Attitudes about contraception in postpartum women with pregestational diabetes

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Women with pregestational diabetes mellitus (DM) who thought contraception and preconception care were beneficial were 50% more likely to use contraception postpartum than women with pregestational DM who did not share those beliefs, according to a cross-sectional, descriptive survey in the Journal of Obstetrics, Gynecologic & Neonatal Nursing.

“The United States has alarming rates of maternal/child morbidity and mortality,” said principal investigator Laura Britton, PhD, RN, a postdoctoral fellow at Columbia University School of Nursing in New York City. “As a nurse, I was interested in ways healthcare providers can better support women with pre-existing chronic medical conditions to have healthy pregnancies.”

Dr. Britton, who focuses on pregestational diabetes, said high blood glucose levels increase the risk of pregnancy complications, “particularly in the early weeks of pregnancy before many women know they have conceived.”

Contraception can help women align pregnancies to periods of better glycemic control, according to Dr. Britton. And in the postpartum period, “it is important for women to think ahead about if and when they want to get pregnant again, and to use contraception accordingly,” she said.

Methods
The goal of the survey was to learn more about the attitudes of women with diabetes toward planning and preparing for pregnancy in this unique time of life. Fifty-five women age 18 or older with pregestational Type 1 or Type 2 DM who were patients at three high-risk obstetric clinics in the Southeastern United States participated.

Investigator-developed items and psychometrically validated scales measured participants' perceptions and behaviors about contraception and preconception care during postpartum.

The authors dichotomized use of contraception in the postpartum period as procedure/prescription or nonprescription/no method. They then tested the hypothesis that perceptions are linked to contraceptive use. 

Findings
Within 6 to 8 weeks after birth, nearly half (49%, n = 27) of the participants had resumed sexual activity; however, almost all (95%, n = 52) did not desire another pregnancy in the upcoming 18 months. 

In addition, 56% percent (n = 31) of participants usedhighly effective procedural or prescription contraceptives, including sterilization procedures, intrauterine devices (IUDs) and combined hormonal contraceptives. This compared to 44% (n = 24) who used nonprescription/no method. 

Those who believed there was value in planning and preparing for pregnancies were significantly more likely to use procedure/prescription contraception than those who did not: adjusted odds ratio (aOR) = 1.52; 95% confidence interval (CI): 1.07 to 2.17.

Conclusions
“I was surprised, however, that only 17% of women with pregestational diabetes identified preconception glycemic control as part of how they planned for pregnancy,” Dr. Britton told Contemporary OB/GYN. 

The study did not address breastfeeding goals, mental health or women’s preference for contraceptive features. Nonetheless, the results underscore how healthcare providers “can support women with diabetes to understand how family planning and preconception glycemic control can help them achieve their personal pregnancy goals,” said Dr. Britton, who believes it is vital “to center the voices of those most affected.”

She is currently conducting a qualitative study of women with T2DM to understand how they want preconception care integrated into diabetes management.

Disclosures:

Dr. Britton reports no relevant financial disclosures.