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A Longitudinal Study of Lipids and Blood Pressure in Relation to Method of Contraception in Latino Women With Prior Gestational Diabetes Mellitus

¹ Department of Preventive Medicine, University of Southern California, Los Angeles, California
² Department of Medicine, University of Southern California, Los Angeles, California
³ Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, California

Address correspondence and reprint requests to Anny H. Xiang, PhD, Keck School of Medicine, University of Southern California, Preventive Medicine, 1540 Alcazar St., CHP-222, Los Angeles, CA 90033. E-mail: xiang{at}usc.edu

OBJECTIVE—To investigate the effect of nonhormonal contraception (NHC), combination oral contraception (COC), and depo-medroxyprogesterone acetate (DMPA) on lipids and blood pressure in women with recent gestational diabetes mellitus (GDM).

RESEARCH DESIGN AND METHODS—An observational cohort of 972 nondiabetic, normotensive, postpartum Latino women who elected NHC (n = 448), COC (n = 430), or DMPA (n = 94) were followed for at least one subsequent metabolic evaluation on the same contraception. Baseline and follow-up measures included glucose tolerance testing, fasting serum LDL and HDL cholesterol, triglycerides, and systolic (SBP) and diastolic (DBP) blood pressure. Patterns of changes in lipids and blood pressure were evaluated by comparing slopes over follow-up time using random coefficient linear mixed-effects models.

RESULTS—Median follow-up times were 20, 12, and 11 months in the NHC, COC, and DMPA groups. The DMPA users gained significantly more weight (4.3 ± 6.9 kg/year) compared with NHC and COC users (1.2 ± 4.7 and 0.7 ± 6.0 kg/year, respectively; P < 0.0001). Patterns of change in LDL cholesterol, triglycerides, and DBP were not significantly different among groups. HDL cholesterol change differed only between COC and NHC groups (adjusted slopes: 1.0 vs. –1.6 mg · dl^–1 · year^–1, respectively; P < 0.0001). SBP change differed only between COC and DMPA groups (adjusted slopes: 1.3 vs. –1.7 mmHg/year, respectively; P = 0.01).

CONCLUSIONS—These results, derived predominantly from the initial 1–2 years of treatment in Hispanic women, demonstrate that DMPA was associated with greater weight gain than NHCs or COCs. Other differences in blood pressure and lipid effects were very small. These findings should be taken into account when advising women with recent GDM about their contraceptive choices.

Abbreviations: AUC, area under the curve • COC, combination oral contraception • DBP, diastolic blood pressure • DMPA, depo-medroxyprogesterone acetate • GDM, gestational diabetes mellitus • NHC, nonhormonal contraception • OGTT, oral glucose tolerance test • SBP, systolic blood pressure

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