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Heart disease is the single most common cause of maternal death in the UK,1 with substandard care being reported in up to 40% of these deaths. Cardiologists need to be able to both advise women with heart disease of the risks of pregnancy and to give them the information they need to avoid unplanned pregnancies safely.
There is a lack of published data about contraception for women with heart disease. As a result, family planning physicians may be over-cautious, denying women appropriate contraception, thus leading to unplanned pregnancies.2 Similarly, cardiologists may be unaware of the range of effective and safe contraceptive methods so that patients with the highest risk lesions may not have access to effective contraception and have unintended, high risk pregnancies. In extreme examples women whose cardiac risk associated with pregnancy is low have been advised to undergo termination and sterilisation.
For each contraceptive method the contraceptive efficacy and the cardiovascular risks should be considered. Likewise, for each cardiac condition, the choice of contraceptive method depends on the cardiac risks associated with the method, the level of contraceptive efficacy required (high in those for whom unplanned pregnancy may be life-threatening), and on patient choice.
The risk of pregnancy for women with heart disease depends on the specific cardiac condition and ranges from up to 50% risk of maternal death for pulmonary hypertension, to the same as the general population for minor lesions such as mild pulmonary stenosis.
In general, there is poor provision of family planning and pre-pregnancy advice for women with heart disease.2 In particular, there is a lack of specialist services for the growing population of young women with congenital heart disease. Few cardiologists have practical knowledge of the interactions between complex heart disease, pregnancy and contraception. Advice from a multispecialty team of …
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Conflicts of interest: EA MacGregor has received lecture fees, research grants, ad hoc consultancy fees and payments for expenses from the manufacturers of contraceptive products. There are no other conflicts of interest