Contraceptive Use and Unintended Pregnancy in Women With Congenital Heart Disease.

OBJECTIVE: To identify patterns of contraceptive use and pregnancy in an academic adult congenital cardiology practice. METHODS: In this cross-sectional study from October 2013 through March 2014 100 women with congenital heart disease aged 18-45 years were recruited from an academic congenital heart disease clinic and administered a survey regarding pregnancy history contraception use and understanding of pregnancy-related and contraceptive-related risk. The primary outcome was current use of long-acting reversible contraception including intrauterine devices or subdermal implants. RESULTS: Of 83 sexually active women 63 (75.9% 95% confidence interval [CI] 65.3-85.1) reported currently using any contraceptive method including 30 of 83 (36.1% 95% CI 25.9-47.4) using tier I methods (typical-use failure rates of less than 1% per year) and 20 of 83 (24.1% 95% CI 15.4-34.7) using tier II methods (typical-use failure rates of 6-12% per year). Nine of 83 (10.8% 95% CI 5.1-19.6) reported currently using long-acting reversible contraception. Sixty-four of 141 total pregnancies (45.4% 95% CI 31.9-58.9) were self-reported by participants as "unexpected" rather than "planned." Only one (1.6% 95% CI 0-4.6) of the 64 unintended pregnancies occurred when the woman was using a tier I method of contraception at the time of conception. CONCLUSION: Most women with congenital heart disease of childbearing age are sexually active. The high incidence of unintended pregnancy in this group may be related to underuse of highly effective methods of contraception. Specific counseling on tier I methods may reduce unintended pregnancies in women with congenital heart disease. LEVEL OF EVIDENCE: III.