patterns of contraception in iddm in the uk
DESCRIPTION
Patterns of contraception in IDDM in the UK. RA Lawrenson, GM Leydon, TJ Williams, RB Newson, MD Feher* Department of Epidemiology and Public Health, *Department of Clinical Pharmacology Imperial College School of Medicine. Contraception in women with IDDM. No UK studies - PowerPoint PPT PresentationTRANSCRIPT
![Page 1: Patterns of contraception in IDDM in the UK](https://reader035.vdocument.in/reader035/viewer/2022062501/5681675b550346895ddc216f/html5/thumbnails/1.jpg)
Patterns of contraception in IDDM in the UK
RA Lawrenson, GM Leydon, TJ Williams, RB Newson, MD Feher*
Department of Epidemiology and Public Health,
*Department of Clinical PharmacologyImperial College School of Medicine
![Page 2: Patterns of contraception in IDDM in the UK](https://reader035.vdocument.in/reader035/viewer/2022062501/5681675b550346895ddc216f/html5/thumbnails/2.jpg)
Contraception in women with IDDM
• No UK studies• No comparative studies• Important to prevent unwanted
pregnancies• Risks of contraceptive use may have
more serious consequencies in women with IDDM
![Page 3: Patterns of contraception in IDDM in the UK](https://reader035.vdocument.in/reader035/viewer/2022062501/5681675b550346895ddc216f/html5/thumbnails/3.jpg)
Oral contraceptive use
• Commonest method used in the UK• Combined oral contraceptives with high doses of
oestrogen may increase risk of cardiovascular disease and increase requirement for insulin
• CHD risk may be due to changes in lipids. New generation oral contarceptives (gestodene and desogestrel) seem to increase HDL and decrease LDL
![Page 4: Patterns of contraception in IDDM in the UK](https://reader035.vdocument.in/reader035/viewer/2022062501/5681675b550346895ddc216f/html5/thumbnails/4.jpg)
Oral contraceptive use (POPs)
• Progestogen only pills have less risk of cardiovascular problems.
• However they are less effective with 3 pregnancies per 100 women years of use
• Also have the problem of irregular bleeding
![Page 5: Patterns of contraception in IDDM in the UK](https://reader035.vdocument.in/reader035/viewer/2022062501/5681675b550346895ddc216f/html5/thumbnails/5.jpg)
Percentage of women by age using combined oral contraceptives for contraception
0
10
20
30
40
50
60
15-19
20-24
25-29
30-34
35-39
40-44
45-49
No diabIDDM
![Page 6: Patterns of contraception in IDDM in the UK](https://reader035.vdocument.in/reader035/viewer/2022062501/5681675b550346895ddc216f/html5/thumbnails/6.jpg)
Percentage of women by age using third generation combined oral contraceptives
05
101520253035
15-19
20-24
25-29
30-34
35-39
40-44
45-49
No diabIDDM
![Page 7: Patterns of contraception in IDDM in the UK](https://reader035.vdocument.in/reader035/viewer/2022062501/5681675b550346895ddc216f/html5/thumbnails/7.jpg)
Percentage of women by age using second generation combined oral contraceptives
0
5
10
15
20
25
15-19
20-24
25-29
30-34
35-39
40-44
45-49
No diabIDDM
![Page 8: Patterns of contraception in IDDM in the UK](https://reader035.vdocument.in/reader035/viewer/2022062501/5681675b550346895ddc216f/html5/thumbnails/8.jpg)
Preferential prescribing of third generation oral contraceptives ?
• Proportion of women with IDDM using a third generation oral contraceptive was 60% compared with 58% in women with no diabetes - OR 1.06 which was not statistically significant.
![Page 9: Patterns of contraception in IDDM in the UK](https://reader035.vdocument.in/reader035/viewer/2022062501/5681675b550346895ddc216f/html5/thumbnails/9.jpg)
Percentage of women by age using oral progestogen preparations for contraception
02468
10121416
15-19
20-24
25-29
30-34
35-39
40-44
45-49
No diabIDDM
![Page 10: Patterns of contraception in IDDM in the UK](https://reader035.vdocument.in/reader035/viewer/2022062501/5681675b550346895ddc216f/html5/thumbnails/10.jpg)
Percentage of women by age using injectable progestogen preparations for contraception
00.5
11.5
22.5
33.5
4
15-19
20-24
25-29
30-34
35-39
40-44
45-49
No diabIDDM
![Page 11: Patterns of contraception in IDDM in the UK](https://reader035.vdocument.in/reader035/viewer/2022062501/5681675b550346895ddc216f/html5/thumbnails/11.jpg)
Percentage of women by age using diannette progestogen preparations for contraception
0
0.5
1
1.5
2
2.5
15-19
20-24
25-29
30-34
35-39
40-44
45-49
No diabIDDM
![Page 12: Patterns of contraception in IDDM in the UK](https://reader035.vdocument.in/reader035/viewer/2022062501/5681675b550346895ddc216f/html5/thumbnails/12.jpg)
Comparison of different hormonal contraception usage in women with IDDM
and women without diabetes in 1994
IDDM No diabetes Crude OR Adjusted OR
All hormonalcontraception
238(25 .4%)
3196(31.96)
0.72(0.62,0.84)
0.74(0.63,0.88)
COC 162(17.3)
2823(28.2)
0.53(0.45,0.63)
0.52(0.43,0.63)
POP 81(8.6)
393(3.9)
2.31(1.80,2.96)
2.11(1.64,2.71)
Dianette 0 129(1.3)
Injectables 12(1.3)
159(1.6)
0.8(0.44,1.45)
0.85(0.47,1.56)
![Page 13: Patterns of contraception in IDDM in the UK](https://reader035.vdocument.in/reader035/viewer/2022062501/5681675b550346895ddc216f/html5/thumbnails/13.jpg)
Summary of use of oral contraceptives in women with IDDM
• Women with IDDM are less likely to be prescribed an oral contraceptive
• If they are prescribed an oral contraceptive it is most likely to be a combined oral contraceptive
• Women with IDDM are twice as likely to be prescribed a POP
• There is no evidence of preferential prescribing of third generation COCs to women with IDDM in 1994
![Page 14: Patterns of contraception in IDDM in the UK](https://reader035.vdocument.in/reader035/viewer/2022062501/5681675b550346895ddc216f/html5/thumbnails/14.jpg)
IUCD
• IUCD use has been associted with increased risk of pelvic inflammatory disease
• One series in 30 women with diabetes resulted in 11 pregnancies in the first year (contradicted by other studies)
![Page 15: Patterns of contraception in IDDM in the UK](https://reader035.vdocument.in/reader035/viewer/2022062501/5681675b550346895ddc216f/html5/thumbnails/15.jpg)
Percentage of women by age using an intra uterine device for contraception
01234567
15-19
20-24
25-29
30-34
35-39
40-44
45-49
No diabIDDM
![Page 16: Patterns of contraception in IDDM in the UK](https://reader035.vdocument.in/reader035/viewer/2022062501/5681675b550346895ddc216f/html5/thumbnails/16.jpg)
IUCD summary
• 2.9% use in women with IDDM and 2.2% in those with no diabetes - adjusted OR 1.21 (0.80,1.82)
• No evidence that it is being avoided as a method in women with IDDM
![Page 17: Patterns of contraception in IDDM in the UK](https://reader035.vdocument.in/reader035/viewer/2022062501/5681675b550346895ddc216f/html5/thumbnails/17.jpg)
Barrier methods
• Under reporting on GP records• Diaphragm or cap 0.8% in women with
IDDM and 0.4 in comparison groupadjusted OR 1.64 (0.72,3.74)
• Condom use 0.3% in IDDM and 0.9% in othersadjusted OR 0.32 (0.10,1.02)
![Page 18: Patterns of contraception in IDDM in the UK](https://reader035.vdocument.in/reader035/viewer/2022062501/5681675b550346895ddc216f/html5/thumbnails/18.jpg)
Percentage of women by age with a prescription for condoms
00.20.40.60.8
11.21.41.61.8
15-19
20-24
25-29
30-34
35-39
40-44
45-49
No diabIDDM
![Page 19: Patterns of contraception in IDDM in the UK](https://reader035.vdocument.in/reader035/viewer/2022062501/5681675b550346895ddc216f/html5/thumbnails/19.jpg)
Surgery
• May be under recording of hysterectomy and sterilisation
• No information of vasectomy in partners• In high risk women with IDDM pregnancy
maybe such a risk that sterilisation is recommended (Steel)
![Page 20: Patterns of contraception in IDDM in the UK](https://reader035.vdocument.in/reader035/viewer/2022062501/5681675b550346895ddc216f/html5/thumbnails/20.jpg)
Proportion of women by age with a record of sterilisation prior to 1995
02468
101214
15-19
20-24
25-29
30-34
35-39
40-44
45-49
No diabIDDM
![Page 21: Patterns of contraception in IDDM in the UK](https://reader035.vdocument.in/reader035/viewer/2022062501/5681675b550346895ddc216f/html5/thumbnails/21.jpg)
Proportion of women by age with a record of a hysterectomy prior to 1995
02468
10121416
15-19
20-24
25-29
30-34
35-39
40-44
45-49
No diabIDDM
![Page 22: Patterns of contraception in IDDM in the UK](https://reader035.vdocument.in/reader035/viewer/2022062501/5681675b550346895ddc216f/html5/thumbnails/22.jpg)
Use of sterilisation
• 5.8% women with IDDM had a record of sterilisation compared with 3.7% of others. adjusted OR 1.32 (0.98,1.79)
• Hysterectomy rate was 3.8% vs 3.7% which after adjustment gave an OR of 0.91 (0.63,1.30)
• Some evidence of an increased use of sterilisation in women with IDDM
![Page 23: Patterns of contraception in IDDM in the UK](https://reader035.vdocument.in/reader035/viewer/2022062501/5681675b550346895ddc216f/html5/thumbnails/23.jpg)
Confounding variable
• Age• Sexual activity• Smoking• Obesity• Hypertension
![Page 24: Patterns of contraception in IDDM in the UK](https://reader035.vdocument.in/reader035/viewer/2022062501/5681675b550346895ddc216f/html5/thumbnails/24.jpg)
Age
![Page 25: Patterns of contraception in IDDM in the UK](https://reader035.vdocument.in/reader035/viewer/2022062501/5681675b550346895ddc216f/html5/thumbnails/25.jpg)
Sexual activity
![Page 26: Patterns of contraception in IDDM in the UK](https://reader035.vdocument.in/reader035/viewer/2022062501/5681675b550346895ddc216f/html5/thumbnails/26.jpg)
Proportion of women by age in whom there is a record of a claim from the GP for
contraceptive services in 1994
05
1015202530354045
15-19
20-24
25-29
30-34
35-39
40-44
45-49
No diabIDDM
![Page 27: Patterns of contraception in IDDM in the UK](https://reader035.vdocument.in/reader035/viewer/2022062501/5681675b550346895ddc216f/html5/thumbnails/27.jpg)
Evidence of a cervical smear in 1992, 1993 or 1994 - women with IDDM and women
with no diabetes
01020304050607080
15-19
20-24
25-29
30-34
35-39
40-44
45-49
No diabIDDM
![Page 28: Patterns of contraception in IDDM in the UK](https://reader035.vdocument.in/reader035/viewer/2022062501/5681675b550346895ddc216f/html5/thumbnails/28.jpg)
Smoking
![Page 29: Patterns of contraception in IDDM in the UK](https://reader035.vdocument.in/reader035/viewer/2022062501/5681675b550346895ddc216f/html5/thumbnails/29.jpg)
Proportion of women recorded as being current smokers in 1994 by age
0
5
10
15
20
25
15-19
20-24
25-29
30-34
35-39
40-44
45-49
AGE
% No diabetesIDDM
![Page 30: Patterns of contraception in IDDM in the UK](https://reader035.vdocument.in/reader035/viewer/2022062501/5681675b550346895ddc216f/html5/thumbnails/30.jpg)
Proportion of women recorded as being ex-smokers in 1994 by age
02468
101214161820
15-19
20-24
25-29
30-34
35-39
40-44
45-49
AGE
% No diabetesIDDM
![Page 31: Patterns of contraception in IDDM in the UK](https://reader035.vdocument.in/reader035/viewer/2022062501/5681675b550346895ddc216f/html5/thumbnails/31.jpg)
Smoking
• 20.4% of women with IDDM and 20.2% without were recorded as being current smokers
• More emphasis should be put on this risk factor for women with IDDM
![Page 32: Patterns of contraception in IDDM in the UK](https://reader035.vdocument.in/reader035/viewer/2022062501/5681675b550346895ddc216f/html5/thumbnails/32.jpg)
Obesity
• Obese women have an increased risk of CVD and should therefore be less likely to be prescribed combined oral contraceptives
![Page 33: Patterns of contraception in IDDM in the UK](https://reader035.vdocument.in/reader035/viewer/2022062501/5681675b550346895ddc216f/html5/thumbnails/33.jpg)
Proportion of women in each BMI category(1 = <20, 2 = 20-25, 3 = 25-30, 4 = 30-35, 5 = 35+)
0
10
20
30
40
50
60
1 2 3 4 5
BMI
% No diabetesIDDM
![Page 34: Patterns of contraception in IDDM in the UK](https://reader035.vdocument.in/reader035/viewer/2022062501/5681675b550346895ddc216f/html5/thumbnails/34.jpg)
Obesity
• The mean BMI of women with IDDM was 26.2 (95% CI 25.4,26.9)
• Mean BMI in women without diabetes was 24.1 (24.0,24.2)
• Differences in the two groups suggest that this should be adjusted for in the analysis
![Page 35: Patterns of contraception in IDDM in the UK](https://reader035.vdocument.in/reader035/viewer/2022062501/5681675b550346895ddc216f/html5/thumbnails/35.jpg)
Hypertension
• Record of a diagnosis of hypertension linked to a prescription in 1994
• 17/938 (1.8%) women with IDDM and 54/10,000 (0.5%) women without diabetes were being treated for hyertension
• Not statistically different
![Page 36: Patterns of contraception in IDDM in the UK](https://reader035.vdocument.in/reader035/viewer/2022062501/5681675b550346895ddc216f/html5/thumbnails/36.jpg)
Pregnancy
• Increased risk to mother with IDDM• Increased risk of abnormality in the baby
![Page 37: Patterns of contraception in IDDM in the UK](https://reader035.vdocument.in/reader035/viewer/2022062501/5681675b550346895ddc216f/html5/thumbnails/37.jpg)
Risk of pregnancy by age group IDDM vs no diabetes in 1994
Overall RR 0.77 (.59,1.02)
0
1
2
3
4
5
6
15 20 25 30 35 40
UpperPointLower
![Page 38: Patterns of contraception in IDDM in the UK](https://reader035.vdocument.in/reader035/viewer/2022062501/5681675b550346895ddc216f/html5/thumbnails/38.jpg)
Proportion of women with a record of a pregnancy in 1994 by age
02468
10121416
15-19 25-29 35-39 45-49
AGE
% No diabetesIDDM
![Page 39: Patterns of contraception in IDDM in the UK](https://reader035.vdocument.in/reader035/viewer/2022062501/5681675b550346895ddc216f/html5/thumbnails/39.jpg)
Use of oral contraceptives in women with IDDM from different countries
OC0
10
20
30
40
50
OC
UKFranceDenmarkGermanyNZ
![Page 40: Patterns of contraception in IDDM in the UK](https://reader035.vdocument.in/reader035/viewer/2022062501/5681675b550346895ddc216f/html5/thumbnails/40.jpg)
Use of progestogen only pills in women with IDDM from different countries
POP0
5
10
15
20
POP
UKFranceDenmarkGermanyNZ
![Page 41: Patterns of contraception in IDDM in the UK](https://reader035.vdocument.in/reader035/viewer/2022062501/5681675b550346895ddc216f/html5/thumbnails/41.jpg)
Use of IUCD in women with IDDM from different countries
IUCD0
5
10
15
20
25
30
35
IUCD
UKFranceDenmarkGermanyNZ
![Page 42: Patterns of contraception in IDDM in the UK](https://reader035.vdocument.in/reader035/viewer/2022062501/5681675b550346895ddc216f/html5/thumbnails/42.jpg)
Use of female sterilisation in women with IDDM from different countries
Sterile0
5
10
15
20
25
Sterile
UKFranceDenmarkGermanyNZ
![Page 43: Patterns of contraception in IDDM in the UK](https://reader035.vdocument.in/reader035/viewer/2022062501/5681675b550346895ddc216f/html5/thumbnails/43.jpg)
Use of vasectomy in the partners of women with IDDM from different countries
Vasect0
2
4
6
8
10
12
Vasect
UKFranceDenmarkGermanyNZ
![Page 44: Patterns of contraception in IDDM in the UK](https://reader035.vdocument.in/reader035/viewer/2022062501/5681675b550346895ddc216f/html5/thumbnails/44.jpg)
Use of barrier methods of contraception in women with IDDM from different countries
Barrier0
5
10
15
20
25
Barrier
UKFranceDenmarkGermanyNZ
![Page 45: Patterns of contraception in IDDM in the UK](https://reader035.vdocument.in/reader035/viewer/2022062501/5681675b550346895ddc216f/html5/thumbnails/45.jpg)
Conclusions