Reproductive health conversations in adolescents with CHD

Abstract

Background: Reproductive issues as related to CHD must be discussed in the clinic and at home. Providers can ensure that correct information is imparted to the adolescent and encourage mothers to provide support and guidance to the adolescent. The level to which these conversations occur is unknown. Methods: A survey distributed to female adolescent/mother dyads assessed self-reported conversations with the healthcare provider and between each other about reproductive health topics. A clinician survey was completed to assess CHD diagnosis, risk of hormonal contraception, and pregnancy risk. Results: Among 91 dyads, 33.0% of adolescents and 42.9% of mothers reported discussing recurrence risk of CHD with the provider. In regard to the cardiac lesion affecting a baby, 30.7% of adolescents and 28.7% of mothers reported discussing this with a provider. Significantly less adolescents and mothers reported discussing the risks of hormonal contraception and pregnancy with a provider. In assessing conversations between adolescents and mothers, only 44.2% of adolescents and 52.3% of mothers reported discussing with each other the safety of using birth control and 46.5% of adolescents and 64.0% of mothers reported discussing the safety of pregnancy. Conclusions: Adolescents with CHD and their mothers report low rates of reproductive health-related conversations with the healthcare provider, and mothers report low rates of having these conversations with their daughters. These topics should be discussed at each appointment with the cardiologist and must be encouraged to continue at home.

Sexual and Reproductive Health Care Experiences and Perceptions of Women with Congenital Heart Disease

“…Additionally, women with CHD have reported receiving incorrect recommendations regarding contraceptive safety [10][11]. Only about half of women with CHD in prior studies reported receiving information on birth control options and risks from a provider [9][10][11][13][14]. As demonstrated in our study, women frequently expressed concern about a lack of safe contraception options due to CHD.…”

“…Prior investigations found that one-to two-thirds of women with CHD reported never discussing the risks of pregnancy or the safety of contraception related to their heart condition with a physician [9][10][11][13][14]. Most of the participants in our study report having had a conversation about SRH with a provider at some point; however, many still had misconceptions about their risks and options for care.…”

“…ACOG and AHA developed enhanced guidelines re ecting the importance of SRH counseling by CHD providers [6][7][8]. Given only about half of women in prior studies report getting SRH counseling from their cardiologist, it is clear that many cardiologists have not fully embraced this role [9][10][11][13][14].…”

“…The American College of Obstetricians and Gynecologists (ACOG) and The American Heart Association (AHA) have recommended individualized pre-pregnancy counseling by multidisciplinary physician teams including Adult Congenital Heart Disease (ACHD) and Maternal Fetal Medicine (MFM) providers [8]. However, despite these care recommendations, women with CHD have poor knowledge regarding their cardiovascular pregnancy risk and the safety of various forms of contraception, and many hold misconceptions about CHD and sexual and reproductive health (SRH) [9][10][11][12][13][14].…”