Contraception Use in Adolescents and Young Adults with Congenital Heart Disease

Women with congenital heart disease (CHD) are at elevated risk for morbidity and mortality during childbirth. Pediatric cardiologists are in a unique position to provide reproductive counseling to their patients with CHD. We evaluated contraception use in adolescents and young adults with CHD seen in a pediatric cardiology practice. Utilizing retrospective chart review, we evaluated all encounters for female patients aged 14 - 21 years with CHD between January 2017 and June 2023 at a tertiary care center. Female patients without CHD seen over the same period were included as a comparator group. Logistic regression was used to evaluate predictors of contraception use. There were 12, 368 visits included in our study. Of the 9924 visits in patients without CHD, 23% were on contraception, and of the 2444 visits in patients with CHD, 22% were on contraception. There was an increase in contraception use over time. Controlling for age at visit, later visit year was associated with contraception use (OR 1.09 [95% CI 1.04-10.9] per year). CHD was associated with lower likelihood of contraception use [OR 0.79 [95% CI 0.70 - 0.88]). Those with single ventricle (SV) CHD and complex CHD used long-acting reversible contraception more often (54% and 46% respectively) compared to those with simple or moderate CHD (17% and 16% respectively) or no CHD (18%). Patients with CHD are receiving contraception at a lower rate than those without CHD. Given the risks that women with CHD face with pregnancy, there should be a dedicated effort to increase the percentage of women with CHD on contraception.