140 - Contraception Use in Adolescents with Congenital Heart Disease

Poster Number: 140
Publication Number: 140.2839

Background: Congenital heart disease (CHD) is the most commonly diagnosed congenital disorder worldwide, and advances in early care has led to the vast majority living to childbearing age. Women with CHD, especially those with single ventricle (1V) physiology, face significant physiologic challenge during pregnancy and delivery. Over time we have seen that women with CHD are at high risk for morbidity and mortality during child birth. Pediatric cardiologists are in a unique position to provide reproductive counseling to their adolescent patients with CHD given their understanding of the unique physiology and limitations that come with their underlying diagnosis.

Objective: We aimed to evaluate contraception use in adolescents and young adults with CHD seen in a tertiary care center pediatric cardiology practice.

Design/Methods: 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. Similar age 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.

Results: During the study period, 1,020 patients with CHD had 2,582 visits, and 6,842 patients without CHD had 9,919 visits. During 571 (22%) of visits, the patient was on some form of contraception at time of visit (33/123 [27%] 1V CHD visits, 538/2,459 [22%] two-ventricular (2V) disease, visits ) compared to 2,288/9,919 (23)% without heart disease, with a trend towards increasing over the years studied in all groups (Figure A). Of those on contraception at any visit, 64% of patients with 1V were using long-acting reversible contraception compared to 32% with 2V physiology and 28% without heart disease, (Figure B). In multivariable logistic regression model, controlling for age at visit, later visit year (OR 1.06 [95% CI 1.04 – 1.09] per year) was associated with being on contraception, while a diagnosis of CHD was associated with lower likelihood of being on contraception [OR 0.77 [95% CI 0.67 – 0.86]).

Conclusion(s): Our data demonstrate those with congenital heart disease are receiving contraception at a lower rate than those without structural heart disease seen in cardiology clinic, though all groups are seeing encouraging trends in contraception use over time. Given the significant risks that women with congenital heart disease face with pregnancy, there should be a more dedicated effort to increase the percentage of women with CHD on contraception.