Contraception before and after GDM

Abstract

Increasing parity is a risk factor for GDM. For women with a history of GDM, a subsequent pregnancy increases 3-fold the risk of progressing to type 2 diabetes. Therefore, the proper use of contraception to prevent unwanted pregnancies in young women both before and after a pregnancy complicated by GDM is essential. There are several forms of hormonal contraceptives available that offer effective contraception. Some forms of hormonal contraceptives also have unwanted metabolic side effects, and the risks associated with the use of individual contraceptives should be weighed against their benefits. Women with a history of GDM may be particularly vulnerable to metabolic side effects. This chapter summarizes hormonal contraceptive use before pregnancy and its effect on risk of GDM and reviews family planning methods in women after a GDM pregnancy, including postpartum lactational amenorrhea, barrier methods, combination oral contraceptives, progesterone-only contraception, and intrauterine devices. We will review the risks and benefits of each method, as the effect of the method in preventing unintended pregnancies may outweigh any adverse impacts on glucose tolerance and lipid metabolism. © 2010 Springer-Verlag London Limited.