A study of contraception and pregnancy planning knowledge in reproductive-aged female patients in the single-center adult congenital heart clinic
N Charnvaivit, S Kongrat, P Pancharoen, T TangcharoenAbstract
Background
Cardiovascular disease is a primary cause of maternal mortality. Although survival of CHD patients into adulthood has reached 90%, ACHD women remain at high risk for pregnancy complications. Despite ESC recommendations for mWHO-based counseling, a shortage of ACHD specialists leads to inadequate family planning and contraceptive guidance for high-risk patients.
Purpose
This study aims to assess the level of knowledge regarding pregnancy and contraception among reproductive-aged women (15–49 years) with ACHD attending the adult congenital heart clinic at a single-center university hospital. The findings will be used to develop primary prevention strategies and improve the multidisciplinary care model for ACHD patients.
Methods
This descriptive study focuses on women of childbearing age diagnosed with ACHD. Data will be collected regarding their understanding of pregnancy risks associated with their specific cardiac condition and their knowledge of appropriate contraceptive methods.
Results
The study included 86 women with ACHD of reproductive age (mean age of 31.81 ± 7.75 years). Within the past year, 54.7% were sexually active. Only 59.3% had received formal birth control counseling, and effective contraceptive use was only 31.4%. Regarding overall obstetric history, 39.5% had been pregnant, and 35.8% had a history of miscarriage or termination of pregnancy. Among these 86 patients, 32 patients (37.2%) were classified as mWHO class IV. In this high-risk group, 54.7% were sexually active, but only 43.8% had effective contraception. Although the number of patients who take highly effective contraceptives was higher in mWHO class IV compared with other mWHO classes (43.8% vs. 24%, p = 0.025), 37.6% of patients with mWHO class IV had a history of pregnancy, and 50% of this group of patients had experienced miscarriage or pregnancy termination. Figure 1 demonstrates demographic data comparison between patients with mWHO class IV and other classes.
Conclusion
This study highlights a critical clinical gap: only 59.3% of ACHD patients received birth control counseling, with no difference between the high-risk mWHO class IV group and the other mWHO class. There is an urgent need to transition toward proactive, risk-stratified reproductive counseling that emphasizes both the severity of cardiac complications and the selection of highly effective contraception. This necessitates a multidisciplinary care model—integrating cardiologists, maternal-fetal medicine specialists, and specialized nurses—to safeguard the reproductive health and survival of women living with ACHD.Figure 1