OBJECTIVE: To evaluate the impact of diabetes on provision of contraceptive counseling.
METHODS: We compared counseling provided to diabetic and nondiabetic women on 40,304 visits made to U.S. ambulatory practices by nonpregnant women, 14–44 years of age, included in the National Ambulatory Medical Care Survey and National Hospital Ambulatory Medical Care Survey, 1997–2000. Logistic regression, adjusting for age, race, ethnicity, insurance status, and provider characteristics was used to estimate the relationship between provision of contraceptive counseling and diabetes.
RESULTS: Visits made by diabetic women of reproductive age were significantly less likely to include contraceptive counseling than visits made by nondiabetic women of reproductive age (odds ratio [OR] 0.42, 95% confidence interval [CI] 0.21–0.81). Visits made by diabetic women under 25 years of age were less likely to include contraceptive counseling than visits made by older diabetic women (OR 0.17, 95% CI 0.06–0.54). Overall, only 4% of visits made by diabetic women documented contraceptive counseling. When family planning was the primary reason for a visit (OR 34.4, 95% CI 20.8–56.9) or women visited a gynecologist (OR 24.3, 95% CI 16.7–35.2), women were significantly more likely to receive contraceptive counseling. However, diabetic women made only 0.3% of all visits to gynecologists.
CONCLUSION: Ambulatory physicians in the United States rarely provide contraceptive counseling to diabetic women. This may contribute to adverse birth outcomes for some diabetic mothers who conceive before optimal glucose control is obtained.
LEVEL OF EVIDENCE: II-3