Hormonal versus non-hormonal contraceptives in women with diabetes mellitus type 1 and 2

Abstract

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.

Associations of periconceptional oral contraceptive use with pregnancy complications and adverse birth outcomes

“… 14 reported that any past usage (no time limit) of hormonal contraceptives (including OCs, injections, patches, cervical rings and intrauterine devices) increased the risk of gestational diabetes compared with no contraception. Given our findings and the review of evidence that OC use may only minimally dysregulate glucose control, 43 an association between OC use and gestational diabetes seems unlikely for those discontinuing before conception.…”

“…Observations from our analyses of exposure characteristics are broadly in line with the literature: oestrogen-containing OCs are more often associated with adverse effects compared with progestin-only pills. 7 , 43 , 44 One of the more notable findings is the increased risk of SGA with periconceptional OC use containing low to moderate oestrogen levels, whereas the effect seems to be protective with high-oestrogen-dose OCs. There is no consensus on the issue as both positive 45 , 46 and negative 47 associations between oestrogen level and birthweight were previously described.…”

Associations of periconceptional oral contraceptive use with pregnancy complications and adverse birth outcomes

“… 14 reported that any past usage (no time limit) of hormonal contraceptives (including OCs, injections, patches, cervical rings and intrauterine devices) increased the risk of gestational diabetes compared with no contraception. Given our findings and the review of evidence that OC use may only minimally dysregulate glucose control, 43 an association between OC use and gestational diabetes seems unlikely for those discontinuing before conception.…”

“…Observations from our analyses of exposure characteristics are broadly in line with the literature: oestrogen-containing OCs are more often associated with adverse effects compared with progestin-only pills. 7 , 43 , 44 One of the more notable findings is the increased risk of SGA with periconceptional OC use containing low to moderate oestrogen levels, whereas the effect seems to be protective with high-oestrogen-dose OCs. There is no consensus on the issue as both positive 45 , 46 and negative 47 associations between oestrogen level and birthweight were previously described.…”

Diabetes and Birth Control: Part 1

“…However, high dose combined estrogen and progesterone pills, and those containing desogestrel, a particular type of progesterone, did cause a slight increase in blood sugar levels. Low dose versions of the pill without desogestrel did not cause a change in blood sugar levels, nor HbA1c [7].…”

Differential Effect of 2 Hormonal Contraceptives on the Relative Telomere Length of Youth With Type 1 Diabetes

“…Previously, the Wisconsin Epidemiologic study showed that COC does not increase the rate of retinopathy [ 45 ] or cardiovascular mortality [ 47 ]. However, studies evaluating the effect of currently available COC therapy on the risk of developing micro- and macrovascular complications in AYA with T1D currently with modern diabetes therapy are not available [ 48 ].…”

Associations of periconceptional oral contraceptive use with pregnancy complications and adverse birth outcomes

“… 14 reported that any past usage (no time limit) of hormonal contraceptives (including OCs, injections, patches, cervical rings and intrauterine devices) increased the risk of gestational diabetes compared with no contraception. Given our findings and the review of evidence that OC use may only minimally dysregulate glucose control, 43 an association between OC use and gestational diabetes seems unlikely for those discontinuing before conception.…”

“…Observations from our analyses of exposure characteristics are broadly in line with the literature: oestrogen-containing OCs are more often associated with adverse effects compared with progestin-only pills. 7 , 43 , 44 One of the more notable findings is the increased risk of SGA with periconceptional OC use containing low to moderate oestrogen levels, whereas the effect seems to be protective with high-oestrogen-dose OCs. There is no consensus on the issue as both positive 45 , 46 and negative 47 associations between oestrogen level and birthweight were previously described.…”

Diabetes and Birth Control: Part 1

“…However, high dose combined estrogen and progesterone pills, and those containing desogestrel, a particular type of progesterone, did cause a slight increase in blood sugar levels. Low dose versions of the pill without desogestrel did not cause a change in blood sugar levels, nor HbA1c [7].…”

Differential Effect of 2 Hormonal Contraceptives on the Relative Telomere Length of Youth With Type 1 Diabetes

“…Previously, the Wisconsin Epidemiologic study showed that COC does not increase the rate of retinopathy [ 45 ] or cardiovascular mortality [ 47 ]. However, studies evaluating the effect of currently available COC therapy on the risk of developing micro- and macrovascular complications in AYA with T1D currently with modern diabetes therapy are not available [ 48 ].…”

Associations of periconceptional oral contraceptive use with pregnancy complications and adverse birth outcomes

“… 14 reported that any past usage (no time limit) of hormonal contraceptives (including OCs, injections, patches, cervical rings and intrauterine devices) increased the risk of gestational diabetes compared with no contraception. Given our findings and the review of evidence that OC use may only minimally dysregulate glucose control, 43 an association between OC use and gestational diabetes seems unlikely for those discontinuing before conception.…”

“…Observations from our analyses of exposure characteristics are broadly in line with the literature: oestrogen-containing OCs are more often associated with adverse effects compared with progestin-only pills. 7 , 43 , 44 One of the more notable findings is the increased risk of SGA with periconceptional OC use containing low to moderate oestrogen levels, whereas the effect seems to be protective with high-oestrogen-dose OCs. There is no consensus on the issue as both positive 45 , 46 and negative 47 associations between oestrogen level and birthweight were previously described.…”

Diabetes and Birth Control: Part 1

“…However, high dose combined estrogen and progesterone pills, and those containing desogestrel, a particular type of progesterone, did cause a slight increase in blood sugar levels. Low dose versions of the pill without desogestrel did not cause a change in blood sugar levels, nor HbA1c [7].…”

Differential Effect of 2 Hormonal Contraceptives on the Relative Telomere Length of Youth With Type 1 Diabetes

“…Previously, the Wisconsin Epidemiologic study showed that COC does not increase the rate of retinopathy [ 45 ] or cardiovascular mortality [ 47 ]. However, studies evaluating the effect of currently available COC therapy on the risk of developing micro- and macrovascular complications in AYA with T1D currently with modern diabetes therapy are not available [ 48 ].…”