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 Intrauterine devices (IUDs) and contraceptive implants that are
placed under the skin, both of which are highly effective, were
linked with the lowest risk of blood clots in these higher-risk
women.
Hormonal contraceptives boost women's risk for clots, which can lead
to heart attack and strokes. That's a particular problem for women
with diabetes, who are at increased risk for blood clots to begin
with.
While many contraceptives use a combination of two hormones,
estrogen and progestin, the World Health Organization advises that
women at increased risk of a blockage caused by a blood clot - known
as a thromboembolism - use contraceptives containing only progestin.
Women with advanced diabetes and those with diabetes and other risk
factors for heart disease are in that high-risk group, according to
the authors of the new report.
Dr. Eleanor Bimla Schwarz of the University of California, Davis in
Sacramento and her colleagues analyzed data on 146,080 U.S. women
with diabetes, ages 14 to 44.
As reported in Diabetes Care, the majority were not using hormonal
contraceptive pills or devices during the study. Only 28 percent
were using hormonal contraception, and most of those were taking
estrogen-containing pills. Only 4 percent were using progestin-only
contraception.
During the study, the researchers identified 3,012 so-called
thrombotic events.
Blood clots were most common among women using estrogen-containing
contraceptive patches, with 16 events each year for every 1,000
women.
Progestin injections were tied to 12.5 blood clots per 1,000 women
each year, the researchers found.
Rates of blood clots were lowest for women using progestin-only IUDs
and under-the-skin (subdermal) contraceptives. There were an average
of only 3 events each year for every 1,000 women using the IUDs and
less than 1 event per year among women using the subdermal implant.
"In some ways, that’s a convenient finding, because . . . IUDs and
implants are the most effective form of contraceptive," Schwarz told
Reuters Health.
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She noted, however, that the best form of birth control is the one
women want to use.
Schwarz also emphasized that the absolute risk of thromboembolism
with contraception is low, even for women with diabetes.
Dr. Natalie Whaley, an obstetrician/gynecologist and family planning
provider at the University of Rochester Medical Center in New York,
said the findings confirm earlier research about women's risk for
thromboembolism with diabetes.
"For women with chronic medical conditions where you can have poor
obstetric outcomes including risk for fetal anomalies, it's even
more important that women are getting highly effective
contraception," said Whaley, who wasn't involved with the new study.
She told Reuters Health that women with diabetes need to time their
pregnancies for a number of reasons, including the fact that having
good control of their blood sugar will reduce the risk of
miscarriage and fetal anomalies.
The new study had some limitations. The researchers did not have
data on the women's family history of blood clots, and their
information on whether women smoked or were obese may have been
incomplete. Also, most women were enrolled in commercial health
plans, and the results may not be applicable to uninsured women or
those in publicly funded insurance programs.
SOURCE: http://bit.ly/2gZqgbX Diabetes Care, online November 29,
2016.
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