Contraception and the adolescent diabetic
Fennoy, I.
Health Education 20(6): 21-23; 31
1989
ISSN/ISBN: 0097-0050 PMID: 2516509 Document Number: 378055
Between 1984-1988, a pediatrician followed 11 15-19 year old diabetic adolescents (10 blacks and 1 Hispanic; 10 of whom were sexually active) living in New York City to determine the effect of counseling to use diaphragms and condoms. 3 births of live-born infants occurred during this 5-year period. This equaled a fertility rate of 300 compared with 53 for the US. In 1980, the pregnancy rate for sexually active black adolescents in New York state was 119.8. This high fertility rate confirmed the results of other studies that diabetic adolescents have higher pregnancy rates than the general population. These 3 patients had only a mean glycosylated hemoglobin of 13.5% indicating they were not in good control at conception. Another study found the mean glycosylated hemoglobin to be 9.5% among diabetics with considerable congenital abnormalities. Poor control of diabetes during adolescence is not unusual because adolescents have higher insulin requirements, increase in circulating growth hormone resulting in a diabetogenic effect, and adolescent developmental issues such as seeking identity and separation from parental authority. These factors make it difficult for adolescents to hold to a regimen of timed exercise, measured and timed meals, and timed insulin injections and to monitor and record their progress through many blood and/or urine tests. Pregnancy without normalization of blood glucose which rarely occurs among adolescents is very high risk. Thus pregnancy prevention is crucial for diabetic adolescents. The most effective contraception among adolescents is oral contraceptives, but they are contraindicated in diabetics. Research is needed to identify a safe and effective contraceptive for diabetic adolescents to reduce the risks pregnancy poses to them and their fetuses.