Contraceptive Counseling Missed in One-Third of Women With CVD

Photo Credit: Viktoriya Kabanova

Approximately one-third of women with cardiovascular disease did not receive contraceptive counseling appropriate for their condition and history.

A recent systematic review identified gaps in contraceptive counseling for women with cardiovascular disease (CVD), particularly those with more severe disease. The findings were published in Clinical Research in Cardiology.

CVD has become increasingly prevalent in women over the last decade. In addition, women are developing CVD at younger ages, with up to one-third diagnosed during reproductive years, according to Tesfaye Regassa Feyissa, PhD, and colleagues.

“Adverse maternal and fetal outcomes among women with CVD can be significantly reduced by preventing high risk unintended pregnancies,” the authors wrote.

“As a standard practice, contraceptive counseling should encompass information about highly effective and long-term safe options like long-acting reversible contraception while being tailored to individual reproductive goals and health conditions. While providing contraceptive counseling to women with CVD is crucial, it is not entirely clear how current contraceptive counseling is provided.”

Gathering Data on Contraception Counseling

The researchers searched MEDLINE, EMBASE, CINAHL, MIDRIS, and APA PsycInfo for peer-reviewed, English-language studies published in the last 10 years reporting contraceptive counseling for women with CVD. The authors excluded studies where CVD data couldn’t be separated, as well as randomized controlled trials, case studies, literature reviews, and editorials.

Of 1,228 identified articles, nine cross-sectional and two retrospective studies met the inclusion criteria for the review. Seven occurred in the US; the other two were conducted in the UK.

Two researchers performed data extraction, and the authors conducted a random effects meta-analysis to estimate the prevalence of contraceptive counseling.

One-Third Miss Out on Counseling

Per the review, women with CVD were more likely to receive contraceptive counseling than those without CVD. However, only about two-thirds of women with CVD received counseling.

Dr. Feyissa and colleagues estimated the pooled prevalence of contraceptive counseling to be 63% (95% CI, 49%–76%), although there was significant heterogeneity (P<0.001).

Subgroup analyses revealed that the counseling prevalence was 65% (95% CI, 48%–81%; P<0.001) in cross-sectional studies but 54% (95% CI, 38%–71%) (P<0.001) in retrospective designs.

Counseling occurred slightly more often in US-based studies, with a pooled prevalence of 67% (95% CI, 45%–89%; P<0.001) compared with 57% (95% CI, 42%-73%; P<0.001) in other countries.

In addition, the pooled prevalence was slightly higher in studies related to congenital heart disease, at 66% (95% CI, 47%-86%; P<0.001) compared with 56% (95% CI, 41%–72%; P<0.001). In one study, women with complex congenital heart disease were more likely to receive counseling than those with less complex disease (56% vs 45%, P=0.036).

In two studies, half the women did not receive contraceptive counseling appropriate for their heart conditions.

“A cross-sectional survey from the USA at a single tertiary adult [congenital heart disease] clinic showed 54% of women reported that a healthcare professional had never discussed their options for birth control with respect to their heart condition. Of the 38 participants who did report receiving contraceptive counseling that specifically addressed their heart condition, only 47% received such counseling prior to their first sexual intercourse,” Dr. Feyissa and colleagues reported.

The authors also found that women in higher WHO pregnancy risk classes were more likely to receive counseling than those in lower WHO classes (P<0.002).

Of note, many women’s risk perception differed from their actual risk, underscoring a significant knowledge gap. One study showed that only 51% of women accurately assessed their cardiovascular pregnancy risk score, while the other half of the participants either underestimated (22%) or overestimated (27%) their score.

The review also identified a knowledge gap in terms of contraceptive choices, with only 46% of women in one study correctly identifying which options were appropriate for their health conditions.

Five of the studies assessed contraceptive uptake. The reviewers reported a pooled contraception prevalence of 64% (95% CI, 45%–82%) with slight heterogeneity (P<0.001).

“Some women were using less effective methods as well as methods where the risks … outweighed the benefits,” Dr. Feyissa and colleagues noted. “A cross-sectional study from the USA reported that only 24% of sexually active women with CHD were using effective methods (failure rate, 6%–12% a year), and 16% were using less effective methods (failure rate, 18%–24% per year).”

Offering Information & Closing Gaps

The authors concluded that contraceptive counseling appears to occur at higher rates for women with CVD than those without. However, gaps still exist, particularly regarding which contraceptive methods are most appropriate for their conditions and history.

Contraception uptake barriers may include cultural or personal beliefs, misinformation, and concern about possible side effects. To bridge gaps, the authors emphasized the importance of patient education and women-centered, culturally appropriate care.

“One-third of women with CVD still miss out on contraceptive counseling, with counseling prioritized for those with severe disease. It is important to provide long-term comprehensive contraceptive care to all women with CVD, which not only safeguards their reproductive health but also plays a vital role in the overall management of their cardiovascular health,” Dr. Feyissa and colleagues concluded.