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Published online February 15, 2007
Diabetes Care 30:1062-1068, 2007
DOI: 10.2337/dc06-2227
© 2007 by the American Diabetes Association
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Clinical Care/Education/Nutrition
Original Article

Androgenicity of Progestins in Hormonal Contraceptives and the Risk of Gestational Diabetes Mellitus

Monique M. Hedderson, PHD1,2, Assiamira Ferrara, MD, PHD1,2, Michelle A. Williams, SCD2,3, Victoria L. Holt, PHD2,4 and Noel S. Weiss, MD, DRPH2,4

1 Division of Research, Kaiser Permanente Medical Care Program of Northern California, Oakland, California
2 Department of Epidemiology, University of Washington School of Public Health and Community Medicine, Seattle, Washington
3 Center for Perinatal Studies, Swedish Medical Center, Seattle, Washington
4 Fred Hutchinson Cancer Research Center, Seattle, Washington

Address correspondence and reprint requests to Monique Hedderson, PhD, Division of Research, The Kaiser Permanente Medical Group, 2000 Broadway, Oakland, CA. E-mail: monique.m.hedderson{at}kp.org

OBJECTIVE—There is some evidence that use of hormonal contraceptives, particularly the more androgenic formulations, can alter a woman's glucose tolerance. We examined the association between hormonal contraceptive use, categorized by the androgenicity of the progestin component, and risk of gestational diabetes mellitus (GDM) in a nested case-control study.

RESEARCH DESIGN AND METHODS—Case (n = 356) and control (n = 368) subjects were selected from a multiethnic cohort of 14,235 women who delivered a singleton live birth between 1 January 1996 and 30 June 1998, who were screened for GDM at 24–28 gestational weeks, and who were members of Kaiser Permanente for at least 5 years before pregnancy. GDM was defined using the National Diabetes Data Group plasma glucose cutoffs. Information concerning hormonal contraceptive use during the 5 years before pregnancy was obtained from medical charts and some pharmacy data.

RESULTS—There was a suggestion that compared with no hormonal contraceptive use, use of a low-androgen hormonal contraceptive before pregnancy was associated with a slight reduction in risk of GDM (odds ratio 0.84 [95% CI 0.58–1.22]), whereas use of a high-androgen hormonal contraceptive was associated with a modest increase in GDM risk (1.43 [0.92–2.22]).

CONCLUSIONS—The effects of hormonal contraceptive use on GDM risk may vary by the androgenicity of the progestin component.

Abbreviations: GCT, glucose challenge test • GDM, gestational diabetes mellitus • KPMCP, Kaiser Permanente Medical Care Program of Northern California • PCOS, polycystic ovary syndrome


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