DIABETES-MELLITUS AND FERTILITY-CONTROL - CONTRACEPTION MANAGEMENT ISSUES

The need to prevent complications in the woman and fetus mandates that pregnancies in diabetic women always be planned and that safe and eff ective contraceptives be used at all times until it is determined that pregnancy is a safe and desired option. Pregnancy may aggravate compl ications of diabetes such as retinopathy and coronary artery disease. A pregnant diabetic woman is also more likely to experience such compl ications as hypertension, urinary tract infection, polyhydramnios, and cesarean section. Her fetus is at increased risk for congenital malfo rmations, prematurity, stillbirth, neonatal morbidity, and diabetes la ter in life. Good diabetic control must be maintained before and throu ghout the pregnancy to minimize the risk of these and other complicati ons. Until such time as good control is achieved and the woman desires pregnancy, a reliable method of contraception should be used. Most re cent research supports the use of barrier methods, low-dose monophasic or triphasic oral contraceptives, or progestin-only methods, at least for the short-term. Under some circumstances the intrauterine device may be an appropriate option. Long-term data regarding the use of thes e methods is lacking. The decision regarding which method of contracep tion is used should be made by the woman in consultation with her phys ician.