WASHINGTON, DC (March 25, 2025)—Guidelines from the American Heart Association recommend that all women of reproductive age with congenital heart defects (CHDs) receive counseling on contraceptive options and the potential impact of pregnancy on their condition. In a study selected as the Editor’s Choice for the March/April Women’s Health Issues, the authors examine the extent to which women with CHDs in three states report receiving such counseling.
Women’s Health Issues is the official journal of the Jacobs Institute of Women’s Health, which is based at the Milken Institute School of Public Health (Milken Institute SPH) at the George Washington University.
Maureen K. Galindo, of the University of Arizona College of Medicine – Tucson, and colleagues used data from the Congenital Heart Survey to Recognize Outcomes, Needs, and well-beinG (CH STRONG) study, which surveyed people in Arizona, Arkansas, and Georgia born with CHDs between 1980 and 1997. The authors analyzed responses from 765 female respondents with CHDs (who were aged 19-38 when they completed the surveys) regarding their experiences with health care provider counseling about contraception and potential pregnancy.
Galindo and colleagues found that respondents with severe CHDs were more likely than those with non-severe CHDs to report having received counseling about which methods of contraception they could use most safely (44% vs 14%), and the difference was even larger for reporting a past provider discussion about how their condition might affect pregnancy (63% of those with severe CHDs vs 17% of those with non-severe CHDs). The proportions who recalled being advised to avoid pregnancy — 32% of those with severe CHDs and 6% of those with non-severe CHDs — are high, the authors note, given that the World Health Organization cardiac risk category for which pregnancy is contraindicated comprises a very small proportion of women with CHDs, and that most women with CHDs who pursue childbearing have healthy pregnancies.
“By acknowledging potential biases and prioritizing patients' preferences, providers can cultivate a more collaborative and patient-centered approach,” Galindo and colleagues write. “Evidence-based continuing medical education for clinicians (including cardiologists, primary care providers, and obstetricians/gynecologists) can further enhance access to comprehensive reproductive health services for the growing population of women with CHDs.” They mention the American Academy of Pediatrics/CDC Congenital Heart Defects Toolkit as one resource for providers.
“The American Heart Association guidelines aim to improve the health and well-being of women with congenital heart defects, but they’re only effective if providers implement them,” said Karen McDonnell, Editor-in-Chief of Women's Health Issues and associate professor of prevention and community health at Milken Institute SPH. “This study should lead providers to improve the care they give to patients with congenital heart defects who want to avoid or delay pregnancy, as well as to those who want to plan for a healthy pregnancy and birth.”
“Reproductive Health Counseling and Outcomes Among Women With Congenital Heart Defects: Results From the Congenital Heart Survey to Recognize Outcomes, Needs, and Well-Being, 2016–2019” has been published in the March/April 2025 issue of Women’s Health Issues.