Preconception Counseling and Birth Control Options
Being your own advocate is imperative for women with diabetes, especially when it comes to gynecologic care. As soon as a young woman is ready to become sexually active, she needs to talk with her doctor about contraceptive options. This conversation should continue through the time when she is ready to stop taking contraceptives and prepare for a family.
I started taking the pill in high school and stayed on it until my husband and I began to talk about becoming parents. I couldn't wait to stop taking the pill, but when I told my endocrinologist, he said I should continue until my A1C was under 7%. He explained that tight blood sugar control is the best way to ensure a healthy pregnancy and that it is especially important during the first few weeks of gestation. So I dutifully began my work: charting my blood sugars, eating well, and keeping a food diary. Three months later, my doctor gave me the green light to go off the pill. The hard work and careful planning have helped me have three healthy and complication-free pregnancies.
Research shows that tight glycemic control before and during pregnancy reduces rates of congenital malformations. Most often, preconception counseling falls to the woman's OB/GYN. However, the United States Centers for Disease Control and Prevention (CDC) has recently recommended that "preconception care be considered an essential part of routine primary and preventive care for women of reproductive age."
Unfortunately, studies have also shown that "clinicians provided contraceptive or preconception counseling less frequently to women with diabetes than women without any chronic medical conditions. These findings are supported by previous work that has shown that, nationally, diabetic women receive less contraceptive counseling and are less likely to use contraception than nondiabetic women." These results highlight the need for women to act as their own advocates when it comes to gynecological care and preconception planning.
As a 40-year-old working mother of three sons, I'm finally ready to revisit my best options for contraception. However, I've lived with type 1 diabetes for 26 years and am not sure that the pill is still my best option. The last time I thought about contraception was seven years ago, when I was getting prepped for my second Cesarean section, and my OB/GYN asked me if I wanted to have my tubes tied "while she was in there." At the cusp of becoming a mother for the second time, I was stunned by her suggestion and didn't want to think about saying no to motherhood for good. If I'd followed her advice, we would not be a family of five.
The study mentioned above also shows that my experience is not unique. It states, "Women with diabetes were less likely to receive highly effective reversible contraception and more likely to undergo sterilization procedures. Increasing the use of highly effective reversible contraceptives may help diabetic women who want to retain their fertility to delay pregnancy until glycemic control is achieved."
Lead author Dr. Eleanor B. Schwarz says that the higher incidences of sterilization probably result from a combination of factors. "Time to discuss all the issues women with diabetes need to juggle can be limited, and women with diabetes may be worn out visiting their PCP and endocrinologist and not feel like getting all the way to a gynecologist. Gynecologists get paid more to do a surgical procedure than to place an IUD. Young women may be embarrassed to ask about birth control, older women may be embarrassed that they still don't know all they might need to about birth control...and then, despite my ongoing efforts to educate my colleagues, many are less up-to-date on alternatives to ‘the pill' than they should be (e.g., IUDs and implanon)." She adds, "Women who learn about IUDs (Paragard or Mirena) and implanon on their own and go ask their doctor to help them are likely to be in much better shape. All are safe for women with diabetes and all are entirely reversible."
Don't let embarrassment keep you from taking charge of your sexual health. Preconception counseling and a variety of birth control options are available to all women.
E.B. Schwarz, D. Postlethwaite, Y. Hung, E. Lantzman, M. A. Armstrong, and M.A. Horberg, Provision of Contraceptive Services to Women with Diabetes Mellitus, J Gen Intern Med DOI: 10.1007/s11606-011-1875-6, Society of General Internal Medicine 2011Click Here To View Or Post Comments