title: Provision of contraceptive services to women with diabetes mellitus.
abstract: BACKGROUND
  Women with diabetes mellitus who delay pregnancy until glycemic control is achieved experience lower rates of adverse pregnancy outcomes.
  
  
  OBJECTIVE
  To compare rates of provision of contraceptive services among women with diabetes mellitus and women without chronic medical conditions.
  
  
  METHODS
  A retrospective cohort study of 459,181 women aged 15-44 who had continuous membership and pharmacy benefits in a managed care organization in Northern California between January 2006 and June 2007. Rates of documented provision of contraceptive counseling, prescriptions, and services were compared between women with diabetes and women without chronic medical conditions.
  
  
  RESULTS
  Among 8,182 women with diabetes and 122,921 women without any chronic conditions, women with diabetes were less likely than women without a chronic condition to have documented receipt of any contraceptive counseling, prescriptions, or services (47.8% vs 62.0%, p < 0.001). After controlling for age and race, women with diabetes were more likely to have undergone tubal sterilization compared to women without a chronic condition (OR = 1.41, 95% CI 1.30-1.54), but less likely to have received highly effective, reversible methods of contraception such as intrauterine contraception (OR = 0.68, 95% CI 0.61-0.75). In addition, more women with diabetes had undergone hysterectomy, which is rarely performed solely for contraceptive purposes.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Departments of Medicine, Epidemiology, Obstetrics, Gynecology, and Reproductive Sciences, University of Pittsburgh, Center for Research on Health Care, 230 McKee Place, Suite 600, Pittsburgh, PA 15213, USA. Schwarzeb@upmc.edu
authors.forename: Eleanor Bimla
authors.initials: EB
authors.lastname: Schwarz
authors.forename: Debbie
authors.initials: D
authors.lastname: Postlethwaite
authors.forename: Yun-Yi
authors.initials: YY
authors.lastname: Hung
authors.forename: Eric
authors.initials: E
authors.lastname: Lantzman
authors.forename: Mary Anne
authors.initials: MA
authors.lastname: Armstrong
authors.forename: Michael A
authors.initials: MA
authors.lastname: Horberg
mesh_terms: D000293:Adolescent; D000328:Adult; D015331:Cohort Studies; D003267:Contraception / Q000379:methods*; D048909:Diabetes Complications / Q000453:epidemiology* / Q000517:prevention & control*; D003920:Diabetes Mellitus / Q000453:epidemiology*; D005260:Female; D006801:Humans; D011247:Pregnancy; D011248:Pregnancy Complications / Q000453:epidemiology / Q000628:therapy; D011254:Pregnancy in Diabetics / Q000453:epidemiology* / Q000628:therapy*; D012189:Retrospective Studies; D055815:Young Adult