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Baró-Mariné F, Pijuan-Domènech A, Goya MDM, Suárez-Edo E, Miranda-Barrio B, Dos-Subirà L, Pancorbo ML, Ferreira-Gonzalez I, Carreras-Moratonas E. Progestogen only contraception in women with congenital heart disease. J OBSTET GYNAECOL 2024; 44:2320296. [PMID: 38466189 DOI: 10.1080/01443615.2024.2320296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2023] [Accepted: 02/13/2024] [Indexed: 03/12/2024]
Abstract
BACKGROUND There is little information of progestogen-only contraceptives in patients with congenital heart disease (CHD) on the long-term. OBJECTIVE To evaluate the use of contraception in patients with CHD. We studied both short-acting reversible contraceptives (SARCs), oral progestin-only pills (POPs) and long-acting reversible contraceptives (LARCs): intrauterine devices (IUD-IPs) and subdermal implants both impregnated with progestogens (SI-IPs). STUDY DESIGN Retrospective study of all women attending the preconception clinic. Contraceptive methods were classified in three TIERs of effectiveness before and after consultation. ESC classification regarding pregnancy risk, WHOMEC classification for combined oral contraceptive safety was collected. RESULTS Six hundred and fifty-three patients. A significant proportion of them switched from TIER 3 to TIER 2 or 1 (p < .001) after consultation. One hundred and ninety-nine patients used POPs, 53 underwent IUD-IPs implantation and 36 SI-IPs, mean duration was 58 ± 8, 59 ± 8 and 53 ± 38 months, respectively. CONCLUSIONS Because of their safety and efficacy, IUD-IPs and SI-IPs should be considered as first-line contraception in patients with CHD.
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Affiliation(s)
- Francesc Baró-Mariné
- Department of Obstetrics and Gynaecology, University Hospital Vall d'Hebron, Barcelona, Spain
| | - Antonia Pijuan-Domènech
- Integrated Hospital Vall d'Hebron-Hospital Sant Pau Adult Congenital Heart Disease Unit, University Hospital Vall d'Hebron, Barcelona, Spain
- Department of Cardiology, University Hospital Vall d'Hebron, CIBER-CV, Barcelona, Spain
| | - Maria Del Mar Goya
- Department of Obstetrics and Gynaecology, University Hospital Vall d'Hebron, Barcelona, Spain
| | - Elena Suárez-Edo
- Department of Anesthesiology, Hospital Vall d'Hebron, Barcelona, Spain
| | - Berta Miranda-Barrio
- Integrated Hospital Vall d'Hebron-Hospital Sant Pau Adult Congenital Heart Disease Unit, University Hospital Vall d'Hebron, Barcelona, Spain
- Department of Cardiology, University Hospital Vall d'Hebron, CIBER-CV, Barcelona, Spain
| | - Laura Dos-Subirà
- Integrated Hospital Vall d'Hebron-Hospital Sant Pau Adult Congenital Heart Disease Unit, University Hospital Vall d'Hebron, Barcelona, Spain
- Department of Cardiology, University Hospital Vall d'Hebron, CIBER-CV, Barcelona, Spain
| | - Maria Luisa Pancorbo
- Department of Obstetrics and Gynaecology, University Hospital Vall d'Hebron, Barcelona, Spain
| | - Ignacio Ferreira-Gonzalez
- Department of Cardiology, University Hospital Vall d'Hebron, CIBER-CV, Barcelona, Spain
- Department of Cardiology, University Hospital Vall d'Hebron, CIBER-ESP, Barcelona, Spain
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Feyissa TR, Akter S, Harris ML. Contraceptive counselling and uptake of contraception among women with cardiovascular diseases: a systematic review and meta-analysis. Clin Res Cardiol 2024; 113:1151-1170. [PMID: 38985159 PMCID: PMC11269356 DOI: 10.1007/s00392-024-02472-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2023] [Accepted: 05/24/2024] [Indexed: 07/11/2024]
Abstract
To address the lack of clarity regarding contraceptive counselling and uptake of contraception among women with cardiovascular disease (CVD), this study aimed to conduct a systematic review and meta-analysis on contraceptive counselling and the subsequent uptake of contraception among women with CVD. A search across six databases identified 1228 articles, with 11 studies (2580 participants) included. The pooled prevalence of contraceptive counselling was 63%, varying from 36 to 94% in individual studies. Inconsistent delivery and documentation of counselling were noted, along with a lack of knowledge about pregnancy complications and misconceptions regarding CVD severity. For contraceptive uptake (n = 5), the pooled prevalence was 64% (95% confidence interval, 45 to 82%). Women with CVD were also found to use less effective methods as well as methods not recommended for their condition (e.g., combined hormonal methods among participants with absolute or relative contraindications). Improving contraceptive counselling and choices for women with CVD can not only enhance knowledge and decision-making for women with CVD in line with their reproductive goals and preferences but reduce high-risk unintended pregnancies and adverse pregnancy outcomes.
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Affiliation(s)
- Tesfaye Regassa Feyissa
- Deakin Rural Health, School of Medicine, Deakin University, Warrnambool, Australia.
- Geohealth Laboratory, Dasman Diabetes Institute, 15462, Kuwait City, Kuwait.
| | - Shahinoor Akter
- John Richards Centre for Rural Ageing Research, La Trobe Rural Health School, La Trobe University, Albury-Wodonga, Victoria, Australia
| | - Melissa L Harris
- Centre for Women's Health Research, College of Health, Medicine and Wellbeing, The University of Newcastle, Newcastle, New South Wales, Australia
- Hunter Medical Research Institute, Newcastle, New South Wales, Australia
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3
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Sarma AA, Lau ES, Sharma G, King LP, Economy KE, Wood R, Wood MJ, Feinberg L, Isselbacher EM, Hameed AB, DeFaria Yeh D, Scott NS. Maternal Cardiovascular Health Post-Dobbs. NEJM EVIDENCE 2024; 3:EVIDra2300273. [PMID: 38320493 DOI: 10.1056/evidra2300273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/08/2024]
Abstract
Maternal Cardiovascular Health Post-DobbsPregnancy is associated with increasing morbidity and mortality in the United States. In the post-Dobbs era, many pregnant patients at highest risk no longer have access to abortion, which has been a crucial component of standard medical care.
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Affiliation(s)
- Amy A Sarma
- Division of Cardiology, Massachusetts General Hospital, Boston
| | - Emily S Lau
- Division of Cardiology, Massachusetts General Hospital, Boston
| | - Garima Sharma
- Inova Schar Heart and Vascular, Inova Health System, Falls Church, VA
| | - Louise P King
- Division of Obstetrics and Gynecology, Brigham and Women's Hospital, Boston
| | | | - Rachel Wood
- Division of Obstetrics and Gynecology, Brigham and Women's Hospital, Boston
| | | | - Loryn Feinberg
- Division of Cardiology, Beth Israel Deaconess Medical Center, Boston
| | | | | | | | - Nandita S Scott
- Division of Cardiology, Massachusetts General Hospital, Boston
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4
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Shao SJ, Cassidy AG, Alanizi A, Agarwal A, Sobhani NC. Contraceptive counseling and choices in pregnancies with maternal cardiac disease. J Matern Fetal Neonatal Med 2023; 36:2217318. [PMID: 37263627 DOI: 10.1080/14767058.2023.2217318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Revised: 05/12/2023] [Accepted: 05/18/2023] [Indexed: 06/03/2023]
Abstract
OBJECTIVE Unplanned pregnancies in women with maternal cardiac disease (MCD) are associated with increased morbidity and mortality, but the majority of these individuals do not use highly reliable contraception on postpartum hospital discharge. Contraceptive counseling in this population outside of pregnancy is incomplete and counseling during pregnancy remains poorly characterized. Our objective was to evaluate the provision and quality of contraceptive counseling for individuals with MCD during pregnancy. METHODS All individuals with MCD who delivered between 2008 and 2021 at a tertiary care institution with a multidisciplinary cardio-obstetrics team were sent a 27-question survey. A subset of questions were derived from the validated Interpersonal Quality in Family Planning (IQFP) survey, which emphasizes interpersonal connection, adequate information, and decision support for the individual. Each participant received a $15 gift card for survey completion. We performed chart review for clinical and demographic details, including cardiac risk score. RESULTS Of 522 individuals to whom the survey was sent, 133 responded and met inclusion criteria. Overall, 67% discussed contraception with their general obstetrician, 36% with their maternal-fetal medicine (MFM) specialist, and 24% with their cardiologist. Compared to individuals with low cardiac risk scores, those with high cardiac risk scores had a nonsignificant trend toward being more likely to discuss contraception with a MFM provider (52% vs 33%, p = .08). 65% reported that their provider was 'excellent' or 'good' in all IQFP domains. Respondents valued providers who respected their autonomy and offered thorough counseling. Respondents disliked feeling pressured or uninformed about the safety of contraceptive options. CONCLUSION Most individuals with MCD reported excellent contraceptive counseling during pregnancy. Additional work is needed to understand barriers to and enablers for effective, patient-centered contraceptive counseling and use in this population.
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Affiliation(s)
- Shirley J Shao
- School of Medicine, University of California San Francisco, CA, USA
| | - Arianna G Cassidy
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Division of Maternal-Fetal Medicine, University of California, San Francisco, CA, USA
| | - Aryn Alanizi
- School of Medicine, Eastern Virginia Medical School, Norfolk, VA, USA
| | - Anushree Agarwal
- Department of Medicine, Division of Cardiology, University of California, San Francisco, CA, USA
| | - Nasim C Sobhani
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Division of Maternal-Fetal Medicine, University of California, San Francisco, CA, USA
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5
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Yellin S, Wiener S, Kankaria R, Vorawandthanachai T, Hsu D, Haberer K, Bortnick AE, Diana WS. Characteristics and outcomes of socioeconomically disadvantaged pregnant individuals with adult congenital heart disease presenting to a Cardio-Obstetrics Program. Am J Obstet Gynecol MFM 2023; 5:101146. [PMID: 37659603 PMCID: PMC11157696 DOI: 10.1016/j.ajogmf.2023.101146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Revised: 07/20/2023] [Accepted: 08/26/2023] [Indexed: 09/04/2023]
Abstract
BACKGROUND Outcomes of individuals with adult congenital heart disease who are socioeconomically disadvantaged and cared for in cardio-obstetrical programs, are lacking. OBJECTIVE This study aimed to describe the clinical characteristics, maternal pregnancy outcomes, and contraceptive uptake in individuals with adult congenital heart disease in an urban cardio-obstetrical program. STUDY DESIGN Retrospective data were collected for individuals with adult congenital heart disease seen in the Maternal Fetal Medicine-Cardiology Joint Program at Montefiore Health System between 2015 and 2021 and compared using modified World Health Organization class I, II vs the modified World Health Organization class ≥II/III. RESULTS Over 90% of individuals with adult congenital heart disease were pregnant at the time of referral. Modified World Health Organization class I, II (n=77, 62.4% Black or Hispanic/Latina) had a total of 94 pregnancies and modified World Health Organization class ≥II/III (n=49, 49.0% Black or Hispanic/Latina) had a total of 56 pregnancies. Over 25% of individuals in each group had a body mass index ≥30 (P=.78), and very low summary socioeconomic scores. Modified World Health Organization class ≥II/III were more likely to be anticoagulated in the first trimester than modified World Health Organization class I, II (10.7% vs 0.0%, P=.002) and throughout pregnancy (14.3% vs 3.2% P=.02). Modified World Health Organization class ≥II/III were more likely to require arterial monitoring during delivery than modified World Health Organization class I, II (14.3% vs 0.0%, P=.001) or delivery under general anesthesia (8.9% vs 1.1%, P=.03) but had a comparable frequency of cesarean delivery (35.8% vs 41.3%, P=.68). There were no in-hospital maternal deaths. There was no difference in the type of contraception recommended by modified World Health Organization class, however, modified World Health Organization class ≥II/III were more likely to receive long-acting types or permanent sterilization (35.6% vs 54.6%, P=.045). CONCLUSION In a socioeconomically disadvantaged cohort with adult congenital heart disease from a historically marginalized community, those with modified World Health Organization class ≥II/III had more complex antepartum and intrapartum needs but similar maternal and obstetrical outcomes as modified World Health Organization class I, II. The multidisciplinary approach offered by a cardio-obstetrics program may contribute to successful outcomes in this high-risk cohort, and these data are hypothesis-generating.
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Affiliation(s)
- Shira Yellin
- Albert Einstein College of Medicine, Bronx, NY (Dr. Yellin, Dr. Wiener, Dr. Kankaria, Dr. Vorawandthanachai, Dr. Hsu, Dr. Haberer, Dr. Bortnick, and Dr. Diana)
| | - Sara Wiener
- Albert Einstein College of Medicine, Bronx, NY (Dr. Yellin, Dr. Wiener, Dr. Kankaria, Dr. Vorawandthanachai, Dr. Hsu, Dr. Haberer, Dr. Bortnick, and Dr. Diana)
| | - Rohan Kankaria
- Albert Einstein College of Medicine, Bronx, NY (Dr. Yellin, Dr. Wiener, Dr. Kankaria, Dr. Vorawandthanachai, Dr. Hsu, Dr. Haberer, Dr. Bortnick, and Dr. Diana)
| | - Thammatat Vorawandthanachai
- Albert Einstein College of Medicine, Bronx, NY (Dr. Yellin, Dr. Wiener, Dr. Kankaria, Dr. Vorawandthanachai, Dr. Hsu, Dr. Haberer, Dr. Bortnick, and Dr. Diana)
| | - Daphne Hsu
- Albert Einstein College of Medicine, Bronx, NY (Dr. Yellin, Dr. Wiener, Dr. Kankaria, Dr. Vorawandthanachai, Dr. Hsu, Dr. Haberer, Dr. Bortnick, and Dr. Diana); Division of Pediatric Cardiology and Adult Congenital Heart Program, Department of Pediatrics, Children's Hospital at Montefiore Medical Center, Bronx, NY (Dr. Hsu and Dr. Haberer)
| | - Kim Haberer
- Albert Einstein College of Medicine, Bronx, NY (Dr. Yellin, Dr. Wiener, Dr. Kankaria, Dr. Vorawandthanachai, Dr. Hsu, Dr. Haberer, Dr. Bortnick, and Dr. Diana); Division of Pediatric Cardiology and Adult Congenital Heart Program, Department of Pediatrics, Children's Hospital at Montefiore Medical Center, Bronx, NY (Dr. Hsu and Dr. Haberer)
| | - Anna E Bortnick
- Albert Einstein College of Medicine, Bronx, NY (Dr. Yellin, Dr. Wiener, Dr. Kankaria, Dr. Vorawandthanachai, Dr. Hsu, Dr. Haberer, Dr. Bortnick, and Dr. Diana); Division of Cardiology, Department of Medicine, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, NY (Dr. Bortnick and Dr. Diana); Maternal Fetal Medicine-Cardiology Joint Program, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, NY (Dr. Bortnick and Dr. Diana); Department of Women's Health, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, NY (Dr. Bortnick and Dr. Diana)
| | - Wolfe S Diana
- Albert Einstein College of Medicine, Bronx, NY (Dr. Yellin, Dr. Wiener, Dr. Kankaria, Dr. Vorawandthanachai, Dr. Hsu, Dr. Haberer, Dr. Bortnick, and Dr. Diana); Division of Cardiology, Department of Medicine, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, NY (Dr. Bortnick and Dr. Diana); Maternal Fetal Medicine-Cardiology Joint Program, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, NY (Dr. Bortnick and Dr. Diana); Department of Women's Health, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, NY (Dr. Bortnick and Dr. Diana).
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6
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West KM, Bayley E, Pechan J, Engelberg RA, Albright C, Buber J, Steiner JM. Adults with CHD balancing motivations and concerns in pregnancy decision-making. Cardiol Young 2023; 33:2221-2227. [PMID: 36632799 DOI: 10.1017/s1047951122004139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
BACKGROUND While the incidence of pregnancy has increased among individuals with adult CHD, little has been described about considerations and experiences of patients with adult CHD regarding pregnancy. OBJECTIVE We aimed to explore patients' motivations, concerns, and decision-making processes regarding pregnancy. METHODS In April 2019-January 2020, we conducted in-depth telephone interviews with patients (n = 25) with simple, moderate, or complex adult CHD, who received prenatal care at the University of Washington during 2010-2019 and experienced a live birth. Transcripts were analysed using thematic analysis. RESULTS Participants described motivations for pregnancy as both internal desires (motherhood, marriage fulfillment, biological connection, fetal personhood, self-efficacy) and external drivers (family or community), as well as concerns for the health and survival of themselves and the fetus. Factors that enabled their decision to maintain a pregnancy included having a desire that outweighed their perceived risk, using available data to guide their decision, planning for contingencies and knowing their beliefs about termination, plus having a trusted healthcare team, social support, and resources. Factors that led to insurmountable risk in subsequent pregnancies included desire having been fulfilled by the first pregnancy, compounding risk with age and additional pregnancies, new responsibility to an existing child, and reduced healthcare team and social support. CONCLUSIONS Understanding individuals' motivations and concerns, and how they weigh their decisions to become or remain pregnant, can help clinicians better support patients with adult CHD considering pregnancy. Clinician education on patient experiences is warranted.
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Affiliation(s)
- Kathleen M West
- Department of Health Systems and Population Health, University of Washington, Seattle, WA, USA
| | - Elizabeth Bayley
- Division of Cardiology, University of Washington, Seattle, WA, USA
| | - Jaimie Pechan
- Division of Cardiology, University of Washington, Seattle, WA, USA
| | - Ruth A Engelberg
- Cambia Palliative Care Center of Excellence, University of Washington, Seattle, WA, USA
- Division of Pulmonary, Critical Care and Sleep Medicine, University of Washington, Seattle, WA, USA
| | - Catherine Albright
- Department of Obstetrics & Gynecology, University of Washington, Seattle, WA, USA
| | - Jonathan Buber
- Division of Cardiology, University of Washington, Seattle, WA, USA
| | - Jill M Steiner
- Division of Cardiology, University of Washington, Seattle, WA, USA
- Cambia Palliative Care Center of Excellence, University of Washington, Seattle, WA, USA
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Panah LG, Menachem JN, Boos EW, Lindley KJ. Pregnancy and Adult Congenital Heart Disease in a Post-Roe World. J Card Fail 2023; 29:1556-1560. [PMID: 37973315 DOI: 10.1016/j.cardfail.2023.07.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Revised: 07/18/2023] [Accepted: 07/24/2023] [Indexed: 11/19/2023]
Affiliation(s)
- Lindsay G Panah
- From the Department of Medicine, Division of Cardiology, Vanderbilt University Medical Center, Nashville, TN
| | - Jonathan N Menachem
- From the Department of Medicine, Division of Cardiology, Vanderbilt University Medical Center, Nashville, TN
| | - Elise W Boos
- Department of Obstetrics and Gynecology, Vanderbilt University Medical Center, Nashville, TN
| | - Kathryn J Lindley
- From the Department of Medicine, Division of Cardiology, Vanderbilt University Medical Center, Nashville, TN; Department of Obstetrics and Gynecology, Vanderbilt University Medical Center, Nashville, TN.
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8
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Farr SL, Galindo M, Downing KF, Nembhard WN, Klewer SE, Judge AS, Bolin EH, Benavides A, Oster ME. Reproductive Health Counseling and Concerns Among Women with Congenital Heart Defects With and Without Disabilities. J Womens Health (Larchmt) 2023; 32:740-746. [PMID: 37184635 PMCID: PMC10680446 DOI: 10.1089/jwh.2022.0395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/16/2023] Open
Abstract
Background: Women with disabilities are less likely to receive reproductive health counseling than women without disabilities. Yet, little is known about reproductive health counseling and concerns among women with congenital heart defects (CHD) and disabilities. Methods: We used population-based survey data from 778 women aged 19 to 38 years with CHD to examine contraceptive and pregnancy counseling and pregnancy concerns and experiences by disability status, based on six validated questions on vision, hearing, mobility, cognition, self-care, and living independently. Multivariable Poisson regression was used to examine adjusted prevalence ratios between disability status and each outcome, adjusted for CHD severity, age, race/ethnicity, place of birth (Arkansas, Arizona, Georgia), and insurance type. Results: Women with disabilities (n = 323) were 1.4 and 2.3 times more likely than women without disabilities (n = 455) to receive clinician counseling on safe contraceptive methods and avoiding pregnancy because of their CHD. Women with CHD and disabilities, compared to those without disabilities, were more likely to be concerned about their ability to have children (aPR = 1.2) and to have delayed or avoided pregnancy (aPR = 2.2); they were less likely to have ever been pregnant (aPR = 0.7). Associations differed slightly across specific disability types. All associations remained after excluding 71 women with chromosomal anomalies. Conclusion: Among women with CHD, reproductive counseling, concerns, and experiences differ by disability status.
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Affiliation(s)
- Sherry L. Farr
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Maureen Galindo
- University of Arizona Medical Center-University Campus, Tucson, Arizona, USA
| | - Karrie F. Downing
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Wendy N. Nembhard
- University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Scott E. Klewer
- University of Arizona Medical Center-University Campus, Tucson, Arizona, USA
| | - Ashley S. Judge
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
- Oak Ridge Institute for Science and Education, University of California Santa Cruz, Santa Cruz, California, USA
| | - Elijah H. Bolin
- University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Argelia Benavides
- University of Arizona Medical Center-University Campus, Tucson, Arizona, USA
| | - Matthew E. Oster
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
- Children’s Healthcare of Atlanta and Emory University School of Medicine, Atlanta, Georgia, USA
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Farr SL, Downing KF, Tepper NK, Oster ME, Glidewell MJ, Reefhuis J. Reproductive Health of Women with Congenital Heart Defects. J Womens Health (Larchmt) 2023; 32:132-137. [PMID: 36757282 PMCID: PMC10680443 DOI: 10.1089/jwh.2022.0513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/10/2023] Open
Abstract
This report provides an overview of the unique reproductive health issues facing women with congenital heart defects (CHDs) and of the clinical care and professional guidelines on contraception, preconception care, and pregnancy for this population. It describes Centers for Disease Control and Prevention (CDC) activities related to surveillance of reproductive health issues among females with CHDs. It also describes CDC's work bringing awareness to physicians who provide care to adolescents and women with CHDs, including obstetrician/gynecologists, about the need for lifelong cardiology care for their patients with CHDs.
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Affiliation(s)
- Sherry L Farr
- Division of Birth Defects and Infant Disorders, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Karrie F Downing
- Division of Birth Defects and Infant Disorders, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Naomi K Tepper
- Division of Birth Defects and Infant Disorders, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Matthew E Oster
- Division of Birth Defects and Infant Disorders, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Melissa J Glidewell
- Division of Birth Defects and Infant Disorders, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Jennita Reefhuis
- Division of Birth Defects and Infant Disorders, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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10
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Herrick N, Al-Rousan T, Rodriguez C, Lee JH, Valente AM, Stone J, Ramos G, Asante-Boateng B, El-Said H, Moceri-Casas M, Alshawabkeh L. Priorities and Understanding of Pregnancy Among Women With Congenital Heart Disease: A Mixed-Methods Study. JACC. ADVANCES 2022; 1:100112. [PMID: 38939700 PMCID: PMC11198376 DOI: 10.1016/j.jacadv.2022.100112] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Revised: 08/09/2022] [Accepted: 08/11/2022] [Indexed: 06/29/2024]
Abstract
Background Many women with congenital heart disease (CHD) desire safe and successful pregnancies, but a significant proportion does not seek prepregnancy counseling. Objectives This study aims to distinguish the personal priorities and perceptions about pregnancy in this growing population. Methods Women aged 18 to 50 years with CHD were enrolled from 2 sites. Using a mixed-methods approach (Q-methodology), 179 participants sorted 23 statements representing a collection of views on pregnancy using priority forced ranking along a scale from "strongly agree" to "strongly disagree." Results Majority of women were between 25 and 29 years of age, had moderate or severely complex CHD, and were married. Five unique group identities were elucidated from patient responses. Group 1 was centered around a strong desire to start a family. Women in group 2 had significant anxiety, and their psychological wellbeing interfered with their decision to start a family. Women in group 3 were concerned about premature death; if they do have kids, they want to be alive to see them grow old. Women in group 4 had strong objections to termination. Group 5 valued health care engagement. Group identities were unrelated to CHD complexity and demographic factors such as age and marital status. Six differentiating statements were identified that help distinguish which group a woman aligns with. Conclusions Women with CHD have diverse priorities and values relating to pregnancy and heart disease. This study used a mixed-methods approach to provide a framework identifying several domains for targeted prepregnancy counseling in women with CHD.
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Affiliation(s)
- Nicole Herrick
- Adult Congenital Heart Disease Program, Division of Cardiovascular Medicine, University of California-San Diego, San Diego, California, USA
| | - Tala Al-Rousan
- Herbert Wertheim School of Public Health and Human Longevity, University of California-San Diego, San Diego, California, USA
| | - Carla Rodriguez
- Division of Cardiology, Department of Cardiology, Boston Children's Hospital, Boston, Massachusetts, USA
- Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Ji Hae Lee
- Division of Cardiology, Department of Cardiology, Boston Children's Hospital, Boston, Massachusetts, USA
- Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Anne Marie Valente
- Division of Cardiology, Department of Cardiology, Boston Children's Hospital, Boston, Massachusetts, USA
- Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Jordan Stone
- Reproductive Medicine Department, University of California-San Diego, San Diego, California, USA
| | - Gladys Ramos
- Reproductive Medicine Department, University of California-San Diego, San Diego, California, USA
| | - Bendelyn Asante-Boateng
- Adult Congenital Heart Disease Program, Division of Cardiovascular Medicine, University of California-San Diego, San Diego, California, USA
| | - Howaida El-Said
- Division of Pediatric Cardiology, Rady Children's Hospital and UC San Diego School of Medicine, San Diego, California, USA
| | - Maria Moceri-Casas
- Adult Congenital Heart Disease Program, Division of Cardiovascular Medicine, University of California-San Diego, San Diego, California, USA
| | - Laith Alshawabkeh
- Adult Congenital Heart Disease Program, Division of Cardiovascular Medicine, University of California-San Diego, San Diego, California, USA
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MILLER HE, DO SC, CRUZ G, PANELLI DM, LEONARD SA, GIRSEN A, LEE CJ, KHANDELWAL A, SHAW KA, BIANCO K. Addressing postpartum contraception practices utilizing a multidisciplinary Pregnancy Heart Team approach. AJOG GLOBAL REPORTS 2022; 2:100100. [DOI: 10.1016/j.xagr.2022.100100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Katz AJ, Lyon S, Farrell AG, Srivastava N, Wilkinson TA, Shew ML. Adolescent Women with Congenital Heart Disease: Self-Reported Reproductive Health Discussions with Health Care Providers. J Pediatr Adolesc Gynecol 2022; 35:299-304. [PMID: 34999230 PMCID: PMC9149112 DOI: 10.1016/j.jpag.2021.12.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Revised: 12/14/2021] [Accepted: 12/29/2021] [Indexed: 10/19/2022]
Abstract
STUDY OBJECTIVE This study evaluated self-reported discussions with health care providers (HCPs) among adolescent and young adult (AYA) women with congenital heart disease (CHD). DESIGN Data were collected through a one-time survey of AYA women. SETTING Participants were recruited from pediatric cardiology clinics. PARTICIPANTS AYA women with CHD, ages 14-21 (N = 107) INTERVENTIONS: None MAIN OUTCOME MEASURES: Questionnaires assessed adolescent characteristics and specific HCP discussions regarding transmissibility of a cardiac condition to the infant, risk of pregnancy, and hormonal contraception. Outcome measures were self-reported discussions with HCPs about these reproductive health topics. RESULTS Mean age was 16.8 years (SD = 2.1). Self-reported reproductive health discussions were infrequent, including discussions on transmissibility of a heart condition to their offspring (37%), risk of pregnancy to their offspring (34%), risks of pregnancy to their health (46%), and risks of hormonal contraception given their heart condition (21%). Reported discussions were most commonly with a cardiologist. CONCLUSIONS AYA women with CHD reported limited discussions about reproductive health topics important to those with CHD. Lack of appropriate and timely counseling could lead to poor maternal and child health outcomes. Targeted interventions that improve reproductive health discussions between HCPs and AYA women with CHD are needed to close critical information and service gaps.
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Affiliation(s)
- Amy J Katz
- Division of Adolescent Medicine, Department of Pediatrics, Indiana University School of Medicine, Indianapolis, Indiana
| | - Shannon Lyon
- Department of Cardiology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Anne G Farrell
- Department of Pediatric Cardiology, Riley Hospital for Children, Indiana University Health, Indianapolis, Indiana
| | - Nayan Srivastava
- Department of Pediatric Cardiology, Riley Hospital for Children, Indiana University Health, Indianapolis, Indiana
| | - Tracey A Wilkinson
- Division of Children's Health Services Research, Department of Pediatrics, Indiana University School of Medicine, Indianapolis, Indiana
| | - Marcia L Shew
- Division of Adolescent Medicine, Department of Pediatrics, Indiana University School of Medicine, Indianapolis, Indiana.
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Nekuei N, Kohan S, Movahedi M, Sadeghi M. Identifying and responding to the sexual reproductive health needs of women with heart disease: A qualitative study. IRANIAN JOURNAL OF NURSING AND MIDWIFERY RESEARCH 2022; 27:221-228. [PMID: 36237959 PMCID: PMC9552580 DOI: 10.4103/ijnmr.ijnmr_230_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Revised: 09/06/2021] [Accepted: 11/29/2021] [Indexed: 11/06/2022]
Abstract
Background: Recognizing the needs of women with heart disease in the field of reproductive health and meeting them can reduce the related complications. The aim of this study was to identify the sexual and reproductive health needs of these women. Materials and Methods: The present study was conducted with qualitative approach (Content analysis). Ten married women of reproductive age with heart disease and 20 providers and managers in, Isfahan, Iran, were selected by using purposive and snowball methods (in 2020). The research setting included heart disease clinics, offices of health team, comprehensive health centers, and the Isfahan Maternal Health Department. Data were collected by semi-structured individual face-to-face interviews in the clinic or other appropriate locations. Some interviews were conducted virtually. Analysis was performed by Qualitative contentment analysis / Conventional content analysis. Results: Sexual and reproductive health needs of women with heart disease were emerged in five main categories, “planned childbearing,” “ssociocultural support,” “Early reproductive health care of girls,” “health team attention to sexual health,” and “health system revision.” Conclusions: Providing comprehensive reproductive health services before and during pregnancy, family planning, and sexual health for women with heart disease is necessary. It seems that using a multidisciplinary team approach could improve their reproductive health.
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Kasargod Prabhakar CR, Pamment D, Thompson PJ, Chong H, Thorne SA, Fox C, Morris K, Hudsmith LH. Pre-conceptual counselling in cardiology patients: still work to do and still missed opportunities. A comparison between 2015 and 2019 in women with cardiac disease attending combined obstetric cardiology clinics. Should the European Guidelines change anything? Cardiol Young 2022; 32:64-70. [PMID: 34030760 DOI: 10.1017/s1047951121001530] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Women with underlying cardiac conditions have an increased risk of adverse pregnancy outcomes. Counselling reproductive age women with heart disease is important to assist them in deciding whether to pursue pregnancy, to ensure their best cardiovascular status prior to pregnancy, and that they understand the risks of pregnancy for them and baby. This also provides an opportunity to explore management strategies to reduce risks. For this growing cohort of women, there is a great need for pre-conceptual counselling.This retrospective comparative audit assessed new referrals and pre-conceptual counselling of women attending a joint obstetric-cardiology clinic at a tertiary maternity centre in a 12-month period of 2015-2016 compared with 2018-2019. This reflected the timing of the introduction of a multidisciplinary meeting prior to clinics and assessed the impact on referrals with the introduction of the European Society of Cardiology guidelines.Data were reviewed from 56 and 67 patients in respective audit periods. Patient's risk was stratified using modified World Health Organization classification.Less than 50% of women with pre-existing cardiac conditions had received pre-conceptual counselling, although half of them had risks clearly documented. The majority of patients had a recent electrocardiograph and echocardiogram performed prior to counselling, and there was a modest improvement in the number of appropriate functional tests performed between time points. One-third of patients in both cohorts were taking cardiac medications during pregnancy.There was a significant increase in the number of pregnant women with cardiac disease and in complexity according to modified World Health Organization risk classification. While there have been improvements, it is clear that further work to improve availability and documentation of pre-pregnancy counselling is needed.
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Affiliation(s)
| | - Daisy Pamment
- University of Birmingham Medical School, Birmingham, UK
| | | | - Hsu Chong
- The Rosie Maternity Hospital, Cambridge, UK
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Reyes-Martí L, Rubio-Rico L, Ortega-Sanz L, Raigal-Aran L, de la Flor-López M, Roca-Biosca A, Valls-Fonayet F, Moharra-Francés M, Escuriet-Peiro R, de Molina-Fernández MI. Contraceptive counselling experiences in Spain in the process of creating a web-based contraceptive decision support tool: a qualitative study. Reprod Health 2021; 18:237. [PMID: 34838040 PMCID: PMC8626746 DOI: 10.1186/s12978-021-01254-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Accepted: 10/04/2021] [Indexed: 11/15/2022] Open
Abstract
Background The choice of contraceptive method is a complex decision, and professionals should offer counselling based on the preferences, values and personal situation of the user(s). Some users are unsatisfied with the counselling received, which may, among other consequences, adversely affect method use adherence. In view of this situation, we propose exploring the experiences and needs of users and professionals for contraceptive counselling, in the context of creating a web-based contraceptive decision support tool. Methods/design Qualitative research was conducted through focus group discussions (64 users split into eight groups, and 19 professionals in two groups, in Tarragona, Spain) to explore the subjects’ experiences and needs. The data were categorized and the categories were defined and classified based on the three-step protocol or framework for Quality on Contraceptive Counseling (QCC), created by experts, which reviews the quality of interactions between user and professional during the counselling process. Results In counselling, users demand more information about the different methods, in an environment of erroneous knowledge and misinformation, which lead to false beliefs and myths in the population that are not contrasted by the professional in counselling. They complain that the method is imposed on them and that their views regarding the decision are not considered. Professionals are concerned that their lack of training leads to counselling directed towards the methods they know best. They acknowledge that a paternalistic paradigm persists in the healthcare they provide, and decision support tools may help to improve the situation. Conclusions Users feel unsatisfied and/or demand more information and a warmer, more caring approach. Professionals are reluctant to assume a process of shared decision-making. The use of a contraception DST website may solve some shortcomings in counselling detected in our environment. In Spain, individuals can use a variety of contraceptive methods. Professionals involved in contraceptive counselling should help users to choose and properly use the method that best suits their preferences, personal situation and health status. However, there is a high number of unplanned pregnancies and the population feels dissatisfied with the counselling received. In the context of creating a website dealing with contraceptive methods, we wished to find out how counselling was taking place, giving voice those directly concerned. A qualitative study was proposed to explore the experiences and needs of users and professionals during counselling. Ten focus groups were conducted involving 64 users and 19 professionals from Tarragona (Spain). The results were ordered based on the Quality on Contraceptive Counseling (QCC) framework, created by experts, which determines what the relationship between user and professional should be like during the counselling process. Our analysis highlighted users’ little knowledge and false beliefs concerning contraception who, moreover, complained of receiving little information during counselling. They expressed their discontent with methods being imposed on them by the professional without exploring their preferences or needs. Meanwhile, the professionals argued that they often prescribe the method with which they are most familiar due to the lack of time during consultations at their office and/or because they are unfamiliar with other methods. These results, among others, offer the possibility of improving contraceptive counselling in Spain, if solutions to the difficulties and/or barriers detected are posed and implemented.
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Affiliation(s)
- Laura Reyes-Martí
- Nursing Department, Universitat Rovira i Virgili, Av/Catalunya, 35, 43002, Tarragona, Spain
| | - Lourdes Rubio-Rico
- Nursing Department, Universitat Rovira i Virgili, Av/Catalunya, 35, 43002, Tarragona, Spain.
| | - Laura Ortega-Sanz
- Nursing Department, Universitat Rovira i Virgili, Av/Catalunya, 35, 43002, Tarragona, Spain
| | - Laia Raigal-Aran
- Nursing Department, Universitat Rovira i Virgili, Av/Catalunya, 35, 43002, Tarragona, Spain
| | - Miriam de la Flor-López
- Medicine Department, Universitat Rovira i Virgili, C/Dr. Mallafrè Guasch, 4, 43005, Tarragona, Spain
| | - Alba Roca-Biosca
- Nursing Department, Universitat Rovira i Virgili, Av/Catalunya, 35, 43002, Tarragona, Spain
| | - Francesc Valls-Fonayet
- Nursing Department, Universitat Rovira i Virgili, Av/Catalunya, 35, 43002, Tarragona, Spain
| | - Montse Moharra-Francés
- Agency for Health Quality and Assessment of Catalonia (AQuAS) of the Catalan Ministry of Health, Carrer de Roc Boronat, 81, 08005, Barcelona, Spain
| | - Ramon Escuriet-Peiro
- Catalan Health Service of the Catalan Ministry of Health, Travessera de Les Corts, 131-159 - Edifici Olímpia. Població, 08028, Barcelona, Spain
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Affiliation(s)
- Iris M van Hagen
- Cardiology, Erasmus Medical Center, Rotterdam, Zuid-Holland, The Netherlands
- Cardiology, Maasstad Hospital, Rotterdam, Zuid-Holland, The Netherlands
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Anderson KN, Tepper NK, Downing K, Ailes EC, Abarbanell G, Farr SL. Contraceptive methods of privately insured US women with congenital heart defects. Am Heart J 2020; 222:38-45. [PMID: 32014720 PMCID: PMC7521137 DOI: 10.1016/j.ahj.2020.01.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2019] [Accepted: 01/11/2020] [Indexed: 01/20/2023]
Abstract
BACKGROUND The American Heart Association recommends women with congenital heart defects (CHD) receive contraceptive counseling early in their reproductive years, but little is known about contraceptive method use among women with CHD. We describe recent female sterilization and reversible prescription contraceptive method use by presence of CHD and CHD severity in 2014. METHODS Using IBM MarketScan Commercial Databases, we included women aged 15 to 44 years with prescription drug coverage in 2014 who were enrolled ≥11 months annually in employer-sponsored health plans between 2011 and 2014. CHD, CHD severity, contraceptive methods, and obstetrics-gynecology and cardiology provider encounters were identified using billing codes. We used log-binomial regression to calculate adjusted prevalence ratios (aPRs) and 95% confidence intervals (CIs) to compare contraceptive method use overall and by effectiveness tier by CHD presence and, for women with CHD, severity. RESULTS Recent sterilization or current reversible prescription contraceptive method use varied slightly among women with (39.2%) and without (37.3%) CHD, aPR = 1.04, 95% CI [1.01-1.07]. Women with CHD were more likely to use any Tier I method (12.9%) than women without CHD (9.3%), aPR = 1.41, 95% CI [1.33-1.50]. Women with severe, compared to non-severe, CHD were less likely to use any method, aPR = 0.85, 95% CI [0.78-0.92], or Tier I method, aPR = 0.84, 95% CI [0.70-0.99]. Approximately 60% of women with obstetrics-gynecology and <40% with cardiology encounters used any included method. CONCLUSIONS There may be missed opportunities for providers to improve uptake of safe, effective contraceptive methods for women with CHD who wish to avoid pregnancy.
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Affiliation(s)
- Kayla N Anderson
- Division of Birth Defects and Infant Disorders, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA, USA.
| | - Naomi K Tepper
- Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Karrie Downing
- Division of Birth Defects and Infant Disorders, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Elizabeth C Ailes
- Division of Birth Defects and Infant Disorders, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Ginnie Abarbanell
- Department of Pediatrics, Division of Pediatric Cardiology, Washington University School of Medicine/St. Louis Children's Hospital, St. Louis, MO, USA
| | - Sherry L Farr
- Division of Birth Defects and Infant Disorders, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA, USA
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Farr SL, Downing KF, Ailes EC, Gurvitz M, Koontz G, Tran EL, Alverson CJ, Oster ME. Receipt of American Heart Association-Recommended Preconception Health Care Among Privately Insured Women With Congenital Heart Defects, 2007-2013. J Am Heart Assoc 2019; 8:e013608. [PMID: 31510829 PMCID: PMC6818013 DOI: 10.1161/jaha.119.013608] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Background Our objective was to estimate receipt of preconception health care among women with congenital heart defects (CHD), according to 2017 American Heart Association recommendations, as a baseline for evaluating recommendation implementation. Methods and Results Using 2007 to 2013 IBM MarketScan Commercial Databases, we identified women with CHD diagnosis codes ages 15 to 44 years who became pregnant and were enrolled in health insurance for ≥11 months in the year before estimated conception. We assessed documentation of complete blood count, electrolytes, thyroid‐stimulating hormone, liver function, ECG, comprehensive echocardiogram, and exercise stress test, using procedural codes, and outpatient prescription claims for US Food and Drug Administration category D and X cardiac‐related medications. Differences were examined according to CHD severity, age, region of residence, year of conception, and documented encounters at obstetric and cardiology practices. We found 2524 pregnancies among 2003 women with CHD (14.4% severe CHD). In the 98.3% of women with a healthcare encounter in the year before conception, <1% received all and 22.6% received no American Heart Association–recommended tests or assessments (range: 54.4% for complete blood count to 3.1% for exercise stress test). Women with the highest prevalence of receipt of recommended care were 35 to 44 years old, pregnant in 2012 to 2013, or had a documented obstetric or cardiology encounter in the year before conception (P<0.05 for all). In 9.0% of pregnancies, ≥1 prescriptions for US Food and Drug Administration category D or X cardiac‐related medications were filled in the year before conception. Conclusions A low percentage of women with CHD received American Heart Association–recommended preconception health care in the year before conception.
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Affiliation(s)
- Sherry L Farr
- National Center on Birth Defects and Developmental Disabilities Centers for Disease Control and Prevention Atlanta GA
| | - Karrie F Downing
- National Center on Birth Defects and Developmental Disabilities Centers for Disease Control and Prevention Atlanta GA
| | - Elizabeth C Ailes
- National Center on Birth Defects and Developmental Disabilities Centers for Disease Control and Prevention Atlanta GA
| | | | | | - Emmy L Tran
- National Center on Birth Defects and Developmental Disabilities Centers for Disease Control and Prevention Atlanta GA.,Oak Ridge Institute for Science and Education Oak Ridge TN
| | - C J Alverson
- National Center on Birth Defects and Developmental Disabilities Centers for Disease Control and Prevention Atlanta GA
| | - Matthew E Oster
- National Center on Birth Defects and Developmental Disabilities Centers for Disease Control and Prevention Atlanta GA.,Children's Healthcare of Atlanta Emory University School of Medicine Atlanta GA
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Deng LX, Gleason LP, Awh K, Khan AM, Drajpuch D, Fuller S, Goldberg LA, Mascio CE, Partington SL, Tobin L, Kovacs AH, Kim YY. Too little too late? Communication with patients with congenital heart disease about challenges of adult life. CONGENIT HEART DIS 2019; 14:534-540. [DOI: 10.1111/chd.12778] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Revised: 03/10/2019] [Accepted: 04/15/2019] [Indexed: 12/01/2022]
Affiliation(s)
- Lisa X. Deng
- Department of Medicine University of California, San Francisco San Francisco California
| | - Lacey P. Gleason
- Division of Cardiology The Children’s Hospital of Philadelphia Philadelphia Pennsylvania
| | - Katherine Awh
- Division of Cardiology The Children’s Hospital of Philadelphia Philadelphia Pennsylvania
| | - Abigail May Khan
- Knight Cardiovascular Institute Oregon Health & Science University Portland Oregon
| | - David Drajpuch
- Division of Cardiology The Children’s Hospital of Philadelphia Philadelphia Pennsylvania
- Division of Cardiovascular Medicine Hospital of the University of Pennsylvania Philadelphia Pennsylvania
| | - Stephanie Fuller
- Division of Cardiothoracic Surgery The Children’s Hospital of Philadelphia Philadelphia Pennsylvania
| | - Leah A. Goldberg
- Division of Cardiology The Children’s Hospital of Philadelphia Philadelphia Pennsylvania
| | - Christopher E. Mascio
- Division of Cardiothoracic Surgery The Children’s Hospital of Philadelphia Philadelphia Pennsylvania
| | - Sara L. Partington
- Division of Cardiology The Children’s Hospital of Philadelphia Philadelphia Pennsylvania
- Division of Cardiovascular Medicine Hospital of the University of Pennsylvania Philadelphia Pennsylvania
| | - Lynda Tobin
- Division of Cardiology The Children’s Hospital of Philadelphia Philadelphia Pennsylvania
- Division of Cardiovascular Medicine Hospital of the University of Pennsylvania Philadelphia Pennsylvania
| | - Adrienne H. Kovacs
- Knight Cardiovascular Institute Oregon Health & Science University Portland Oregon
| | - Yuli Y. Kim
- Division of Cardiology The Children’s Hospital of Philadelphia Philadelphia Pennsylvania
- Division of Cardiovascular Medicine Hospital of the University of Pennsylvania Philadelphia Pennsylvania
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Abarbanell G, Tepper NK, Farr SL. Safety of contraceptive use among women with congenital heart disease: A systematic review. CONGENIT HEART DIS 2019; 14:331-340. [PMID: 30681774 PMCID: PMC6719294 DOI: 10.1111/chd.12752] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2018] [Revised: 12/31/2018] [Accepted: 01/04/2019] [Indexed: 01/16/2023]
Abstract
OBJECTIVE Women with congenital heart disease (CHD) are at increased risk of pregnancy complications and need information on safe, effective contraceptive methods to avoid unintended pregnancy. This systematic review examines evidence regarding safety of contraceptive use among women with CHD. METHODS The PubMed database was searched for any peer-reviewed articles published through April 2018 that included safety outcomes associated with reversible contraceptive methods among women with CHD. RESULTS Five articles met inclusion criteria: three studies comparing contraceptive users to nonusers and two noncomparative studies. Sample sizes ranged from 65 to 505 women with CHD. Two studies found a higher percent of thromboembolic complications among women with Fontan palliation or transposition of the great arteries using oral contraceptives. One study, among women with Fontan palliation, found no increased risk of thromboembolic complications between contraceptive users (not separated by type) and nonusers. Two studies found no endocarditis among intrauterine device users. CONCLUSIONS There is a paucity of data regarding the safety of contraceptive methods among women with CHD. Limited evidence suggests an increased incidence of thromboembolic complications with use of oral contraceptives. Further studies are needed to evaluate contraceptive safety and quantify risk in this growing population. There is also limited data regarding the safety of contraceptive methods among women with CHD. Further information is needed to assist practitioners counseling women with CHD on safety of contraceptive methods.
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Affiliation(s)
- Ginnie Abarbanell
- Department of Pediatrics, Division of Pediatric Cardiology, Washington University School of Medicine/St. Louis Children’s Hospital, St. Louis, Missouri
| | - Naomi K. Tepper
- Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Sherry L. Farr
- Division of Congenital and Developmental Disorders, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia
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Sobhani NC, Schultz H, Kheiwa A, Killion M, Parikh NI, Harris IS, Gonzalez JM, Agarwal A. Contraceptive Choices in the Immediate Postpartum Period in Women With Cardiac Disease. Am J Cardiol 2019; 123:1364-1369. [PMID: 30712772 DOI: 10.1016/j.amjcard.2019.01.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2018] [Revised: 01/16/2019] [Accepted: 01/17/2019] [Indexed: 11/29/2022]
Abstract
Maternal cardiac disease (MCD) is associated with increased maternal and neonatal morbidity and mortality. Because unplanned pregnancies are especially risky, active use of reliable contraception is critical in this population. Studies in the noncardiac population have demonstrated that the postpartum period is an ideal time to address contraceptive plans. This retrospective cohort study was designed to describe contraceptive choices in women with MCD in the immediate postpartum period and to identify factors associated with specific contraceptive plans. We included women with MCD who delivered from January 2008 to September 2017 at a tertiary care institution with a multidisciplinary obstetrics and cardiology team. Maternal demographics, specifics of MCD, obstetrical outcomes, and contraceptive plans were obtained through chart review. Contraceptive plans were categorized into highly reliable methods (sterilization or long-acting reversible contraceptive methods) or less reliable methods (nonlong-acting reversible contraceptive methods or no contraception). In the 254 women included in this study, 40% planned to use highly reliable methods, while 60% planned to use less reliable methods. Women with cardiomyopathy were more likely to choose a highly reliable method of contraception (adjusted odds ratio 2.6, 95% confidence interval 1.2 to 5.7), a reassuring finding, given the particularly high risk of poor pregnancy outcome with this diagnosis. There were no differences in other cardiac diagnoses between the 2 contraceptive groups. In conclusion, the finding that <50% of postpartum women with MCD plan to use a highly reliable method of contraception warrants further examination to identify and address barriers to reliable contraceptive plans in this high-risk population.
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Affiliation(s)
- Nasim C Sobhani
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Division of Maternal-Fetal Medicine, University of California, San Francisco, California.
| | - Hayley Schultz
- School of Medicine, University of California, San Francisco, California
| | - Ahmed Kheiwa
- Adult Congenital Heart Disease Program, Loma Linda University Medical Center, Loma Linda, California
| | - Molly Killion
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Division of Maternal-Fetal Medicine, University of California, San Francisco, California
| | - Nisha I Parikh
- Department of Medicine, Division of Cardiology, University of California, San Francisco, California
| | - Ian S Harris
- Department of Medicine, Division of Cardiology, University of California, San Francisco, California
| | - Juan M Gonzalez
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Division of Maternal-Fetal Medicine, University of California, San Francisco, California
| | - Anushree Agarwal
- Department of Medicine, Division of Cardiology, University of California, San Francisco, California
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Kronwitter A, Mebus S, Neidenbach R, Tutarel O, Ewert P, Kaemmerer H, Nagdyman N. Psychosocial situation in adults with congenital heart defects today and 20 years ago: Any changes? Int J Cardiol 2019; 275:70-76. [PMID: 30336959 DOI: 10.1016/j.ijcard.2018.10.030] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2018] [Revised: 10/05/2018] [Accepted: 10/08/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND While diagnosis and treatment of congenital heart diseases have improved over the last two decades, data regarding the course of psychosocial parameters is missing. METHODS In a cross-sectional study, 283 adults with congenital heart disease completed a slightly modified questionnaire that was applied in a comparable study twenty years ago. Significant differences between the two populations as well as possible predictors of psychosocial burden for the recent population were sought. RESULTS Despite the presence of more complex heart defects in the current cohort (p < 0.001), both populations exhibited similar values in the Ability Index. Furthermore, the current cohort reported significantly improved outcomes regarding school performance, employment, and sports. Regarding psychosocial functioning, the current cohort showed better outcomes in the domains of sadness (p < 0.01), independence (p < 0.01), understanding (p < 0.001), and acceptance (p < 0.01) of heart disease. Predictors for a worse psychosocial situation in a multiple regression analysis were anxiety, lack of curiosity, and age over 33. In the current study women, as opposed to men, reported significantly more dissatisfaction with too little information provided about their illness (p < 0.05), higher anxiety levels (p < 0.01), and heightened illness-connected burden (p < 0.05). However, women showed higher levels of independence (p < 0.01) and lower alcohol consumption (p < 0.001). CONCLUSION The psychosocial situation of adults with congenital heart disease has improved over the span of 20 years. However, particular needs and concerns should be addressed individually via doctor-patient communication. The findings here suggest that especially female patients appear to have a higher demand for counselling information, e.g. reproduction issues.
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Affiliation(s)
- Alina Kronwitter
- Department of Pediatric Cardiology and Congenital Heart Disease, German Heart Centre Munich, Technical University of Munich (TUM), Munich, Germany
| | - Siegrun Mebus
- Department of Pediatric Cardiology and Congenital Heart Disease, German Heart Centre Munich, Technical University of Munich (TUM), Munich, Germany
| | - Rhoia Neidenbach
- Department of Pediatric Cardiology and Congenital Heart Disease, German Heart Centre Munich, Technical University of Munich (TUM), Munich, Germany
| | - Oktay Tutarel
- Department of Pediatric Cardiology and Congenital Heart Disease, German Heart Centre Munich, Technical University of Munich (TUM), Munich, Germany
| | - Peter Ewert
- Department of Pediatric Cardiology and Congenital Heart Disease, German Heart Centre Munich, Technical University of Munich (TUM), Munich, Germany
| | - Harald Kaemmerer
- Department of Pediatric Cardiology and Congenital Heart Disease, German Heart Centre Munich, Technical University of Munich (TUM), Munich, Germany
| | - Nicole Nagdyman
- Department of Pediatric Cardiology and Congenital Heart Disease, German Heart Centre Munich, Technical University of Munich (TUM), Munich, Germany.
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