pdm-contraception-use

name	pdm-contraception-use
description	Recommends contraception when pregnancy is not desired for individuals with diabetes who could become pregnant. Triggered by discussions about pregnancy planning, contraception needs, or when pregnancy is not desired.

Recommend contraception when pregnancy is not desired in individuals with diabetes

STEP 1 — Gather Information

Assess pregnancy intention, current contraceptive use, medical history (type of diabetes, comorbidities, medications, BMI, blood pressure), and reproductive goals. Document whether pregnancy is desired or not desired.

STEP 2 — Rule In / Rule Out

If pregnancy is desired → proceed to preconception care counseling; if pregnancy is not desired → proceed to contraception counseling.

STEP 3 — Classify or Stratify

Stratify contraceptive options using US Medical Eligibility Criteria (MEC) for women with diabetes:

Condition	Typical MEC Category	Examples
No vascular complications	1 (no restriction) or 2 (advantages > risks)	IUD, implant, progestin-only pill
Hypertension, nephropathy, or other vascular disease	3 (risks > benefits) or 4 (unacceptable risk) for combined hormonal methods	Avoid estrogen-containing pills/patch/ring; prefer IUD, implant, progestin-only
Obesity (BMI ≥30)	2 for most methods; monitor for VTE risk with estrogen-containing	Consider IUD, implant, progestin-only
Select method based on MEC category, efficacy, and patient preference.

STEP 4 — Decide

Initiate shared decision‑making to choose a contraceptive method aligned with MEC stratification and patient values; provide noncoercive counseling and prescribe or refer for the selected method.

Clinical Guardrails / Mimics / Pitfalls

• Ensure counseling is patient‑centered and free of coercion; respect autonomy.
• Avoid prescribing estrogen‑containing contraceptives in women with established vascular disease, nephropathy, or retinopathy (US MEC 3/4).
• Do not assume pregnancy desire; always ask explicitly.
• Do not overlook drug‑drug interactions (e.g., enzyme‑inducing antiepileptics reducing hormonal efficacy).
• Do not delay contraception provision while awaiting preconception optimization if pregnancy is truly not desired.

Concrete Clinical Example

A 30‑year‑old woman with type 2 diabetes, BMI 31, hypertension controlled on lisinopril, states she does not desire pregnancy for the next 2 years. After reviewing US MEC, a levonorgestrel IUD (category 2) is chosen. She receives counseling on insertion, benefits, and risks, and the IUD is placed during the visit.

Source: Preexisting Diabetes and Pregnancy: An Endocrine Society and European Society of Endocrinology Joint Clinical Practice Guideline, Endocrine Society/European Society of Endocrinology, 2025, https://doi.org/10.1210/clinem/dgaf288