{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,17]],"date-time":"2026-09-17T10:04:18Z","timestamp":1789639458011,"version":"4.0.0"},"reference-count":32,"publisher":"American Diabetes Association","issue":"2","license":[{"start":{"date-parts":[[2017,1,20]],"date-time":"2017-01-20T00:00:00Z","timestamp":1484870400000},"content-version":"vor","delay-in-days":52,"URL":"http:\/\/www.diabetesjournals.org\/content\/license"}],"funder":[{"DOI":"10.13039\/100000041","name":"American Diabetes Association","doi-asserted-by":"publisher","award":["1-13-CE-31"],"award-info":[{"award-number":["1-13-CE-31"]}],"id":[{"id":"10.13039\/100000041","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["diabetesjournals.org"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2017,2,1]]},"abstract":"<jats:sec>\n                  <jats:title>OBJECTIVE<\/jats:title>\n                  <jats:p>To investigate safety of hormonal contraception with regard to thromboembolic events in women with type 1 or 2 diabetes.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>RESEARCH DESIGN AND METHODS<\/jats:title>\n                  <jats:p>We used data from 2002\u20132011 in Clinformatics Data Mart to identify women in the U.S., 14\u201344 years of age, with an ICD-9-CM code for diabetes and a prescription for a diabetic medication or device. We examined contraceptive claims and compared time to thromboembolism (venous thrombosis, stroke, or myocardial infarction) among women with diabetes dispensed hormonal contraception using a modification of Cox regression to control for age, smoking, obesity, hypertension, hyperlipidemia, diabetic complications, and history of cancer; we excluded data for 3 months after women gave birth.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>RESULTS<\/jats:title>\n                  <jats:p>We identified 146,080 women with diabetes who experienced 3,012 thromboembolic events. Only 28% of reproductive-aged women with diabetes had any claims for hormonal contraception, with the majority receiving estrogen-containing oral contraceptives. Rates of thromboembolism were highest among women who used the contraceptive patch (16 per 1,000 woman-years) and lowest among women who used intrauterine (3.4 per 1,000 woman-years) and subdermal (0 per 163 woman-years) contraceptives. Compared with use of intrauterine contraception, progestin-only injectable contraception was associated with increased risk of thromboembolism (12.5 per 1,000 woman-years; adjusted hazard ratio 4.69 [95% CI 2.51\u20138.77]).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>CONCLUSIONS<\/jats:title>\n                  <jats:p>The absolute risk of thromboembolism among women with type 1 or 2 diabetes using hormonal contraception is low. Highly effective, intrauterine and subdermal contraceptives are excellent options for women with diabetes who hope to avoid the teratogenic effects of hyperglycemia by carefully planning their pregnancies.<\/jats:p>\n               <\/jats:sec>","DOI":"10.2337\/dc16-1534","type":"journal-article","created":{"date-parts":[[2016,11,30]],"date-time":"2016-11-30T04:34:46Z","timestamp":1480480486000},"page":"233-238","update-policy":"https:\/\/doi.org\/10.2337\/ada-journal-policies","source":"Crossref","is-referenced-by-count":46,"title":["Hormonal Contraception and Risk of Thromboembolism in Women With Diabetes"],"prefix":"10.2337","volume":"40","author":[{"given":"Sarah H.","family":"O\u2019Brien","sequence":"first","affiliation":[{"name":"Center for Innovation in Pediatric Practice, The Research Institute at Nationwide Children\u2019s Hospital, Columbus, OH"},{"name":"Division of Pediatric Hematology\/Oncology, Nationwide Children\u2019s Hospital\/The Ohio State University, Columbus, OH"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Terah","family":"Koch","sequence":"additional","affiliation":[{"name":"Division of Pediatric Hematology\/Oncology, Nationwide Children\u2019s Hospital\/The Ohio State University, Columbus, OH"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sara K.","family":"Vesely","sequence":"additional","affiliation":[{"name":"Department of Biostatistics and Epidemiology, College of Public Health, University of Oklahoma Health Sciences Center, Oklahoma City, OK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9912-8236","authenticated-orcid":false,"given":"Eleanor Bimla","family":"Schwarz","sequence":"additional","affiliation":[{"name":"Division of General Internal Medicine, University of California, Davis, Sacramento, CA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1167","published-online":{"date-parts":[[2016,11,29]]},"reference":[{"key":"2022031301535855300_B1","doi-asserted-by":"crossref","first-page":"1263","DOI":"10.2337\/dc06-0062","article-title":"Prevalence of diabetes and impaired fasting glucose in adults in the U.S. population: National Health And Nutrition Examination Survey 1999-2002","volume":"29","author":"Cowie","year":"2006","journal-title":"Diabetes Care"},{"key":"2022031301535855300_B2","doi-asserted-by":"crossref","first-page":"294","DOI":"10.1016\/1056-8727(95)00080-1","article-title":"Short- and long-range complications in offspring of diabetic mothers","volume":"10","author":"Weintrob","year":"1996","journal-title":"J Diabetes Complications"},{"key":"2022031301535855300_B3","volume-title":"Medical Management of Pregnancy Complicated by Diabetes","author":"American Diabetes Association","year":"2000","edition":"3rd ed."},{"key":"2022031301535855300_B4","first-page":"S4","volume-title":"Diabetes Care","author":"American Diabetes Association","year":"2005"},{"key":"2022031301535855300_B5","doi-asserted-by":"crossref","first-page":"167","DOI":"10.1016\/j.whi.2005.04.002","article-title":"Contraceptive use by diabetic and obese women","volume":"15","author":"Chuang","year":"2005","journal-title":"Womens Health Issues"},{"key":"2022031301535855300_B6","doi-asserted-by":"crossref","first-page":"1070","DOI":"10.1097\/01.AOG.0000216002.36799.b4","article-title":"Contraceptive counseling of diabetic women of reproductive age","volume":"107","author":"Schwarz","year":"2006","journal-title":"Obstet Gynecol"},{"key":"2022031301535855300_B7","doi-asserted-by":"crossref","first-page":"195","DOI":"10.1016\/j.pcd.2008.10.003","article-title":"Use of hormonal contraceptive methods by women with diabetes","volume":"2","author":"Shawe","year":"2008","journal-title":"Prim Care Diabetes"},{"key":"2022031301535855300_B8","doi-asserted-by":"crossref","first-page":"1026","DOI":"10.2337\/dc08-2105","article-title":"Family-planning practices among women with diabetes and overweight and obese women in the 2002 National Survey For Family Growth","volume":"32","author":"Vahratian","year":"2009","journal-title":"Diabetes Care"},{"key":"2022031301535855300_B9","doi-asserted-by":"crossref","first-page":"489","DOI":"10.1177\/0145721710365171","article-title":"Perceived access to contraception among adolescents with diabetes: barriers to preventing pregnancy complications","volume":"36","author":"Schwarz","year":"2010","journal-title":"Diabetes Educ"},{"key":"2022031301535855300_B10","first-page":"43","article-title":"Pharmacodynamic effects of oral contraceptive steroids on biochemical markers for arterial thrombosis. Studies in non-diabetic women and in women with insulin-dependent diabetes mellitus","volume":"49","author":"Petersen","year":"2002","journal-title":"Dan Med Bull"},{"key":"2022031301535855300_B11","doi-asserted-by":"crossref","first-page":"240","DOI":"10.1111\/j.1749-6632.2010.05662.x","article-title":"Hormonal contraception in obesity, the metabolic syndrome, and diabetes","volume":"1205","author":"Skouby","year":"2010","journal-title":"Ann N Y Acad Sci"},{"key":"2022031301535855300_B12","doi-asserted-by":"crossref","first-page":"2257","DOI":"10.1056\/NEJMoa1111840","article-title":"Thrombotic stroke and myocardial infarction with hormonal contraception","volume":"366","author":"Lidegaard","year":"2012","journal-title":"N Engl J Med"},{"key":"2022031301535855300_B13","volume-title":"Medical Eligibility Criteria for Contraceptive Use","author":"World Health Organization","year":"2015","edition":"5th ed."},{"key":"2022031301535855300_B14","doi-asserted-by":"publisher","DOI":"10.1016\/j.contraception.2016.04.014","article-title":"Progestin-only contraception and thromboembolism: a systematic review","author":"Tepper","journal-title":"Contraception"},{"key":"2022031301535855300_B15","doi-asserted-by":"crossref","first-page":"196","DOI":"10.1007\/s11606-011-1875-6","article-title":"Provision of contraceptive services to women with diabetes mellitus","volume":"27","author":"Schwarz","year":"2012","journal-title":"J Gen Intern Med"},{"key":"2022031301535855300_B16","first-page":"229","article-title":"Complications, comorbidities, and mortality: improving classification and prediction","volume":"32","author":"Roos","year":"1997","journal-title":"Health Serv Res"},{"key":"2022031301535855300_B17"},{"key":"2022031301535855300_B18","doi-asserted-by":"crossref","first-page":"1998","DOI":"10.1056\/NEJMoa1110855","article-title":"Effectiveness of long-acting reversible contraception","volume":"366","author":"Winner","year":"2012","journal-title":"N Engl J Med"},{"key":"2022031301535855300_B19","first-page":"42","article-title":"Can safety and efficacy go hand in hand? Contraception for medically complex patients","volume":"20","author":"Carusi","year":"2008","journal-title":"OBG Management"},{"key":"2022031301535855300_B20","doi-asserted-by":"crossref","first-page":"61","DOI":"10.1055\/s-2003-38333","article-title":"Changes of hemostatic variables during oral contraceptive use","volume":"3","author":"Tans","year":"2003","journal-title":"Semin Vasc Med"},{"key":"2022031301535855300_B21","doi-asserted-by":"crossref","first-page":"218","DOI":"10.1177\/1740774507079439","article-title":"Monitoring the randomized trials of the Women\u2019s Health Initiative: the experience of the Data and Safety Monitoring Board","volume":"4","author":"Wittes","year":"2007","journal-title":"Clin Trials"},{"key":"2022031301535855300_B22","doi-asserted-by":"crossref","first-page":"i2002","DOI":"10.1136\/bmj.i2002","article-title":"Low dose oestrogen combined oral contraception and risk of pulmonary embolism, stroke, and myocardial infarction in five million French women: cohort study","volume":"353","author":"Weill","year":"2016","journal-title":"BMJ"},{"key":"2022031301535855300_B23","doi-asserted-by":"crossref","first-page":"d6423","DOI":"10.1136\/bmj.d6423","article-title":"Risk of venous thromboembolism from use of oral contraceptives containing different progestogens and oestrogen doses: Danish cohort study, 2001-9","volume":"343","author":"Lidegaard","year":"2011","journal-title":"BMJ"},{"key":"2022031301535855300_B24","doi-asserted-by":"crossref","first-page":"344","DOI":"10.1016\/j.contraception.2006.12.019","article-title":"The safety of a drospirenone-containing oral contraceptive: final results from the European Active Surveillance Study on oral contraceptives based on 142,475 women-years of observation","volume":"75","author":"Dinger","year":"2007","journal-title":"Contraception"},{"key":"2022031301535855300_B25","doi-asserted-by":"crossref","first-page":"1610","DOI":"10.1016\/S0140-6736(99)03132-3","article-title":"Risk of cardiovascular diseases associated with oral progestagen preparations with therapeutic indications","volume":"354","author":"Poulter","year":"1999","journal-title":"Lancet"},{"key":"2022031301535855300_B26","doi-asserted-by":"crossref","first-page":"1610","DOI":"10.1016\/S0140-6736(99)04394-9","article-title":"Risk of idiopathic venous thromboembolism in users of progestagens alone","volume":"354","author":"Vasilakis","year":"1999","journal-title":"Lancet"},{"key":"2022031301535855300_B27","doi-asserted-by":"crossref","first-page":"315","DOI":"10.1016\/S0010-7824(98)00041-9","article-title":"Cardiovascular disease and use of oral and injectable progestogen-only contraceptives and combined injectable contraceptives. Results of an international, multicenter, case-control study","volume":"57","author":"World Health Organization Collaborative Study of Cardiovascular Disease and Steroid Hormone Contraception","year":"1998","journal-title":"Contraception"},{"key":"2022031301535855300_B28","doi-asserted-by":"crossref","first-page":"2297","DOI":"10.1161\/ATVBAHA.110.211482","article-title":"The risk of deep venous thrombosis associated with injectable depot-medroxyprogesterone acetate contraceptives or a levonorgestrel intrauterine device","volume":"30","author":"van Hylckama Vlieg","year":"2010","journal-title":"Arterioscler Thromb Vasc Biol"},{"key":"2022031301535855300_B29","doi-asserted-by":"crossref","first-page":"653","DOI":"10.1016\/j.contraception.2012.05.003","article-title":"Progestin-only contraceptive pill use among women in the United States","volume":"86","author":"Hall","year":"2012","journal-title":"Contraception"},{"key":"2022031301535855300_B30","doi-asserted-by":"crossref","first-page":"18","DOI":"10.1186\/1472-6963-12-18","article-title":"Validation of key behaviourally based mental health diagnoses in administrative data: suicide attempt, alcohol abuse, illicit drug abuse and tobacco use","volume":"12","author":"Kim","year":"2012","journal-title":"BMC Health Serv Res"},{"key":"2022031301535855300_B31","doi-asserted-by":"crossref","first-page":"70","DOI":"10.1186\/1472-6963-14-70","article-title":"Coding of obesity in administrative hospital discharge abstract data: accuracy and impact for future research studies","volume":"14","author":"Martin","year":"2014","journal-title":"BMC Health Serv Res"},{"key":"2022031301535855300_B32","first-page":"484","article-title":"Attitudes and knowledge regarding contraception and prepregnancy counselling in insulin dependent diabetes","volume":"107","author":"Gibb","year":"1994","journal-title":"N Z Med J"}],"container-title":["Diabetes Care"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/care.diabetesjournals.org\/syndication\/doi\/10.2337\/dc16-1534","content-type":"unspecified","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/diabetesjournals.org\/care\/article-pdf\/40\/2\/233\/547747\/dc161534.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/diabetesjournals.org\/care\/article-pdf\/40\/2\/233\/547747\/dc161534.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2022,3,13]],"date-time":"2022-03-13T05:58:26Z","timestamp":1647151106000},"score":1,"resource":{"primary":{"URL":"https:\/\/diabetesjournals.org\/care\/article\/40\/2\/233\/37022\/Hormonal-Contraception-and-Risk-of-Thromboembolism"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2016,11,29]]},"references-count":32,"journal-issue":{"issue":"2","published-online":{"date-parts":[[2016,11,29]]},"published-print":{"date-parts":[[2017,2,1]]}},"URL":"https:\/\/doi.org\/10.2337\/dc16-1534","relation":{},"ISSN":["0149-5992","1935-5548"],"issn-type":[{"value":"0149-5992","type":"print"},{"value":"1935-5548","type":"electronic"}],"subject":[],"published":{"date-parts":[[2016,11,29]]}}}