[Preconception and contraceptive counselling of women with cardiovascular diseases]

Thanks to progress in cardiothoracic surgery, an increasing number of women with complex congenital heart diseases enter adulthood. Additionally, demographic and lifestyle changes result in the manifestation of acquired cardiac diseases during child-bearing years. Some 0.5-4% of all pregnancies occur in women with cardiovascular diseases. In the developed countries cardiovascular complications are the leading cause of maternal mortality. In pregnancies with cardiac conditions obstetric complication rates are raised. Up to 50% result in miscarriages or terminations; perinatal morbidity and mortality is increased. Contraceptive counselling should accordingly be offered to adolescents with congenital cardiac malformations and to patients with acquired cardiac diseases. Various contraceptive methods are available with different efficacies. International guidelines aid in the choice of the most appropriate method. Before contemplating pregnancy, preconception counselling by an interdisciplinary team should take place. This includes an assessment of the cardiac complication risk during pregnancy, delivery and post-partum. Cardiac function should be optimized and the medication evaluated with respect to teratogenicity. Special aspects of antenatal care, genetic factors of the cardiac disease and perinatal outcome should also be addressed. This review discusses the relevance of cardiovascular disease in the context of female reproduction. It presents currently available risk scores and the various topics to be covered in preconception counselling. This includes an overview of drugs commonly prescribed and genetic factors of congenital malformations. Furthermore, indications and contraindications of contraceptive methods are reviewed; this includes special aspects in the prescription of contraceptives for this particular group of women.