Good contraceptive advice for diabetic patients is vital to ensure that pregnancies are planned and conception takes place when diabetic control is optimal. All methods of contraception are available to diabetic women; the combined oral contraceptive pill is suitable in the absence of macrovascular disease or microvascular disease especially proteinuria, while progestogen-only methods provide a range of options including highly reliable long term methods, such as Depoprovera and implantable methods such as Implanon.
There is no evidence of any clinically significant effect on diabetic control from either combined oestrogen-progestogen pills or progestogen-only methods, nor is there any influence on the progression of diabetic complications. In the case of women with a history of gestational diabetes, the use of combined pills does not influence the subsequent development of Type 2 diabetes, but there is at present some doubt regarding the use of progestogen-only pills during lactation in women with recent gestational diabetes in whom there may be an increase in the subsequent incidence of Type 2 diabetes.
Intrauterine methods of contraception are suitable for women in stable relationships who have had at least one pregnancy, and may be ideal for diabetic women in whom hormonal (oestrogen containing) methods are contraindicated for either diabetic specific conditions or those unrelated to diabetes including cardiovascular or cerebrovascular disorders, venous thrombosis, pulmonary embolism or liver disease. Barrier methods of contraception have no metabolic consequences but are often insufficiently reliable, particularly if diabetic control is poor, when pregnancy should be rigorously avoided.
Sterilisation may be considered the ideal option when the family is complete, but it should be borne in mind that both Implanon and the progestogen delivering intrauterine system Mirena, provide more reliable contraception than laparoscopic sterilisation and are of course both reversible should circumstances change.
The table showing the incidence and relative risk of congenital malformations in infants of diabetic mothers is adapted from Combs CA, et al. Clin Obstet Gynecol 1991;5:315-31. The photograph of a typically large baby born to a diabetic mother is from Chamberlain G, Morgan M. ABC of Antenatal Care, 4th ed. London: BMJ Publishing Group, 2002.
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