title: Contraception Practices and Pregnancy Outcome in Patients after Fontan Operation.
abstract: OBJECTIVE
  The feasibility and safety of pregnancy after the Fontan operation is not well understood. We sought to determine contraception practices and early and late outcomes of pregnancy after the Fontan operation.
  
  
  METHODS
  We performed a retrospective review of medical records to identify women of childbearing age from the Mayo Clinic Fontan database. A follow-up questionnaire was mailed to all patients not known to be deceased at the time of study. Patients with available contraception and pregnancy data were included in the study.
  
  
  RESULTS
  Of the 138 women with available contraception data, 44% used no contraception, 12% each used barrier methods, combination hormone therapy or sterilization, 8% used Depo-Provera, 7% had intrauterine devices, 4% had a partner with a vasectomy and 1% used progestin pills. Six women had thrombotic complications (only one using oral contraceptives). Thirty-five women had pregnancy data available. Prior to the Fontan operation there were 10 pregnancies (8 miscarriages, 2 therapeutic abortions, and no live births). After the Fontan operation there were 70 pregnancies resulting in 35 miscarriages (50%), 29 live births (41%), and 6 therapeutic abortions (9%). There were no maternal deaths during pregnancy. During long-term follow up (26 ± 6 years since the Fontan), 1 death, and 1 cardiac transplant occurred. Mean gestational age of the newborns (n = 22/29) was 33.1 ± 4.0 weeks; mean birth weight (n = 20/29) was 2086 ± 770 g. There was 1 neonatal death because of prematurity and two children were born with congenital heart disease (one patent ductus arteriosus and one membranous ventricular septal defect).
  
  
  CONCLUSIONS
  Pregnancy after the Fontan operation is associated with a high rate of miscarriages, preterm delivery, and low birth weight. Further studies are needed to identify specific variables influencing risk stratification of pregnancy in this patient population.
authors.affiliation: Division of Pediatric Cardiology, Mayo Clinic, Rochester, Minn, USA.
authors.forename: Kavitha N
authors.initials: KN
authors.lastname: Pundi
authors.affiliation: Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minn, USA.
authors.forename: Krishna
authors.initials: K
authors.lastname: Pundi
authors.affiliation: Division of Pediatric Cardiology, Mayo Clinic, Rochester, Minn, USA.|Division of Cardiovascular Surgery, Mayo Clinic, Rochester, Minn, USA.
authors.forename: Jonathan N
authors.initials: JN
authors.lastname: Johnson
authors.affiliation: Mayo Clinic College of Medicine, Mayo Clinic, Rochester, Minn, USA.
authors.forename: Joseph A
authors.initials: JA
authors.lastname: Dearani
authors.affiliation: Division of Cardiovascular Surgery, Mayo Clinic, Rochester, Minn, USA.
authors.forename: Crystal R
authors.initials: CR
authors.lastname: Bonnichsen
authors.affiliation: Division of Cardiovascular Surgery, Mayo Clinic, Rochester, Minn, USA.
authors.forename: Sabrina D
authors.initials: SD
authors.lastname: Phillips
authors.affiliation: Ahmanson/UCLA Adult Congenital Heart Disease Center, University of California, Los Angeles, Calif, USA.
authors.forename: Mary C
authors.initials: MC
authors.lastname: Canobbio
authors.affiliation: Division of Pediatric Cardiology, Mayo Clinic, Rochester, Minn, USA.
authors.forename: David J
authors.initials: DJ
authors.lastname: Driscoll
authors.affiliation: Division of Pediatric Cardiology, Mayo Clinic, Rochester, Minn, USA.|Division of Cardiovascular Surgery, Mayo Clinic, Rochester, Minn, USA.
authors.forename: Frank
authors.initials: F
authors.lastname: Cetta
mesh_terms: D000022:Abortion, Spontaneous / Q000209:etiology; D000032:Abortion, Therapeutic; D001724:Birth Weight; D003267:Contraception / Q000379:methods*; D003268:Contraception Behavior; D005260:Female; D018729:Fontan Procedure / Q000009:adverse effects*; D005865:Gestational Age; D006330:Heart Defects, Congenital / Q000601:surgery*; D006801:Humans; D007230:Infant, Low Birth Weight; D007231:Infant, Newborn; D007234:Infant, Premature; D050498:Live Birth; D008910:Minnesota; D011247:Pregnancy; D011256:Pregnancy Outcome; D047928:Premature Birth / Q000209:etiology; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors
keywords: Abortion; Contraception; Fontan Operation; Miscarriage; Pregnancy; Prematurity