Androgenicity of progestins in hormonal contraceptives and the risk of gestational diabetes mellitus.
OBJECTIVE
There is some evidence that use of hormonal contraceptives, particularly the more androgenic formulations, can alter a woman's glucose tolerance. We examined the association between hormonal contraceptive use, categorized by the androgenicity of the progestin component, and risk of gestational diabetes mellitus (GDM) in a nested case-control study.


METHODS
Case (n = 356) and control (n = 368) subjects were selected from a multiethnic cohort of 14,235 women who delivered a singleton live birth between 1 January 1996 and 30 June 1998, who were screened for GDM at 24-28 gestational weeks, and who were members of Kaiser Permanente for at least 5 years before pregnancy. GDM was defined using the National Diabetes Data Group plasma glucose cutoffs. Information concerning hormonal contraceptive use during the 5 years before pregnancy was obtained from medical charts and some pharmacy data.


RESULTS
There was a suggestion that compared with no hormonal contraceptive use, use of a low-androgen hormonal contraceptive before pregnancy was associated with a slight reduction in risk of GDM (odds ratio 0.84 [95% CI 0.58-1.22]), whereas use of a high-androgen hormonal contraceptive was associated with a modest increase in GDM risk (1.43 [0.92-2.22]).


CONCLUSIONS
The effects of hormonal contraceptive use on GDM risk may vary by the androgenicity of the progestin component.
Hedderson
Monique M
MM
Division of Research, The Kaiser Permanente Medical Group, 2000 Broadway, Oakland, CA, USA. monique.m.hedderson@kp.org
Ferrara
Assiamira
A
Williams
Michelle A
MA
Holt
Victoria L
VL
Weiss
Noel S
NS
D000328:Adult; D000728:Androgens / Q000009:adverse effects*; D015992:Body Mass Index; D002140:California; D003278:Contraceptives, Oral, Hormonal / Q000009:adverse effects*; D016208:Databases, Factual; D016640:Diabetes, Gestational / Q000453:epidemiology* / Q000209:etiology; D004997:Ethinyl Estradiol / Q000009:adverse effects; D005006:Ethnicity; D005260:Female; D006801:Humans; D016017:Odds Ratio; D011247:Pregnancy; D044469:Racial Groups; D012307:Risk Factors
D000728:Androgens; D003278:Contraceptives, Oral, Hormonal; D004997:Ethinyl Estradiol