Contraception and reproductive counseling in women with peripartum cardiomyopathy.

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±5.7years, median time since diagnosis of 3.0±4.3years) 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. nonuse.

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 nonuse. Contraceptive users had a lower body mass index higher education, and were less likely to be in a dating relationship, have hypertension, wear an external cardioverter-defibrillator, and use antihypertensive medications compared with nonusers (all p<0.05). 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.