(1059) Disparities in contraception in women with cardiovascular diseases in the cardiac-obstetrical clinic

The National Survey of Family Growth 2017-2019 survey reported an overall 65.3% current use of contraception: 18% tubal, 5.6% vasectomy, 18% hormonal therapy, 8.4% intrauterine devices (IUD), and 8.4% condoms. We want to evaluate the use of contraception among women with cardiovascular disease (CVD) in pregnancy seen in the combined cardio-obstetric clinic.

Study Design:

We used the California Maternal Quality Care Collaborative (CMQCC) criteria for cardiology consultation. CVD risk factors included: age ≥40, body mass index (BMI) ≥35, african american race, chronic hypertension (CHTN), diabetes (DM), renal disease, congenital or acquired heart disease, arrhythmias or palpitations. All clinic consultations from 3/2021 to 7/2022 were reviewed. Patient demographics, contraception plans, and final birth control methods were recorded. We classified the methods as highly to moderately effective contraception (tubal ligation, vasectomy, IUD, implant, and hormonal methods) and least effective (condom, diaphragm, natural methods, and no contraception).

Results:

98 of 131 (82.3%) women with CVD were delivered and had complete data. During prenatal visits, 56% of women had an identified contraception plan. During the postpartum visit, actual contraception plans were confirmed in 66.3%. 60% of women chose highly to moderately effective methods. Further, Hispanic women and those with BMI ≥30 chose highly to moderately effective contraceptive methods more frequently than white women. Most Hispanic women were under emergency insurance. Medical comorbidities and CVD diagnosis were not different between the groups (Table 1). The preferred methods were hormonal therapies 22% (oral, injectable, patch, ring) followed by IUD 19.4%. Of those, 47.3% of IUDs were post-placental insertions (Table 2).

Conclusion:

In our clinic, 63% of women with CVD during pregnancy had a contraceptive method. The final choice of contraceptive methods was driven by race, culture and access to medical care rather than by medical conditions complicating pregnancy.