Safety of IUD contraception in women with diabetes – intrauterine device – Obstetrics and Gynecology, December 1994

Safety of IUD contraception in women with diabetes – intrauterine device – Obstetrics and Gynecology, December 1994 – Tips from Other Journals

Barbara Apgar

Because women with type II, or non-insulin-dependent, diabetes mellitus tend to be older, of higher parity, overweight and more likely to have hypertension than other sexually active women, the choice of contraceptive method is problematic. The intrauterine device (IUD) has many advantages in such patients, but its use has been discouraged in patients with any increased susceptibility to infection. Kjos and colleagues evaluated the safety and efficacy of IUD contraception in women with non-insulin-dependent diabetes.

A total of 176 women attending a family planning clinic in California were included in the study. All patients met standard criteria for non-insulin-dependent diabetes and requested IUD contraception after explanation of risks and benefits. In addition, patients met criteria for low risk of sexually transmitted disease and were screened for infection before IUD insertion. Antibiotic prophylaxis was not used at the time of insertion. Patients underwent follow-up evaluation at six and 12 weeks after insertion and then annually. During the five-year study, follow-up was completed in 117 of the 176 women. In general, patients were obese, and the mean age of the study group was 33.2 years.

Overall, 70 percent of the women continued IUD use for three years. The 30 women who discontinued use did so for personal reasons (10 patients), medical indication (11 patients), expulsion (five patients) or pregnancy (four patients). Nine of the medical reasons related to pelvic pain or bleeding, and eight of the 10 removals for personal reasons related to desire to conceive. Salpingitis did not develop in any of the patients.

The authors conclude that the IUD can be a safe and effective method of contraception for women with non-insulin-dependent diabetes. They stress the need for effective contraception in women with diabetes because of the high risk of morbidity for both mother and infant from unintended pregnancy. (Obstetrics and Gynecology, December 1994, vol. 84, p. 1006.)

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