However, due to the low incidence of micro- and macrovascular disease and accordingly the large sample size and follow-up period needed to observe differences in risk, a randomised controlled trial might not be the ideal design.
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Affiliation(s)
- J Visser
- LUMC, Dept. of Obstetrics and Gynaecology, Albinusdreef 2, PO Box 9600, Leiden, Netherlands.
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Kayikcioglu F, Gunes M, Ozdegirmenci O, Haberal A. Effects of levonorgestrel-releasing intrauterine system on glucose and lipid metabolism: a 1-year follow-up study. Contraception 2006; 73:528-31. [PMID: 16627040 DOI: 10.1016/j.contraception.2005.12.005] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2005] [Revised: 12/08/2005] [Accepted: 12/08/2005] [Indexed: 11/16/2022]
Abstract
PURPOSE This prospective study aimed to assess the possible effects of the levonorgestrel-releasing intrauterine system (LNG-IUS) on serum lipids and fasting blood glucose levels over a period of 1 year. METHODS Forty-eight premenopausal women, attending our gynecology clinic with the complaint of menorrhagia, were enrolled in the study. Systolic and diastolic blood pressures were recorded. Serum concentrations of total cholesterol (TC), triglycerides (TG), high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), very low density lipoprotein cholesterol (VLDL-C), aspartate aminotransferase (AST), alanine aminotransferase (ALT) and fasting plasma glucose (FPG) levels were tested before (pretreatment group) and 1 year later following insertion (on-treatment group). Baseline mean parameters were compared with mean parameters at 1 year for statistical significance using paired samples t-test. RESULTS Thirty-three (68.75%) women were eligible for control in the on-treatment group. Mean age of the patients was 44.34+/-7.59 years. The study results showed that mean FPG level was significantly increased, whereas mean diastolic blood pressure was significantly decreased. Although mean systolic blood pressure tended to decrease and HDL-C concentrations to increase, these changes from baseline levels were insignificant. There were no significant changes in mean TG, TC, VLDL, LDL, AST and ALT. DISCUSSION The only significant unfavorable effect observed was an increase in FPG level. Since it did not rise to risky values, but alerted us for the high risk patients for glucose intolerance before insertion. The LNG-IUS can be regarded as being safe in their effects on lipid metabolism, blood pressure and liver function tests.
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Affiliation(s)
- Fulya Kayikcioglu
- T.C.S.B Ankara Maternity and Women's Health Teaching and Research Hospital, TR06010, Etlik, Ankara, Turkey.
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Grigoryan OR, Grodnitskaya EE, Andreeva EN, Shestakova MV, Melnichenko GA, Dedov II. Contraception in perimenopausal women with diabetes mellitus. Gynecol Endocrinol 2006; 22:198-206. [PMID: 16723306 DOI: 10.1080/09513590600624317] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
Abstract
AIM To assess the effect of combined oral contraceptives (COCs) and intrauterine devices (IUDs) on carbohydrate and lipid metabolism and hemostasis in perimenopausal diabetic women. METHODS The open randomized study included a total of 113 diabetic women using COCs with different estrogen/progestogen profiles - ethinylestradiol (EE) 20 microg/desogestrel 150 microg, EE 30 microg/desogestrel 150 microg and EE 30 microg/gestodene 75 microg - and levonorgestrel-releasing or copper IUDs. Average daily insulin requirements, levels of glycosylated hemoglobin, total cholesterol, triglycerides, low-density lipoprotein cholesterol and high-density lipoprotein cholesterol, the state of coagulation hemostatis and fibrinolytic activity were determined at baseline and after 3, 6, 9 and 12 months of contraception. The control group was composed of 40 age-matched diabetic women who did not use any methods of contraception. RESULTS Neither COCs nor IUDs influenced glycosylated hemoglobin and had little or no influence on the elevation in the requirements for insulin preparations. The majority of the preparations did not exert any unfavorable effect on the blood lipid profile. Taking COCs was accompanied by increased intravascular activation of blood platelets and to a lesser degree by alterations in parameters of hemostatic homeostasis. The use of IUDs had a neutral effect on blood coagulation and fibrinolysis systems. CONCLUSION Comparing lipid levels and hemostatic variables as a function of glycosylated hemoglobin level, we conclude that diabetes control has greater influence on these parameters than the type and dose of steroids involved in the contraceptive devices.
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Affiliation(s)
- Olga R Grigoryan
- Federal Facility Endocrinological Research Centre under the Russian Academy of Medical Sciences, Moscow, Russia.
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French R, Van Vliet H, Cowan F, Mansour D, Morris S, Hughes D, Robinson A, Proctor T, Summerbell C, Logan S, Helmerhorst F, Guillebaud J. Hormonally impregnated intrauterine systems (IUSs) versus other forms of reversible contraceptives as effective methods of preventing pregnancy. Cochrane Database Syst Rev 2004; 2004:CD001776. [PMID: 15266453 PMCID: PMC8407482 DOI: 10.1002/14651858.cd001776.pub2] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND In the 1970s a new approach to the delivery of hormonal contraception was researched and developed. It was suggested that the addition of a progestogen to a non-medicated contraceptive device improved its contraceptive action. An advantage of these hormonally impregnated intrauterine systems (IUS) is that they are relatively maintenance free, with users having to consciously discontinue using them to become pregnant rather than taking a proactive daily decision to avoid conception. OBJECTIVES To assess the contraceptive efficacy, tolerability and acceptability of hormonally impregnated intrauterine systems (IUSs) in comparison to other reversible contraceptive methods. SEARCH STRATEGY Literature was identified through database searches, reference lists and individuals/organisations working in the field. Searches covered the period from 1972 to November 2003. SELECTION CRITERIA All randomised controlled trials comparing IUSs with other forms of reversible contraceptives and reporting on pre-determined outcomes in women of reproductive years. The primary outcomes were pregnancy due to method/user failure and continuation rate. DATA COLLECTION AND ANALYSIS The quality assessment of studies and data extraction were completed independently by two blinded reviewers. A quality checklist was designed to identify general methodological and contraceptive specific factors which could bias results. Events per women months and single decrement life table rates were extracted where possible for pregnancy, continuation, adverse events and reasons for discontinuation. Events per total number of women at follow up were collected for hormonal side effects and menstrual disturbance. When appropriate, data were pooled at the same points of follow up to calculate rate ratios in order to determine the relative effectiveness of one method compared to another. For the single decrement life table rates, the rate differences were pooled to determine the absolute difference in effectiveness of one method compared to another. Interventions were only combined if the contraceptive methods were similar. Non-hormonal IUDs were divided into three categories for the purpose of comparison with IUSs: IUDs >250mm2 (i.e. CuT 380A IUD and CuT 380 Ag IUD), IUDs <=250mm2 (i.e. Nova-T, Multiload, CuT 200 and CuT 220 IUDs) and non-medicated IUDs. MAIN RESULTS Twenty-one RCTs comparing hormonally impregnated IUSs to a reversible contraceptive method met the inclusion criteria and it was possible to include eight of these in the meta-analyses, four comparing LNG-20 IUSs with non-hormonal IUDs, one comparing the LNG-20 IUS with Norplant-2 and three comparing Progestasert with non-hormonal IUDs. No significant difference was observed between the pregnancy rates for the LNG-20 users and those for the IUD >250mm2 users. However, women using the LNG-20 IUS were significantly less likely to become pregnant than those using the IUD <=250mm2. Women using the LNG-20 IUS were more likely to experience amenorrhoea and device expulsion than women using IUDs >250mm2. LNG-20 users were significantly more likely than all the IUD users to discontinue because of hormonal side effects and menstrual disturbance, which on further breakdown of the data was due to amenorrhoea. When the LNG-20 IUS was compared to Norplant-2, the LNG-20 users were significantly more likely to experience amenorrhoea and oligomenorrhoea, but significantly less likely to experience prolonged bleeding and spotting. No other significant differences were observed. Progestasert users were significantly less likely to become pregnant and less likely to continue on the method than non-medicated IUD users after one year, but no significant difference was noted for these two outcomes when Progestasert users were compared to IUD<=250mm2 users. The only other significant differences found in the meta-analyses were that Progestasert users were less likely to expel the device and more likely to discontinue the method because of menstrual bleeding and pain than users of IUDs <=250mm2. REVIEWERS' CONCLUSIONl the device and more likely to discontinue the method because of menstrual bleeding and pain than users of IUDs <=250mm2. REVIEWERS' CONCLUSIONS Current evidence suggests LNG-20 IUS users are no more or less likely to have unwanted pregnancies than IUD >250mm2 and Norplant-2 users. The LNG-20 IUS was more effective in preventing either intrauterine or extrauterine pregnancies than IUDs <=250mm2. The contraceptive effectiveness of Progestasert was significantly better than non-medicated IUDs, but no difference was observed when compared to IUDs<=250mm2. Continuation of LNG-20 IUS use was similar to continuation of the non-hormonal IUDs and Norplant-2. Amenorrhoea was the main reason for the discontinuation for the LNG-20 IUS and women should be informed of this prior to starting this method.
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Affiliation(s)
- R French
- Department of STDs, Mortimer Market Centre, University College London Medical School, off Capper Street, London, UK, WC1E 6AU.
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