Reproductive and contraceptive counseling received by adult women with congenital heart disease: a risk-based analysis.

BACKGROUND/OBJECTIVE: Our aim was to study the prevalence of counseling received by adult women with congenital heart disease to determine from whom they received such counseling and to describe their contraceptive and reproductive knowledge.

METHODS/DESIGN: Using a cross-sectional survey, information was collected from 83 women, ≥ 19 years of age with congenital heart disease from a group of 404 women followed in our adult congenital heart disease clinic. Women were stratified into combined hormonal contraceptive and pregnancy World Health Organization risk classes 1-4 based on cardiac lesion.

RESULTS

We hypothesized that >50% of women had not received both contraceptive and reproductive counseling that addressed their heart condition; indeed, 59% of women reported they had not received such counseling (P=.05). Women who had received heart-specific contraceptive counseling were in higher risk combined hormonal contraceptive World Health Organization classes (P=.02). Similarly, women who reported receiving counseling regarding risks of pregnancy were also in higher pregnancy World Health Organization risk classes (P=.002). Fifty-two of 77 women (63%) did not know if there was a contraindicated contraceptive method given their underlying heart condition; 16 of these 52 women (31%) were combined hormonal contraceptive class 3 or class 4.

CONCLUSIONS

This adult congenital heart disease survey study demonstrates an opportunity to improve individualized contraceptive and reproductive counseling with a goal toward minimizing each patient's risk of potentially avoidable adverse events. A stronger collaboration among health care professionals is needed to increase the prevalence of heart-specific counseling and to increase the quality of counseling these women are receiving.