Reproductive journey in women with congenital heart disease: a systematic review of mental health implications.

OBJECTIVES: Advances in medical care have led to increased survival rates among individuals with congenital heart disease (CHD), enabling many women to pursue pregnancy and motherhood; however, their reproductive journey remains complex, involving intertwined medical and psychological challenges that are still not fully understood. This review aimed to explore the lived experiences of women with CHD as they navigate these reproductive challenges. DESIGN: Systematic review of qualitative studies using Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The Critical Appraisal Skills Programme checklist was used for quality assessment. DATA SOURCES: APA PsycArticles, Medline Ultimate, APA PsycInfo, APA PsycTests and CINAHL Ultimate were searched on 10 March 2025. ELIGIBILITY CRITERIA: Studies were included if they examined the lived experiences of women with CHD, focused on reproductive health, used qualitative methods and were published in English without time or geographical limits. Exclusion criteria were studies focusing on family members, men or healthcare professionals; reproductive health in other non-communicable diseases; acquired cardiac disease; single case studies; or quantitative designs. DATA EXTRACTION AND SYNTHESIS: The data extracted from qualitative studies included author(s), aims, location, design, method, analysis, results and clinical implications. The synthesis followed the Thomas and Harden thematic synthesis approach to answer the review question. RESULTS: Eleven studies met the inclusion criteria. Thematic synthesis identified four analytical themes: (1) the need for psychological support in high-stakes decision-making, including the emotional burden of parenthood; (2) challenges of receiving conflicting medical guidance; (3) balancing reproductive autonomy with health risks, including the influence of social norms and comparisons with peers; and (4) the impact of geographical location on access to support. CONCLUSIONS: Women with CHD face unique challenges within their reproductive health which is shaped by medical uncertainty, challenges with healthcare systems and high-stakes decision-making. Holistic care is crucial to support women through this journey and improve their outcomes.