Depo Provera and diabetes risk in women

Contraception with depot medroxyprogesterone acetate is associated with an increase in the risk of diabetes in some women with prior pregnancy-related or gestational diabetes. Depot medroxyprogesterone (DMPA) contraceptives are given by monthly injections, and are often referred to by one brand name, Depo Provera. DMPA and breast-feeding or DMPA and high triglycerides were associated with increased risk of diabetes in these women. Researchers from the University of Southern California in Los Angeles, USA, studied 526 women with prior gestational diabetes who elected to use either DMPA or oral contraceptives. Median follow-up was about 1 year, with a maximum of 9 years. The annual incidence rate of diabetes was 19 percent in the DMPA group compared with 12 percent in the oral contraceptives group. Adjustment for baseline body weight, breast-feeding rates, and family history reduced the increased risk associated with DMPA use from 58 percent to 18 percent and further adjustment for weight gain during follow-up reduced it even further, to 7 percent. Among women who used DMPA, those with higher than median triglyceride levels had more than double the risk of diabetes, and those who breast-fed also had a similar increase in risk, although this difference was not significant. The researchers advise women with a history of diabetes during pregnancy to avoid DMPA, and either use a non-hormonal approach, if breast-feeding and if not breast-feeding, but with relatively high triglycerides, to use a non-hormonal method or low-dose combination pills.