A Longitudinal Study of Lipids and Blood Pressure in Relation to Method of Contraception in Latino Women With Prior Gestational Diabetes Mellitus

Abstract

OBJECTIVE -To investigate the effect of nonhormonal contraception (NHC), combination oral contraception (COC), and depo-medroxyprogesterone acetate (DMPA) on lipids and blood pressure in women with recent gestational diabetes mellitus (GDM).RESEARCH DESIGN AND METHODS -An observational cohort of 972 nondiabetic, normotensive, postpartum Latino women who elected NHC (n ϭ 448), COC (n ϭ 430), or DMPA (n ϭ 94) were followed for at least one subsequent metabolic evaluation on the same contraception. Baseline and follow-up measures included glucose tolerance testing, fasting serum LDL and HDL cholesterol, triglycerides, and systolic (SBP) and diastolic (DBP) blood pressure. Patterns of changes in lipids and blood pressure were evaluated by comparing slopes over follow-up time using random coefficient linear mixed-effects models.RESULTS -Median follow-up times were 20, 12, and 11 months in the NHC, COC, and DMPA groups. The DMPA users gained significantly more weight (4.3 Ϯ 6.9 kg/year) compared with NHC and COC users (1.2 Ϯ 4.7 and 0.7 Ϯ 6.0 kg/year, respectively; P Ͻ 0.0001). Patterns of change in LDL cholesterol, triglycerides, and DBP were not significantly different among groups. HDL cholesterol change differed only between COC and NHC groups (adjusted slopes: 1.0 vs. Ϫ1.6 mg ⅐ dl Ϫ1 ⅐ year Ϫ1 , respectively; P Ͻ 0.0001). SBP change differed only between COC and DMPA groups (adjusted slopes: 1.3 vs. Ϫ1.7 mmHg/year, respectively; P ϭ 0.01).CONCLUSIONS -These results, derived predominantly from the initial 1-2 years of treatment in Hispanic women, demonstrate that DMPA was associated with greater weight gain than NHCs or COCs. Other differences in blood pressure and lipid effects were very small. These findings should be taken into account when advising women with recent GDM about their contraceptive choices. Diabetes Care 30:1952-1958, 2007W omen with prior gestational diabetes mellitus (GDM) have a high risk of developing type 2 diabetes during their reproductive years (1-4). Conception in the face of hyperglycemia in the diabetic range can double the risk of birth defects in offspring (5). Good glucose control before conception can greatly reduce this risk. These three facts make pregnancy planning and, thus, effective contraception, crucial to the health care in women with prior GDM. Equally important is choosing a contraceptive that is metabolically safe (6,7). Low-dose combination oral contraceptives (COCs) (4,8 -13) and depo-medroxyprogesterone acetate (DMPA) do not appear to increase the diabetes risk, with the exception of progestin-only methods in breastfeeding women (4,8) or DMPA in women with hypertriglyceridemia (8). Relatively little has been published regarding the impact of hormonal contraception on other metabolic syndrome components such as abnormal lipids and blood pressure. The present study examines whether COCs, DMPA, and nonhormonal contraceptives (NHCs) have different effects on serum lipids and blood pressure in a clinical cohort of mostly Hispanic women with prior GDM. RESEARCH DESIGN AND...

Metabolic and cardiovascular impact of oral contraceptives in polycystic ovary syndrome

“…In a literature review, Gupta (99) stated that there is no sufficient scientific evidence confirming weight gain as a result of the use of a low‐dose COC. In a cohort study involving 972 women, in which 448 used non‐hormonal contraceptive methods, 430 used a low‐dose COC and 94 used injectable medroxyprogesterone acetate, the COC users presented the lowest weight gain among the groups studied at the end of 1 year of observation (100).…”

How does gestational diabetes affect postpartum contraception in nondiabetic primiparous women?

“…Previously conducted studies have found that low-dose COCs and nonhormonal contraception are generally safe in the aftermath of GDM diagnosis and do not increase risk of developing DM [13,21-23]. A retrospective cohort study of 904 Latinas examined the effect of contraceptives on Type 2 diabetes risk in women with recent GDM [11].…”

“…Annual DM incidence rates were 19% in the DMPA group and 12% in the low-dose COCs group with an unadjusted hazard ratio of 1.58 (95% CI: 1.00–2.50; p=.05) for DMPA group versus the low-dose COCs group. In another prospective cohort study, 972 nondiabetic, normotensive, Latino women with a history of GDM received NHC ( n =448), low-dose COCs ( n =430), or DMPA ( n =94) [23]. They were subsequently followed-up and compared on multiple metabolic indictors including weight, fasting serum low-density lipoprotein (LDL) and high-density lipoprotein (HDL) cholesterol, triglycerides, systolic (SBP) and diastolic (DBP) blood pressures.…”

“…It is also plausible that physicians are familiar with research work that has suggested increased health risks with use of DMPA after a pregnancy complicated by GDM. [23]. …”

Contraception for the Woman with Diabetes

“…38,39 A recent observational study which compared DMPA with COC use in women with prior GDM for up to 9 years after delivery, found higher annual diabetes incidence rates in the DMPA users (19% vs 12%), but these were no longer apparent after correction for baseline cardiovascular and diabetes risk factors. 41 In conclusion, DMPA is not a fi rst choice method for diabetic or prediabetic women. 40 In a separate analysis of women with prior GDM, longitudinal use of DMPA and COC had very slight changes in lipid profi les or blood pressure, but DMPA use was associated with a signifi cant weight gain ( ∼ 4 kg/year) compared to non -hormonal and COC use ( ≤ 1 kg/year).…”