(676) Self-perception of pregnancy risk and contraceptive safety among women with cardiac disease

Objective: To assess perceived safety of contraceptive use and pregnancy among women with cardiac disease in a public hospital setting.

Study Design: Women ages 18-45 with cardiac disease were recruited from the adult congenital cardiac disease or high risk obstetrics clinic at Harbor-UCLA Medical Center from June 2018 - September 2019. A cross-sectional survey was administered regarding contraception use, pregnancy history, and perceptions of risk associated with pregnancy in the context of their cardiac condition. Participants were stratified by WHO Classification (Class 1/2 versus Class 3/4) and tested for differences using Wilcoxon Rank Sum tests for numeric variables and Fisher’s Exact tests for categorical variables.

Results: 42 participants completed the survey: 31 with Class 1/2 disease (73.8%) and 11 with Class 3/4 disease (26.2%). 72.7% of participants with WHO Class 3/4 disease, as well as 61.3% of Class 1/2 participants perceived pregnancy as “Dangerous” or “Very Dangerous”. All (100%) of Class 3/4 group and 87% of Class 1/2 group reported oral contraceptives, regardless of hormone type, as “not safe” or “unsure” about safety. For non-pill, progesterone-only methods, most participants, regardless of WHO Class, regarded these as “not safe” or “unsure” (DMPA 80.5%, Nexplanon 85.4%, LNG IUD 75%).

Conclusion: High risk cardiac participants accurately recognize pregnancy as dangerous in the context of their disease; however, they are uncertain of safe methods of preventing pregnancy. Low-risk cardiac patients also perceive pregnancy as dangerous, even though their risk is not significantly different from the general population. The majority of participants with cardiac disease perceive hormonal birth control to be unsafe regardless of disease severity or hormone type. This study highlights the need for improved patient education to increase utilization of effective methods of contraception in this high-risk patient population.