Advice on Pregnancy and Contraception Lacking in Adults With Congenital Heart Disease

October 07, 2010

October 7, 2010 (Munich, Germany) — Almost half of adult women with congenital heart disease were not given advice about contraception and had not been warned about pregnancy-related risks by their treating physician, a new study shows [1]. These women were being cared for at a specialist center for adult congenital heart disease and so likely represent the best-case scenario, lead author Dr Matthäus Vigl (Deutsches Herzzentrum, Munich. Germany) told heartwire . Vigl and colleagues published their findings online September 14, 2010 in the American Journal of Cardiology.

If you evaluate a patient individually, there should be at least one contraceptive choice available for each patient.

Vigl says that pregnancy is possible in most female congenital heart disease patients, with the exception of those with the most complex lesions, but the benefits and risks need to be discussed individually with each patient. The same advice applies to contraception, as different methods have pros and cons for every patient. But the results show that women with congenital heart disease "don't get informed about their contraceptive choices," Vigl says.

One of the main reasons behind this, he believes, is that no one has ownership of these patients. "Traditionally, congenital heart disease patients are cared for by pediatric cardiologists, who are not used to talking about this topic. Adult cardiologists are more used to it but don't have the necessary knowledge about congenital heart disease, which is very complex. The same applies to gynecologists." Better education of both patients and physicians is needed, together with a multidisciplinary approach between cardiology and family planning, he says.

"If you evaluate a patient individually, there should be at least one contraceptive choice available for each patient," he stresses.

Often the Women, Not the Doctors, Introduce the Topic

Vigl and colleagues followed 536 consecutive adult female patients with congenital heart disease seen at the outpatient clinic of two tertiary-care centers for adults with congenital heart disease in Germany. They underwent a clinical assessment and completed a questionnaire regarding their contraceptive use.

Overall, 43% of the women had not been counseled about contraception and 48% had not been informed of the pregnancy-related risks by their treating physician. And in the group with high pregnancy-associated risks, a large proportion of patients (28%) were not using contraception despite having a sexual relationship.

The researchers identified a substantial number of patients (20%) who were currently using contraceptive methods that were contraindicated for their specific cardiac condition, and pregnancy occurred in almost every tenth woman despite the use of contraception.

And tellingly, in more than 40% of cases in which the topic of contraception or pregnancy was addressed, it had been brought up by the woman and not her doctor.

Disappointingly, the treating physicians often neglected to advise the women appropriately.

"Many women have only limited knowledge about the relation between their congenital heart disease and sexual health and how to prevent unplanned pregnancies. Therefore, they need detailed education about their medical risks, specific pregnancy-related risks, and contraceptive options. Disappointingly, the treating physicians often neglected to advise the women appropriately," the researchers say.

The reasons for this are likely multifactorial, say Vigl et al, but probably reflect a lack of information on the part of the physician. "A stronger collaboration between cardiologic and family-planning experts is mandatory and, at least in tertiary-care centers, would be possible to organize," they note.

"Multidisciplinary guidelines with clear pathways for referral and counseling could help to disseminate the knowledge," they conclude.


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