Many obese and diabetic women neglect contraception

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Forty percent of diabetic women and up to one third of overweight or obese women do not use contraception, according to findings published in the current issue of Diabetes Care. The lack of contraception use in these high-risk populations is related to sociodemographic and other factors related to pregnancy, rather than diabetes and obesity.

“Diabetes and obesity increasingly affect women of reproductive age in the U.S.,” Dr. Anjel Vahratian, of the University of Michigan, Ann Arbor, and colleagues write. “Women with diabetes and those who are obese are at increased risk for pregnancy complications, including those from surgical delivery, and their offspring are at risk for congenital anomalies.”

The researchers used data from the 2002 National Survey for Family Growth to assess contraceptive practices among 5955 women between the ages of 20 and 44 years. Lack of contraception use was defined as absence of hormonal, barrier or sterilization methods. 

Overall, 135 women had diabetes and 2927 were overweight or obese, according to their body mass index (BMI). “We found that (approximately) 40 percent of women with diabetes and up to a third of women with elevated BMIs did not use contraception,” the authors report. BMI is the ratio of height to weight, which is commonly used to determine whether an individual is over- or underweight.

In comparisons of sexually active women, those with diabetes were more likely to not use contraceptives compared with women without diabetes. Compared with women with a lower than average BMI, those with extremely obese (BMI of 35 or higher), were more likely to forgo contraception. However, the association between contraceptive use and less extreme degrees of overweight and obesity was not significant.

Additional analyses revealed that older age, non-Hispanic black race, history of medical assistance to become pregnant, and desire for or ambivalence about pregnancy were associated with lack of contraception. Women with higher educational attainment and those who were cohabiting were more likely to use contraception. After adjusting the data for confounding factors, the associations among diabetes, BMI, and contraception were no longer statistically significant.

“Clinicians caring for women with diabetes and/or elevated body mass index may wish to target women who desire pregnancy or who feel ambivalent about pregnancy for more intensive preconception management, even if these women do not intend to get pregnant,” Vahratian said in an interview with Reuters Health.

“Efforts to improve family planning practices among these women should include factors associated with contraceptive use—particularly their beliefs about fecundity and potential ambivalence about their desires for pregnancy,” she added. “Preconceptional management may be more successful in this subgroup if equal attention is given to daily folic acid use, weight management, and achieving optimal glycemic control and not solely initiation of family planning—regardless of whether pregnancy is immediately intended or not.”

“This will become an increasingly important issue as the number of reproductive-aged women with diabetes increases,” Vahratian said. “Most of these women do not receive any sort of preconception care, and many are diagnosed when they are older, past the reach of current preconception programs targeted primarily at young teenagers.”

SOURCE: Diabetes Care, June 2009.

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