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JACC April 5, 2016

Volume 67, Issue 13

Congenital Heart Disease

SAFETY OF CONTRACEPTIVE USE AMONG WOMEN WITH CONGENITAL HEART DISEASE: A
SYSTEMATIC REVIEW
Poster Contributions
Poster Area, South Hall A1
Saturday, April 02, 2016, 3:45 p.m.-4:30 p.m.

Session Title: Pregnancy and Congenital Heart Disease

Abstract Category: 22. Congenital Heart Disease: Adult
Presentation Number: 1145-191

Authors: Ginnie l. Abarbanell, Margaret Honein, Naomi Tepper, Sherry Farr, Centers for Disease Control, Atlanta, GA, USA
Background: Women with congenital heart disease (CHD) are at increased risk of pregnancy complications and need safe, effective
contraceptive methods to avoid unintended pregnancy. This systematic review examines evidence regarding safety of contraceptive use
among women with CHD.
Methods: Using terms for contraception and CHD, the PubMed database was searched for peer-reviewed articles published from January
1994 to August 2015 that included safety outcomes associated with contraceptive methods among women with CHD.
Results: Five articles met inclusion criteria. Sample sizes ranged from 7 to 237 women with CHD. Cardiac complications of hypertension
and heart failure were reported in 5 women with aortic and/or mitral insufficiency using combined oral contraceptives (COC) and depot
medroxyprogesterone acetate (DMPA). In a separate study, undefined neurological events were reported in 3 women with CHD and history
of COC use. In women with Fontan palliation, the thromboembolic complication rate did not differ between women using contraceptives
compared to those using no contraceptives. There were no reported cases of endocarditis with intrauterine device (IUD) insertion.
Conclusions: There is a paucity of data regarding the safety of contraceptive use among women with CHD. There is limited evidence of
hypertension, heart failure and neurological complications with use of COC and DMPA. Further information is needed to assist practitioners
counseling women with CHD on safe contraceptive methods.

Table: Studies Addressing Safety of Contraceptive Use Among Women with Congenital Heart Disease*, Published January 1994 to August 2015
Author (year) Contraceptive
Study design Study Population Results Quality#
country method
COC: 3 cases of hypertension
Avila et al. (1996) Prospective
89 women with heart disease: 11 with CHD COC, DMPA, IUD DMPA: 2 cases of hypertension, 1 case of heart failure II-2, poor
Brazil cohort
IUD: 1 case of heart failure
40 women with heart disease:
Suri et al. (2008) Prospective
7 with CHD (5 atrial septal defect, 1 ventricular Copper IUD No bacterial endocarditis. No cardiac complications II-3, poor
India noncomparative
septal defect, 1 patent ductus arteriosus)

151 men and women with cryptogenic stroke/

Type of oral
Tanislav et al. (2011) Retrospective transient ischemic attack and patent foramen Univariate association between oral contraceptives and silent pulmonary emboli
contraceptive not II-2, poor
Germany case series ovale. (p=0.07)
defined
9 women with intake of oral contraceptives

Pijuan-Domènech et
Retrospective 237 women with CHD: 219 biventricular CHD and 3 undefined neurological events with COC use
al., (2013) COC, POP II-2 fair
case series 18 univentricular heart No cardiac or thrombolytic events with POP
Spain

Thrombolytic complications in 8% using some form of contraception compared to

Pundi et al. (2015) Retrospective COC, POP, DMPA,
138 women with Fontan palliation 11% using no contraception. II-2, poor
USA cohort IUD
No reports of endocarditis with IUD use

*Studies limited to those assessing CHD excluding history of valve replacement

#Quality of studies assessed with US Preventive Services Task Force system for grading evidence (2001).
CHD, congenital heart disease; COC, combined oral contraceptive; DMPA, depot medroxyprogesterone acetate; IUD, intrauterine device

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