Contraceptive and Pregnancy Planning Essential in Women With Heart Disease, Experts Advise

By Reuters Staff

April 09, 2021

NEW YORK (Reuters Health) - Women of childbearing age with, or at risk for, heart disease should be counseled on maternal and fetal risks of pregnancy, contraceptive safety and effectiveness and pregnancy planning options, the American College of Cardiology (ACC) advises in a new report.

"It is important for cardiovascular clinicians to assess for the need for contraception and appropriateness of contraceptive method both at the time of initial assessment and at subsequent annual encounters in all reproductive age women (age 15-44) with cardiovascular disease," lead author Dr. Kathryn Lindley of Washington University School of Medicine in St. Louis, Missouri, said in a news release.

"If a patient identified to be at increased risk for pregnancy complications is also noted to be using a contraceptive method with low effectiveness, a discussion of reproductive goals and safe and effective methods of contraception is recommended," Dr. Lindley said.

"The specialty of cardio-obstetrics has emerged in response to the rising rates of maternal morbidity and mortality related to cardiovascular disease (CVD) during pregnancy," she and her colleagues write in the Journal of the American College of Cardiology.

"A multidisciplinary cardio-obstetrics team should ensure appropriate monitoring during pregnancy, plan for labor and delivery, and ensure close follow-up during the postpartum period when CVD complications remain common," they advise.

They note that the hemodynamic changes that occur during pregnancy, labor and delivery should be considered with respect to the individual cardiac disease of the patient.

The group also emphasizes that the "fourth trimester," which refers to the 12 weeks after delivery, is a "key time to address contraception, mental health, cardiovascular risk factors, and identify any potential postpartum complications."

"Women with adverse pregnancy outcomes are at increased risk of long-term CVD and should receive appropriate education and longitudinal follow-up," they add.

SOURCE: Journal of the American College of Cardiology, online April 5, 2021.