Contraceptive Practices of Women With Complex Congenital Heart Disease

Abstract

Understanding the contraceptive practices of women with complex congenital heart disease (CHD) and providing them individualized contraception counseling may prevent adverse events and unplanned high-risk pregnancies. Given this, we sought to examine the contraceptive practices in women with CHD, describe adverse events associated with contraceptive use, and describe the provision of contraception counseling. Women >18 years were recruited from 2011 to 2014 from 9 adult CHD (ACHD) centers throughout North America. Subjects completed a 48-item questionnaire regarding contraceptive use and perceptions of contraception counseling, and a medical record review was performed. Of 505 subjects, median age was 33 (interquartile range 26 to 44) and 81% had CHD of moderate or great complexity. The majority (86%, 435 of 505) of the cohort had used contraception. The types included barrier methods (87%), oral contraception (OC) 84%, intrauterine device (18%), Depo-Provera (15%), vaginal ring (7%), patch (6%), hormonal implant (2%), Plan B (19%), and sterilization (16%). Overall OC use was not significantly different by CHD complexity. Women with CHD of great complexity were more likely to report a thrombotic event while taking OC than those with less complex CHD (9% vs 1%, p = 0.003). Contraception counseling by the ACHD team was noted by 43% of subjects. Unplanned pregnancy was reported by 25% with no statistical difference by CHD complexity. In conclusion, contraceptive practices of women with complex CHD are highly variable, and the prevalence of blood clots while taking OC is not insignificant while provision of contraception counseling by ACHD providers appears lacking.

Safety of contraceptive use among women with congenital heart disease: A systematic review

“…19,20 One of these studies found a higher percent of thromboembolic conditions in women with more severe CHD compared with mild CHD. Two of three comparative studies found a higher percent of thromboembolic complications among women with Fontan palliation or transposition of the great arteries using oral contraceptives than among women not using oral contraceptives; however, statistical testing was not reported for these comparisons.…”

“…4 Two studies found no endocarditis among IUD users. 19,20 Two studies did not report outcomes by specific type of contraception, but rather grouped all methods together. All studies were rated as poor quality.…”

“…After reviewing titles and abstracts, 43 full-length articles were reviewed and 5 met the inclusion criteria (Table 1). 4,[18][19][20][21] We excluded 38 articles because they did not include the population of interest, were review articles, or did not address the question of interest. We found no additional articles after reviewing references and review articles.…”

“…4,[18][19][20][21] We excluded 38 articles because they did not include the population of interest, were review articles, or did not address the question of interest. There were three cohort studies, 4,19,20 with data available to compare contraceptive users to nonusers, and two noncomparative studies 18,21 reporting complications among contraceptive users without a comparison group of nonusers. There were three cohort studies, 4,19,20 with data available to compare contraceptive users to nonusers, and two noncomparative studies 18,21 reporting complications among contraceptive users without a comparison group of nonusers.…”

“…20 Overall, 4% of women experienced a thromboembolic event while using oral contraceptives, with a higher percentage among women with complex CHD (9%) than among women with less complex CHD (1%, P value for com- Among these women, 12% (17) were using combined hormonal contraceptives, barrier methods, or sterilization (not further differentiated), 8% (11) were using DMPA, 7% (10) were using IUDs (type not specified), and 1% (2) were using progestin-only pills. 20 Overall, 4% of women experienced a thromboembolic event while using oral contraceptives, with a higher percentage among women with complex CHD (9%) than among women with less complex CHD (1%, P value for com- Among these women, 12% (17) were using combined hormonal contraceptives, barrier methods, or sterilization (not further differentiated), 8% (11) were using DMPA, 7% (10) were using IUDs (type not specified), and 1% (2) were using progestin-only pills.…”