Contraception and Reproductive Counseling in Women with Peripartum Cardiomyopathy

• Published in: Contraception (Stoneham) Vol. 96; no. 1; pp. 36 - 40
• Main Authors: Rosman, Lindsey, Salmoirago-Blotcher, Elena, Wuensch, Karl L, Cahill, John, Sears, Samuel F
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.07.2017
• Subjects: Adult; Body Mass Index; Cardiomyopathies - complications; Cardiomyopathies - epidemiology; Cardiomyopathies - prevention & control; Cardiomyopathy; Contraception; Contraception - methods; Contraception Behavior; Contraceptive counseling; Counseling - statistics & numerical data; Educational Status; Family Planning Services; Female; Humans; Obstetrics and Gynecology; Peripartum Period; Postpartum; Pregnancy; Pregnancy Complications, Cardiovascular - prevention & control; Registries; Reproduction; Risk Factors; Sexual Behavior; Sterilization, Tubal; Surveys and Questionnaires; Pregnancy; Contraception; Contraceptive Counseling; Cardiomyopathy; Postpartum; Contraceptive counseling
• ISSN: 0010-7824; 1879-0518
• DOI: 10.1016/j.contraception.2017.05.003

Abstract Objectives Pregnancies following a diagnosis of Peripartum Cardiomyopathy (PPCM) are associated with increased risk for maternal morbidity and mortality. Yet patterns of contraceptive use and reproductive counseling have received little attention. This nationwide registry-based study sought to evaluate patterns and clinical characteristics associated with contraceptive use, and examine the prevalence of contraceptive counseling in women with PPCM. Methods From December 2015 to June 2016), 177 PPCM patients (mean age of 34.8±5.7 years; median time since diagnosis of 3.0±4.3 years) completed questionnaires about contraceptive use and counseling at registry enrollment. T-tests, chi-square and logistic regression were used to compare demographic and clinical characteristics among women who reported contraceptive use vs. non-use. Results Tubal ligation (24.3%), condoms (22.0%) and intrauterine devices (IUDs; 16.4%) were the most common forms of contraception. Among sexually active women, 28.9% reported contraceptive non-use. Contraceptive users had a lower BMI, higher education, and were less likely to be in a dating relationship, have hypertension, wear an external cardioverter-defibrillator, and use antihypertensive medications than non-users (all p<.05). Two-thirds of women received counseling about risks of subsequent pregnancies and contraceptive strategies. Conclusions This preliminary study indicates that 1 in 4 PPCM patients are sexually active and are not using contraception to prevent PPCM reoccurrence. Although a majority of women did receive reproductive counseling, as many as 25% of patients reported no discussion of contraceptive strategies to prevent unintended pregnancy and heart failure relapse.