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Current attitudes and clinical practice towards the care of pregnant women with underlying CHD: a paediatric cardiology perspective

Published online by Cambridge University Press:  11 April 2016

Marc G. Cribbs
Affiliation:
Division of Cardiovascular Disease, L.M. Bargeron Division of Pediatric Cardiology, University of Alabama Birmingham, Birmingham, Alabama, United States of America
David A. Briston
Affiliation:
Division of Pediatric Cardiology, The Children’s Hospital at Montefiore, Bronx, New York, United States of America
Ali N. Zaidi*
Affiliation:
Division of Pediatric Cardiology, The Children’s Hospital at Montefiore, Bronx, New York, United States of America Montefiore Adult Congenital Heart Disease (MAtCH) Program, Montefiore Heart and Vascular Care Institute, Albert Einstein College of Medicine, Bronx, New York, United States of America
*
Correspondence to: Dr. Ali N. Zaidi, Division of Pediatric Cardiology, The Children’s Hospital at Montefiore, 111 East 210th Street, Bronx, NY 10467, United States of America. Tel: 718-920-5882; Fax: 718-654-6264; E-mail: azaidi@montefiore.org

Abstract

Objectives

The growing number of women with CHD presents unique challenges, including those related to pregnancy, which can lead to significant morbidity and mortality. We sought to evaluate the perception of paediatric cardiologists towards the reproductive health of women with CHD.

Methods

Paediatric cardiologists in the United States of America were invited to participate in a cross-sectional, anonymous survey. Information solicited included knowledge of contraceptive methods, experience caring for pregnant women with CHD, and referral patterns including the utilisation of high-risk obstetric and adult CHD specialists.

Results

A total of 110 cardiologists responded – 90% with an academic affiliation and 70% with ⩾10 years’ clinical experience. Although 95% reported an understanding of available contraceptive options, 32% did not feel comfortable recommending birth control. Pregnant women with CHD were seen by 83% of responders, and 37% of the responders reported a low level of comfort in doing so. Among all respondents, 73% indicated that they would refer a pregnant CHD patient to a high-risk obstetrician and 60% to an adult CHD specialist – almost all respondents would not transfer care to a non-adult CHD cardiologist. Among paediatric cardiologists, 81% indicated that they would resume their patient’s care following delivery.

Conclusion

Our results illustrate a gap in what physicians feel should be done and the care that they feel comfortable providing pregnant women with CHD. As this population continues to grow, training adult CHD cardiologists with specific skills in reproductive health in women with CHD is the first step to closing the care gap that exists in the management of such patients.

Type
Original Articles
Copyright
© Cambridge University Press 2016 

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