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Review
. 2021 Apr 13;77(14):1823-1834.
doi: 10.1016/j.jacc.2021.02.025.

Contraception and Reproductive Planning for Women With Cardiovascular Disease: JACC Focus Seminar 5/5

Kathryn J Lindley  1 , C Noel Bairey Merz  2 , Melinda B Davis  3 , Tessa Madden  4 , Ki Park  5 , Natalie A Bello  6 ; American College of Cardiology Cardiovascular Disease in Women Committee and the Cardio-Obstetrics Work Group
Affiliations
Review

Contraception and Reproductive Planning for Women With Cardiovascular Disease: JACC Focus Seminar 5/5

Kathryn J Lindley et al. J Am Coll Cardiol. .

Abstract

The majority of reproductive-age women with cardiovascular disease are sexually active. Early and accurate counseling by the cardiovascular team regarding disease-specific contraceptive safety and effectiveness is imperative to preventing unplanned pregnancies in this high-risk group of patients. This document, the final of a 5-part series, provides evidence-based recommendations regarding contraceptive options for women with, or at high risk for, cardiovascular disease as well as recommendations regarding pregnancy termination for women at excessive cardiovascular mortality risk due to pregnancy.

Keywords: LARC; abortion; contraception; intrauterine device; pregnancy.

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Conflict of interest statement

Funding Support and Author Disclosures Dr. Bairey Merz has served on the Board of Directors for iRhythm; and has received personal fees paid through CSMC from Abbott Diagnostics and Sanofi. Dr. Madden has served on a data safety monitoring committee for Phase 4 studies of Bayer contraceptive products. Dr. Bello is supported by the National Institutes of Health/National Heart, Lung, and Blood Institute (K23 HL136853-03, R01 HL153382-01). All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.

Figures

Figure 1.
Figure 1.. One-Year Failure Rates of Contraceptive Methods.
Effectiveness of contraceptive methods is based on their typical-use one-year failure rates. The Tier I methods - long-acting reversible methods (IUD and implant) and permanent sterilization - are safe and most effective for women with cardiovascular conditions. Tier II methods have lower effectiveness and increased safety concerns in the estrogen-containing methods (combined hormonal pill, transdermal patch, vaginal ring). The Tier III methods have the lowest effectiveness and are not recommended for use in isolation for women at increased risk of cardiovascular complications of pregnancy.
Figure 2.
Figure 2.. Key Features of Emergency Contraception.
Three forms of emergency contraception are currently available and are considered safe for all cardiovascular conditions. They must be administered within 5 days of intercourse to be effective. Barriers to access reduce their uptake, and advanced provision of emergency contraception may be considered. MEC – Medical Eligibility Criteria
Central Illustration.
Central Illustration.. Multidisciplinary model for shared decision making in contraception and pregnancy counseling for women with cardiovascular conditions.
Multidisciplinary shared decision making including OB/GYN, Cardiology Primary Care Provider and the patient should consider the patient’s goals, preferences and values in addition to their individual and disease-specific risks of contraceptive methods and pregnancy when determining the optimal method of contraception. The cardiologist has an important responsibility to counsel reproductive-age women on pregnancy and contraception, document contraceptive needs, identify and help overcome barriers to contraception access, and advocate for highly effective and safe contraception.
See this image and copyright information in PMC

References

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