Advertisement

Contraceptive Practices of Women With Complex Congenital Heart Disease

Published:December 17, 2016DOI:https://doi.org/10.1016/j.amjcard.2016.11.047

      Highlights

      • Unplanned pregnancies in women with congenital heart disease.
      • Adverse events from oral contraception.
      • Contraception counseling.
      • Complex congenital heart disease thrombotic risk substrates.
      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.
      To read this article in full you will need to make a payment

      References

        • Moons P.
        • Bovijn L.
        • Budts W.
        • Belmans A.
        • Gewillig M.
        Temporal trends in survival to adulthood among patients born with congenital heart disease from 1970 to 1992 in Belgium.
        Circulation. 2010; 122: 2264-2271
        • Warnes C.A.
        • Williams R.G.
        • Bashore T.M.
        • Child J.S.
        • Connolly H.M.
        • Dearani J.A.
        • del Nido P.
        • Fasules J.W.
        • Graham Jr., T.P.
        • Hijazi Z.M.
        • Hunt S.A.
        • King M.E.
        • Landzberg M.J.
        • Miner P.D.
        • Radford M.J.
        • Walsh E.P.
        • Webb G.D.
        ACC/AHA 2008 guidelines for the management of adults with congenital heart disease: a report of the American College of Cardiology/American Heart Association Task Force on practice guidelines (Writing Committee to Develop Guidelines for the Management of Adults with Congenital Heart Disease): developed in collaboration with the American Society of Echocardiography, Heart Rhythm Society, International Society for Adult Congenital Heart Disease, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons.
        Circulation. 2008; 118: e714-e833
        • Marelli A.J.
        • Mackie A.S.
        • Ionescu-Ittu R.
        • Rahme E.
        • Pilote L.
        Congenital heart disease in the general population: changing prevalence and age distribution.
        Circulation. 2007; 115: 163-172
        • Canobbio M.M.
        • Mair D.D.
        • van der Velde M.
        • Koos B.J.
        Pregnancy outcomes after the Fontan repair.
        J Am Coll Cardiol. 1996; 28: 763-767
        • Canobbio M.M.
        • Morris C.D.
        • Graham T.P.
        • Landzberg M.J.
        Pregnancy outcomes after atrial repair for transposition of the great arteries.
        Am J Cardiol. 2006; 98: 668-672
        • Greutmann M.
        • Silversides C.K.
        The ROPAC registry: a multicentre collaboration on pregnancy outcomes in women with heart disease.
        Eur Heart J. 2013; 34: 634-635
        • Tobler D.
        • Fernandes S.M.
        • Wald R.M.
        • Landzberg M.
        • Salehian O.
        • Siu S.C.
        • Colman J.M.
        • Sermer M.
        • Silversides C.K.
        Pregnancy outcomes in women with transposition of the great arteries and arterial switch operation.
        Am J Cardiol. 2010; 106: 417-420
        • Hinze A.
        • Kutty S.
        • Sayles H.
        • Sandene E.K.
        • Meza J.
        • Kugler J.D.
        Reproductive and contraceptive counseling received by adult women with congenital heart disease: a risk-based analysis.
        Congenit Heart Dis. 2013; 8: 20-31
        • Vigl M.
        • Kaemmerer M.
        • Seifert-Klauss V.
        • Niggemeyer E.
        • Nagdyman N.
        • Trigas V.
        • Bauer U.
        • Schneider K.-T.M.
        • Berger F.
        • Hess J.
        • Kaemmerer H.
        Contraception in women with congenital heart disease.
        Am J Cardiol. 2010; 106: 1317-1321
        • Thorne S.
        • MacGregor A.
        • Nelson-Piercy C.
        Risks of contraception and pregnancy in heart disease.
        Heart. 2006; 92: 1520-1525
        • Silversides C.
        • Sermer M.
        • Siu S.
        Choosing the best contraceptive method for the adult with congenital heart disease.
        Curr Cardiol Rep. 2009; 11: 298-305
        • Center for Disease Control and Prevention
        U.S. medical eligibility criteria for contraceptive use 2010.
        (Adapted from the WHO Medical Eligibility Criteria for Contraceptive Use)2010
        • American College of Obstetricians and Gynecologists
        Practice bulletin no. 121: long-acting reversible contraception: implants and intrauterine devices.
        Obstet Gynecol. 2011; 118: 184-196
        • Daniels K.
        • Daugherty J.
        • Jones J.
        Current contraceptive status among women aged 15–44: United States, 2011–2013.
        NCHS Data Brief. 2014; 173: 1-8
        • Eeckhaut M.C.W.
        Marital status and female and male contraceptive sterilization in the United States.
        Fertil Steril. 2015; 103: 1509-1515
        • Mosher W.D.
        • Jones J.
        • Abma J.C.
        Intended and unintended births in the United States: 1982–2010.
        National Health Statistics Reports. 2012; 55: 1-28
        • US Department of Health and Human Services
        Centers for Disease Control and Prevention, National Center for Health Statistics, Vital & Health Statistics: Use of Contraception in the U.S.: 1982-2008, Series 23, Number 29.
        2010
        • Petitti D.B.
        Hormonal contraceptives and arterial thrombosis—not risk-free but safe enough.
        N Engl J Med. 2012; 336: 2316-2318
        • Pijuan-Domènech A.
        • Baró-Mariné F.
        • Rojas-Torrijos M.
        • Dos-Subirà L.
        • Pedrosa-Del Moral V.
        • Subirana-Domènech M.T.
        • Goya-Canino M.
        • Cabero-Roura L.
        • Garcia-Dorado D.
        • Casaldàliga-Ferrer J.
        Usefulness of progesterone-only components for contraception in patients with congenital heart disease.
        Am J Cardiol. 2013; 112: 590-593
        • Potter B.J.
        • Leong-Sit P.
        • Fernandes S.M.
        • Feifer A.
        • Mayer J.E.
        • Triedman J.K.
        • Walsh E.P.
        • Landzberg M.J.
        • Khairy P.
        Effect of aspirin and warfarin therapy on thromboembolic events in patients with univentricular hearts and Fontan palliation.
        Int J Cardiol. 2013; 168: 3940-3943
        • Haeffele C.
        • Lui G.
        Dextro-transposition of the great arteries: long-term sequelae of atrial and arterial switch.
        Cardiol Clin. 2015; 33: 543-558