title: 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.
authors.affiliation: Ahmanson/UCLA Adult Congenital Heart Disease Center, UCLA Medical Center, Los Angeles, California. Electronic address: pminer@mednet.ucla.edu.
authors.forename: Pamela D
authors.initials: PD
authors.lastname: Miner
authors.affiliation: Ahmanson/UCLA Adult Congenital Heart Disease Center, UCLA Medical Center, Los Angeles, California.
authors.forename: Mary M
authors.initials: MM
authors.lastname: Canobbio
authors.affiliation: Boston Adult Congenital Heart Program, Boston Children's Hospital, Boston, Massachusetts.
authors.forename: Dorothy D
authors.initials: DD
authors.lastname: Pearson
authors.affiliation: Adult Congenital Heart Disease Clinic, University of Washington Regional Heart Center, Seattle, Washington.
authors.forename: Mary
authors.initials: M
authors.lastname: Schlater
authors.affiliation: Adult Congenital Heart Clinic, Peter Lougheed Hospital, Calgary, Alberta.
authors.forename: Yvonne
authors.initials: Y
authors.lastname: Balon
authors.affiliation: Center for Adults with Congenital Heart Disease, Washington University School of Medicine, Barnes Jewish Hospital, St. Louis, Missouri.
authors.forename: Kathryn J
authors.initials: KJ
authors.lastname: Junge
authors.affiliation: Congenital Heart Disease Program, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts.
authors.forename: Ami
authors.initials: A
authors.lastname: Bhatt
authors.affiliation: Adult Congenital Heart Service Akron Children's Hospital, Akron, Ohio.
authors.forename: Deena
authors.initials: D
authors.lastname: Barber
authors.affiliation: Penn State Hershey Program for Adult Congenital Heart Disease, Hershey, Pennsylvania.
authors.forename: Michelle J
authors.initials: MJ
authors.lastname: Nickolaus
authors.affiliation: Toronto Congenital Cardiac Centre for Adults, Toronto General Hospital, Toronto, Ontario, Canada.
authors.forename: Adrienne H
authors.initials: AH
authors.lastname: Kovacs
authors.affiliation: Department of Public Health and Primary Care, University of Leuven, KU Leuven, Leuven, Belgium.
authors.forename: Philip
authors.initials: P
authors.lastname: Moons
authors.affiliation: Division of Family Planning Services and Research, Department of Obstetrics and Gynecology, Stanford University, Palo Alto, California.
authors.forename: Kate
authors.initials: K
authors.lastname: Shaw
authors.affiliation: Division of Pediatric Cardiology, Department of Pediatrics, Stanford University, Palo Alto, California; Division of Cardiovascular Medicine, Department of Medicine, Stanford University, Palo Alto, California.
authors.forename: Susan M
authors.initials: SM
authors.lastname: Fernandes
mesh_terms: D000328:Adult; D003268:Contraception Behavior; D003430:Cross-Sectional Studies; D005260:Female; D006330:Heart Defects, Congenital; D006801:Humans; D008875:Middle Aged; D009656:North America; D011247:Pregnancy; D049168:Pregnancy, Unplanned; D011795:Surveys and Questionnaires