Contraceptive Use Among Women with Prediabetes and Diabetes in a US National Sample
Contraceptive Use Among Women with Prediabetes and Diabetes in a US National Sample
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DOI：
10.1111/jmwh.12936
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发表时间：
2019-01-01
影响因子：
2.7
通讯作者：
Bryant, Amy G.
中科院分区：
文献类型：
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作者：
Britton, Laura E.;Hussey, Jon M.;Bryant, Amy G.
虽然血糖升高与不良的孕产妇和胎儿健康结局有关，但有证据表明，糖尿病妇女可能没有得到全面的生殖保健，包括计划生育和怀孕前保健。使用基于人群的样本，我们评估了避孕药使用和生物标记物识别的糖尿病之间的关系。方法这项横断面研究使用了2007年至2009年全国代表性的全国青少年至成人健康纵向研究(ADD Health)中5548名女性的数据。女性年龄在24岁到32岁之间，与男性性行为活跃，没有怀孕。血红蛋白A1C从血液样本中识别出糖尿病前期和糖尿病。主要结果是过去一年中使用的最有效的避孕措施：更有效(绝育、宫内节育器、植入物、联合激素方法或注射)，较不有效(避孕套、避孕套、杀精剂、自然计划生育或停用)，或无效。多项回归模型根据种族和民族、教育、保险、医疗保健机会和体重指数进行了调整。结果糖尿病患者中，37.6%的患者避孕效果较好，33.6%的患者避孕效果较差，28.8%的患者无避孕效果。与血糖正常的女性相比，糖尿病女性不使用避孕措施而不是使用更有效的避孕措施的几率更高(调整后的优势比[AOR]，1.90；95%CI，1.25-2.87)。与确诊的糖尿病妇女相比，未确诊的糖尿病妇女使用效果较差的避孕措施而不是更有效的避孕措施的几率更大(AOR 3.39；95%CI，1.44-7.96)。在糖尿病前期和血糖正常的女性中，避孕药的使用没有区别。讨论糖尿病妇女常用的避孕方法效果较差。助产士和其他妇女保健提供者可以通过提供怀孕前护理和计划生育来支持糖尿病妇女实现怀孕目标。
Introduction Although elevated blood glucose is associated with adverse maternal and fetal health outcomes, evidence suggests that women with diabetes may not be receiving comprehensive reproductive health care, including family planning and preconception care. Using a population-based sample, we evaluated the relationship between contraceptive use and biomarker-identified diabetes. Methods This cross-sectional study used data from 5548 women in the nationally representative National Longitudinal Study of Adolescent to Adult Health (Add Health) from 2007 to 2009. Women were aged 24 to 32 years, sexually active with men, and not pregnant. Hemoglobin A1C identified prediabetes and diabetes from blood specimens. The primary outcome was most effective contraception used in the past year: more effective (sterilization, intrauterine device, implant, combined hormonal methods, or injectable), less effective (condoms, diaphragms, spermicides, natural family planning, or withdrawal), or none. Multinomial regression models were adjusted for race and ethnicity, education, insurance, health care access, and body mass index. Results Of the women with diabetes, 37.6% used more effective contraception, 33.6% less effective contraception, and 28.8% none. Women with diabetes had higher odds of using no contraception, rather than more effective contraception, than women with normoglycemia (adjusted odds ratio [aOR], 1.90; 95% CI, 1.25-2.87). Women with diabetes who were undiagnosed had greater odds of using less effective contraception, rather than more effective contraception, compared with those who were diagnosed (aOR 3.39; 95% CI, 1.44-7.96). Contraceptive use did not differ between women with prediabetes and normoglycemia. Discussion Less effective contraceptive methods were commonly used by women with diabetes. Midwives and other women's health care providers can support women with diabetes to reach their pregnancy goals by providing preconception care and family planning.