Congenital heart disease and family planning: Preconception care, reproduction, contraception and maternal health

With the growth of the adult congenital heart disease (CHD) population, so do the considerations of reproduction, contraception and maternal health become more pressing. Fertility issues and concerns about hereditability may impact both male and female CHD patients. CHD can also influence the choice between contraceptive options, as some involve cardiovascular risks that make them less well-suited to the cardiac patient. For women with CHD, pregnancy acts as a haemodynamic stress test for the maternal cardiovascular system and often precipitates cardiac complications including heart failure, arrhythmias and thromboembolic events. For those with CHD, preconception counselling on the cardiac, obstetric and fetal risks involved in pregnancy is crucial for shared decision making and to optimize pregnancy outcomes. Risk stratification should be individualized, multidisciplinary and includes consideration of the complexity of the original CHD lesion, any residual or recurrent lesions, functional class, ventricular and valvular function, cyanosis, previous cardiac events and comorbidities, as well as the use of diagnostic modalities. In this review, we examine reproductive concerns in CHD patients, including preconception counselling, fertility issues and hereditability of CHD. We describe the advantages and disadvantages of the currently available contraceptive options in the context of cardiac disease. We discuss general considerations in the management of pregnancy in CHD, as well as the current knowledge on the most common CHD lesions.