Beyond glycemic control: contraceptive counseling for diabetic women of reproductive age
Awarded 2014
Complex Family Planning Fellowship Research
Luu Doan Ireland, MD, MPH
University of California, Los Angeles

Diabetes affects 2% of all pregnancies, and this number is only expected to rise. Diabetes can lead to major complications during pregnancy affecting both the mother and baby. The risk of these complications is higher in unplanned pregnancies. In the past, studies have shown that women with diabetes are less likely than women without diabetes to receive birth control counseling by their doctors. They have also shown that women with diabetes are less likely to be using any birth control methods. There is little understanding as to why birth control counseling and use is different between diabetic and non-diabetic women.
This study has two objectives. The first objective is to examine how much primary care doctors (PCPs) know about birth control, how they feel about counseling about birth control, and how often they actually prescribe birth control to their diabetic patients. The second objective is to compare how frequently diabetic women are using the most effective methods of birth control (intrauterine devices, contraceptive implants, or sterilization). Our goal was to see if this differs from how frequently non-diabetic women use these methods. In addition, we also collected information on how much diabetic women knew about birth control, their feelings about birth control, and how often these women were using any type of birth control.
We collected information by surveying doctors and patients who were members of the UCLA Health Care System. In the first part of the study, information was collected through a questionnaire that was distributed among 150 PCPs. In the second part of the study, questionnaires were mailed to 500 diabetic women of reproductive age (18 to 49 years) along with 500 non-diabetic women. Women who did not respond received a telephone call and email to encourage them to complete the survey.
Completed surveys were obtained from 151 PCPs. Ninety-five percent of PCPs agreed it was their responsibility to counsel their diabetic patients about birth control. Ninety-one percent of PCPs felt they should counsel patients on long acting reversible contraceptives (LARC), the most effective reversible methods. In reality, however, only 27% PCPs routinely do birth control counseling and only 24% discuss LARC with their diabetic patients.
There were 178 diabetic women and 175 non-diabetic women who participated in our survey. Seventeen percent of diabetic women, versus 22.0% of non-diabetic women, endorsed using LARC, although this finding did not reach statistical significance. Overall birth control use among diabetic women was 53.9% versus 66.9% of non-diabetic women. Finally, only 29.1% of diabetic women reported receiving contraceptive counseling in the last 12 months versus 46.3% of their non-diabetic counterparts.
In summary, primary care doctors are not providing the birth control counseling that diabetic women need. Diabetic women have a large unmet need for birth control counseling and contraceptive use. Interventions are needed to incorporate contraceptive counseling into routine care for diabetic women of reproductive age.