Fertility outcomes in women with pre-existing type 2 diabetes-a prospective cohort study

OBJECTIVE

To study childbirth and the risk of miscarriage and infertility among women who have received a diagnosis of type 2 diabetes before the start of their reproductive journey.

DESIGN

Register-based cohort study using the Skåne Healthcare Register SETTING: All healthcare visits for the whole population of the southernmost region in Sweden over the past 20 years PATIENT(S): All women who were aged 18-45 years between January 1, 1998 and December 31, 2019 and who received a clinical diagnosis of type 2 diabetes before their first childbirth, miscarriage, or infertility diagnosis (n = 230) were compared with a healthcare-seeking population of women without any type of diabetes, matched for calendar year and age (n = 179,434).

INTERVENTION(S)

None MAIN OUTCOME MEASURE(S): Childbirth, miscarriage, and infertility diagnosis RESULT(S): The birthrate was lower among women with type 2 diabetes (62.6% vs. 83.8%), and they were less likely to give birth (crude risk ratio [RR] = 0.73, 95% confidence interval [CI]: 0.66-0.81). They had a higher risk of experiencing a miscarriage (RR = 1.88, 95% CI: 1.50-2.36). The risk of infertility was increased (RR = 3.44, 95% CI: 2.88-4.10) as was the risk of having infertility and not giving birth (RR = 4.47, 95% CI: 3.44-5.82). All results remained the same after adjustment for polycystic ovary syndrome and obesity.

CONCLUSION(S)

Women with type 2 diabetes with onset before their reproductive journey were more often childless compared with women without diabetes and had a higher risk of experiencing both miscarriage and infertility. This patient group may be in need of targeted information regarding potential fertility issues as part of their clinical treatment.

Changing Patterns of Contraceptive Use and the Decline in Rates of Pregnancy and Birth Among U.S. Adolescents, 2007-2014

PURPOSE

To investigate the influence of sexual activity and contraceptive use on the decline in adolescent birth rates and pregnancy rates since 2007.

METHODS

We estimated trends in pregnancy risk from 2007 to 2014 using national data on behaviors of women aged 15-19.

RESULTS

In 2007-2014, increases occurred in use of one or more contraceptive methods at last sex (78%-88%), dual method use (24%-33%), long-acting reversible contraception including intrauterine device and implant (1%-7%), withdrawal (15%-26%), and withdrawal in combination with other methods (7%-17%). Pill use rose and then fell over time. Level of sexual activity did not change over time. The decline in pregnancy risk among women aged 15-19 was entirely attributable to improvements in contraceptive use.

CONCLUSIONS

Improvements in contraceptive use-including increases in use of long-acting reversible contraception and withdrawal in combination with another method-appear to be driving recent declines in adolescent birth and pregnancy rates.