Intimacy, contraception, and pregnancy prevention in patients with pulmonary arterial hypertension: are we counseling our patients?

Abstract

Pulmonary arterial hypertension is a serious, life-altering condition. Patients who are diagnosed are often of child-bearing potential. Given the well-documented risks associated with this condition during pregnancy, as well as risks to the fetus from medications used to treat this disorder, patients should be strongly advised against pregnancy. Despite this, patients still become pregnant, leading to the question of whether care providers are counseling patients and their partners about the risks of pregnancy, methods of contraception, and issues of intimacy on a regular basis. We have conducted a survey of pulmonary hypertension specialist physicians and allied health care professionals on their practice patterns related to counseling on intimacy, contraception, and pregnancy prevention. Most respondents indicated they are counseling on these issues to varying degrees, but our survey pointed to several areas where improvements can be made. The most significant barrier to counseling for all respondents was lack of time. Survey respondents reported that a large percentage of the pregnancies seen in their practices were either intentional or due to contraceptive noncompliance. We review specific practical approaches to initiate reproductive health counseling as well as ways to integrate this important aspect of pulmonary arterial hypertension care into regular practice routines and documentation. Protocols regarding pregnancy avoidance and pulmonary arterial hypertension should be developed and become standard procedure.

2020 Clinical practice guidelines for Pulmonary hypertension, including chronic thromboembolic pulmonary hypertension

“…Контрацепция и гормонозаместительная терапия -Рекомендуется консультация врача-кардиолога и врача-гинеколога в центре с опытом ведения беременных с ЛАГ для подбора оптимального метода контрацепции с учетом высокого риска прогрессирования заболевания на фоне беременности у пациенток детородного возраста [276,280,284,298,301].…”

“…Сюда относятся стерилизация мужчины/женщины [283] и внутриматочные устройства. Вторая группа контрацептивов (гормоносодержащие таблетированные препараты, инъекции, пластыри) неэффективна в 6-12% случаев и не рекомендуется в качестве единственного метода контрацепции [301]. Пероральные контрацептивы, содержащие прогестерон (медроксипрогестерон**, этоногестрел), обладают эффективным действием и лишены многих побочных эффектов, присущих эстроген-содержащим препаратам предыдущих поколений [6,305], но при их назначении необходимо учитывать, что эффективность контрацепции снижается на фоне приема бозентана**.…”

“…В связи с этим данная процедура должна выполняться в стационарных условиях, особенно у пациенток с физиологией Фонтена и Эйзенменгера. Также необходимо учитывать риски возникновения инфекционных осложнений во время имплантации системы [301]. Барьерные методы безопасны для пациенток, но не дают надежной гарантии от наступления беременности [278,283,284,288].…”

Targeting Myadm to Intervene Pulmonary Hypertension on Rats Before Pregnancy Alleviates the Effect on Their Offspring’s Cardiac-Cerebral Systems

“…In particular, epidemiological data show a higher incidence rate of PAH in women ( Hoeper et al, 2016 ). In addition, women who are diagnosed with PH are usually of child-bearing age ( Sahni et al, 2015 ; Hill et al, 2018 ). Unfortunately, pregnancy is not recommended in patients with PH because of intolerable, hemodynamic, anatomic, and biochemical changes ( Sun et al, 2018 ), and the high mortality rates up to approximately 30–56% and 11–28% of mothers and infants, respectively ( Weiss et al, 1998 ; Olsson and Channick, 2016 ).…”

Expression and role of miR‑338‑3p in peripheral blood and placenta of patients with pregnancy‑induced hypertension

“…Clinical symptoms of PIH are found to gradually disappear after the placenta is excreted. Therefore, termination of pregnancy is currently one of the treatment options for PIH (5,6). In recent years, placental trophoblast cells have been thought to be closely related to the pathogenesis of PIH.…”