Contraception and Pregnancy Planning in Women With Congenital Heart Disease

The cardiovascular risk of pregnancy among women with congenital heart disease is heterogeneous, ranging from negligible to prohibitively high. Nonetheless, many of these patients do not report being counseled about the potential risks, and the incidence of unintended pregnancy is high. These women should be counseled on safe and effective contraceptive options. Long-acting reversible contraceptives, including the intrauterine devices and etonogestrel implant, are highly effective and safe for all cardiac patients. These are good options for pregnancy planning for women at elevated risk of cardiovascular complications during pregnancy, who are taking potentially teratogenic medications, or who have contraindications to estrogen-containing methods. Pregnancy management begins with pre-conceptual risk stratification and counseling regarding individual cardiovascular and fetal risks. As significant lapse in care is common at the time of transition to adult congenital cardiology care, these discussions ideally begin in pediatric clinics and continue upon transfer of care to adult congenital cardiology clinics.