Department of Obstetrics, Gynecology, and Reproductive Sciences, Division of Maternal-Fetal Medicine, University of California, San Francisco, California.
School of Medicine, University of California, San Francisco, California.
Am J Cardiol. 2019 Apr 15;123(8):1364-1369. doi: 10.1016/j.amjcard.2019.01.006. Epub 2019 Jan 25.
Maternal cardiac disease (MCD) is associated with increased maternal and neonatal morbidity and mortality. Because unplanned pregnancies are especially risky, active use of reliable contraception is critical in this population. Studies in the noncardiac population have demonstrated that the postpartum period is an ideal time to address contraceptive plans. This retrospective cohort study was designed to describe contraceptive choices in women with MCD in the immediate postpartum period and to identify factors associated with specific contraceptive plans. We included women with MCD who delivered from January 2008 to September 2017 at a tertiary care institution with a multidisciplinary obstetrics and cardiology team. Maternal demographics, specifics of MCD, obstetrical outcomes, and contraceptive plans were obtained through chart review. Contraceptive plans were categorized into highly reliable methods (sterilization or long-acting reversible contraceptive methods) or less reliable methods (nonlong-acting reversible contraceptive methods or no contraception). In the 254 women included in this study, 40% planned to use highly reliable methods, while 60% planned to use less reliable methods. Women with cardiomyopathy were more likely to choose a highly reliable method of contraception (adjusted odds ratio 2.6, 95% confidence interval 1.2 to 5.7), a reassuring finding, given the particularly high risk of poor pregnancy outcome with this diagnosis. There were no differences in other cardiac diagnoses between the 2 contraceptive groups. In conclusion, the finding that <50% of postpartum women with MCD plan to use a highly reliable method of contraception warrants further examination to identify and address barriers to reliable contraceptive plans in this high-risk population.
母体心脏疾病（MCD）与产妇和新生儿发病率和死亡率的增加有关。由于计划外怀孕风险特别高，因此在该人群中积极使用可靠的避孕措施至关重要。非心脏人群的研究表明，产后是解决避孕计划的理想时机。这项回顾性队列研究旨在描述 MCD 产妇在产后立即选择避孕方法，并确定与特定避孕方法相关的因素。我们纳入了 2008 年 1 月至 2017 年 9 月在一家具有多学科产科和心脏病学团队的三级医疗机构分娩的 MCD 妇女。通过病历回顾获得产妇人口统计学资料、MCD 具体情况、产科结局和避孕方法。避孕方法分为高可靠性方法（绝育或长效可逆避孕方法）或低可靠性方法（非长效可逆避孕方法或无避孕措施）。在这项研究中的 254 名妇女中，40%计划使用高可靠性方法，而 60%计划使用低可靠性方法。患有心肌病的女性更有可能选择高可靠性的避孕方法（调整后的优势比 2.6，95%置信区间 1.2 至 5.7），这是一个令人放心的发现，因为这种诊断与妊娠结局不良的风险特别高。在 2 种避孕方法组之间，其他心脏诊断没有差异。总之，<50%的 MCD 产后妇女计划使用高可靠性的避孕方法，这一发现需要进一步研究，以确定和解决高危人群中可靠避孕方法的障碍。
