Contraception in Women With Cardiovascular Disease

Lindley, Kathryn J.; Teal, Stephanie

doi:10.1001/jama.2022.11541

Cited by 8 publications

(4 citation statements)

References 11 publications

(62 reference statements)

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“…8, 9, 20 Although the use of these treatments for HMB including hysterectomy depends on multiple factors age, HMB pathology, fertility status, and desire to become pregnant 9 , shared decision making and effective treatment strategies are required for CVD management associated with HMB. 8, 10, 37 In addition, reduction of environmental exposure is also useful for minimizing risk of menstrual disorders and CVD events. 3, 38 A higher prevalence of HMB has been reported in women with congenital cardiovascular events.…”

Section: Discussionmentioning

confidence: 99%

Association of heavy menstrual bleeding with cardiovascular diseases in US female hospitalizations

Dubey,

Abdeldayem,

Singh

et al. 2023

Preprint

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BACKGROUNDHeavy menstrual bleeding (HMB) is a common type of menstrual disorder that causes social and mental distress leading to a variety of health problems. Although limited evidence highlights the links between HMB and metabolic abnormalities, the association between HMB and CVD outcomes is unknown in the presence or absence of comorbid irregular menstruation (IM).METHODSAll female hospitalizations between the ages of 12 to 40 years were identified using the National Inpatient Sample database in 2017 and grouped into HMB and no menstrual disorders. Outcomes including major adverse cardiovascular events (MACE), coronary heart disease (CHD), stroke/cerebrovascular accident (CVA), heart failure (HF), arterial fibrillation (AF) or arrhythmia, myocardial infarction (MI), and diabetes (DM) were extracted using ICD-10 codes. Adjusted logistic regression models were conducted to summarize associations with an odds ratio (OR) along with a 95% confidence interval (CI).RESULTSIn the entire cohort, 8,291 (0.69%) had an HMB diagnosis including 1623 (0.14%) with IM and 6668 (0.55%) without IM. In the fully adjusted analysis, HMB was significantly associated with most CVD outcomes, including MACE (OR=1.61; 95% CI: 1.38, 1.88, p<0.001), CHD (OR=1.88; 95% CI: 1.52, 2.31, p<0.001), Stroke/CVA (OR=1.51; 95% CI: 1.1, 2.07, p=0.011), HF (OR=1.60; 95% CI: 1.33, 1.92, p<0.001), AF/arrhythmia (OR=1.93; 95% CI: 1.16, 2.45, p=0.006), and DM (OR=1.45; 95% CI: 1.33, 1.58), p<0.001). HMB without IM was strongly associated with DM, HF, AF, and MACE outcomes while HMB with IM was strongly associated with CHD and AF outcomes.CONCLUSIONSHMB is independently and strongly associated with CVD events among US hospitalizations of young women. Our findings suggest promoting increased awareness, early detection, and optimum management of HMB to avoid adverse CVD outcomes.Clinical PerspectiveWhat Is New?Although menstruation dysfunction is associated with cardiovascular disease (CVD), the relationship between heavy menstrual bleeding (HMB) and CVD outcomes is not evaluated.In a US sample of 1,204,715 hospitalized women, HMB was independently and strongly associated with major adverse cardiovascular events and coronary heart disease.HMB without irregular menstruation was markedly associated with CVD outcomes than HMB with irregular menstruation.What Are the Clinical Implications?Our findings support that HMB as an early vital sign for CVD outcomes among young women. A routine investigation and screening of menstrual disorders, especially HMB, and its effective management is useful for the prevention of CVD risk in women.

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Section: Discussionmentioning

confidence: 99%

Association of heavy menstrual bleeding with cardiovascular diseases in US female hospitalizations

Dubey,

Abdeldayem,

Singh

et al. 2023

Preprint

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“…All women of childbearing age with congenital heart disease should be undergo preconception evaluation and counselling by an adult congenital heart disease (ACHD) clinician to risk stratify cardiac, obstetric and foetal risks prior to conception [14,15 ▪ ]. It is also important to discuss planning for pregnancy via well tolerated and effective contraception options to prevent complications of an unplanned pregnancy [15 ▪ ,16 ▪ ,17,18 ▪ ]. When a patient is ready to begin pregnancy planning, consultation with both an ACHD and a maternal-foetal medicine (MFM) specialist with experience caring for complex ACHD patients will be important to help the patient make informed decisions about proceeding with pregnancy.…”

Section: Preconception Counsellingmentioning

confidence: 99%

“…In a cross-sectional study of 100 women with congenital heart disease, 83 were sexually active and had 141 prior pregnancies, of which 64 (45.5%) were unintended pregnancies [17]. Given the increased risk of thrombosis in patients with Fontan circulation, progestin-only based contraception is preferable [15 ▪ ,16 ▪ ,17,18 ▪ ]. Long-acting reversible contraception (LARC) including progestin containing subdermal implant or intrauterine device are generally preferred to progestin only pills due to superior efficacy [16 ▪ ].…”

Section: Preconception Counsellingmentioning

confidence: 99%

“…There is another important opportunity to discuss contraception, including long-acting reversible contraception or permanent contraception options with the patient prior to discharge [16 ▪ ,20,26]. Combined oestrogen and progestin-containing hormonal methods are not recommended in the first 6 weeks after delivery due to the increased risk of thrombosis and are generally not preferred in Fontan patients due increased inherent risk of thrombosis [18 ▪ ]. Progestin-containing LARC or permanent sterilization are well tolerated and effective options if the patient does not desire further pregnancy [18 ▪ ].…”

Section: Postpartum Carementioning

confidence: 99%

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Management of the Fontan patient during pregnancy

Gupta¹,

Thompson

Lindley

2023

Current Opinion in Cardiology

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Purpose of reviewPatients with single-ventricle Fontan palliation surgery often wish to pursue pregnancy. Pregnancies should be planned with well tolerated and effective contraception, and preconception risk stratification by adult congenital heart disease and maternal foetal medicine specialists.Recent findingsAlthough infertility and foetal complications, including pregnancy loss, preterm birth and foetal growth restriction, are common, most patients with Fontan palliations can successfully complete pregnancy with a team-based approach. Important risk predictors are resting oxygen saturations, baseline functional status and the presence of systemic complications of the Fontan repair, including advanced Fontan associated liver disease, plastic bronchitis and ventricular dysfunction. Common maternal cardiovascular complications include arrhythmia, heart failure and thromboembolism. Delivery planning with input from an obstetric anaesthesiologist who has knowledge of complex congenital heart defects can facilitate appropriate, individualized monitoring and pain control. A vaginal delivery with consideration of an assisted second stage is appropriate for most single ventricle patients, in the absence of obstetric or foetal indications for caesarean delivery. Close postpartum monitoring and follow up is recommended, as the early postpartum period is the highest risk time for cardiovascular complications in patients with congenital heart disease.SummaryA multidisciplinary approach to managing pregnancy and delivery in patients with Fontan circulation facilitates optimal maternal and infant outcomes.

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Sex/Gender Differences in Hypertension and Dyslipidemia

Cho

2024

Sex/Gender-Specific Medicine in Clinical Areas

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Contraception in Women With Cardiovascular Disease

Cited by 8 publications

References 11 publications

Association of heavy menstrual bleeding with cardiovascular diseases in US female hospitalizations

Association of heavy menstrual bleeding with cardiovascular diseases in US female hospitalizations

Management of the Fontan patient during pregnancy

Sex/Gender Differences in Hypertension and Dyslipidemia

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