Did you all see the JAMA article talking about mothers who developed
>  diabetes (who were also breastfeeding) after being put on progestin only
>  contraceptives?
>  Sincerely,
>  Jennifer Myers Coombs, PA-C
Could you post the reference (issue) for this article?
Christine Genthe, MA, RD

The article was in JAMA 1998 Aug 12;280(6):533-8 Contraception and the
risk of type 2 diabetes mellitus in Latina women with prior gestational
diabetes mellitus.  They concluded "Progestin-only OCs were associated
with an increased risk of diabetes in breast-feeding Latinas with recent
GDM and probably should be prescribed with caution.  Combination OCs did
not appear to increase the risk of diabetes in non-breast-feeding women
with recent GDM."  Well, only the breastfeeding moms who had prior
history of Gestational diabetes got the progestin only contraceptives,
and independent of weight gain almost tripled the risk of type 2
diabetes compared with low-dose combination OCs.  The study really had
nothing at all to do with the breastfeeding as a cause, just that they
were the only group that got the progestin only OCs.  My question is
does this translate to Depo Provera and Norplant?  What about non
Latinas, and what about women without a history of Gestational diabetes,
can we translate any of it into a concern for our breastfeeding moms
that don't fit the narrow parameters of the study? And what about non
breastfeeding Latinas who use progestin only contraceptives, will their
risk be tripled or quadrupled?  I sure would like to have seen that in
the study, I could have used that one to convince our Latinas with GDM
to breastfeed (not that we don't have enough reasons already!)  In my
opinion more research must be done.

Sincerely,
Jennifer Myers Coombs, PA-C