Attitudes and perceptions of pregnant women with CHD: results of a single-site survey

Contraceptive counselling and uptake of contraception among women with cardiovascular diseases: a systematic review and meta-analysis

To address the lack of clarity regarding contraceptive counselling and uptake of contraception among women with cardiovascular disease (CVD), this study aimed to conduct a systematic review and meta-analysis on contraceptive counselling and the subsequent uptake of contraception among women with CVD. A search across six databases identified 1228 articles, with 11 studies (2580 participants) included. The pooled prevalence of contraceptive counselling was 63%, varying from 36 to 94% in individual studies. Inconsistent delivery and documentation of counselling were noted, along with a lack of knowledge about pregnancy complications and misconceptions regarding CVD severity. For contraceptive uptake (n = 5), the pooled prevalence was 64% (95% confidence interval, 45 to 82%). Women with CVD were also found to use less effective methods as well as methods not recommended for their condition (e.g., combined hormonal methods among participants with absolute or relative contraindications). Improving contraceptive counselling and choices for women with CVD can not only enhance knowledge and decision-making for women with CVD in line with their reproductive goals and preferences but reduce high-risk unintended pregnancies and adverse pregnancy outcomes.

Adults with CHD balancing motivations and concerns in pregnancy decision-making

BACKGROUND

While the incidence of pregnancy has increased among individuals with adult CHD, little has been described about considerations and experiences of patients with adult CHD regarding pregnancy.

OBJECTIVE

We aimed to explore patients' motivations, concerns, and decision-making processes regarding pregnancy.

METHODS

In April 2019-January 2020, we conducted in-depth telephone interviews with patients (n = 25) with simple, moderate, or complex adult CHD, who received prenatal care at the University of Washington during 2010-2019 and experienced a live birth. Transcripts were analysed using thematic analysis.

RESULTS

Participants described motivations for pregnancy as both internal desires (motherhood, marriage fulfillment, biological connection, fetal personhood, self-efficacy) and external drivers (family or community), as well as concerns for the health and survival of themselves and the fetus. Factors that enabled their decision to maintain a pregnancy included having a desire that outweighed their perceived risk, using available data to guide their decision, planning for contingencies and knowing their beliefs about termination, plus having a trusted healthcare team, social support, and resources. Factors that led to insurmountable risk in subsequent pregnancies included desire having been fulfilled by the first pregnancy, compounding risk with age and additional pregnancies, new responsibility to an existing child, and reduced healthcare team and social support.

CONCLUSIONS

Understanding individuals' motivations and concerns, and how they weigh their decisions to become or remain pregnant, can help clinicians better support patients with adult CHD considering pregnancy. Clinician education on patient experiences is warranted.

Exploring the lived experiences of women with congenital heart disease during pregnancy: A phenomenological study

OBJECTIVE

Congenital heart diseases (CHDs) are the most common birth anomalies, and they embraced a wide range of defects ranging from mild defects to complex and life-threatening defects. Medical advancement improved children's survival, and more females are reaching childbearing age. The purpose of this study was to explore and describe the lived experience of Jordanian pregnant women with CHD during pregnancy.

METHOD

This study used a descriptive phenomenological design. Purposive sampling was used in recruiting 15 women from Jordan with CHD who had given birth to at least one live newborn. The study was conducted from October 2019 to April 2020. Data was collected from a public cardiac centre using face-to-face semi-structured interviews. Interviews were recorded and transcribed verbatim. Analysis was done using Colaizzi's method.

FINDINGS

Three themes were identified: Being a woman with CHD, being pregnant with CHD, and being a CHD patient and healthcare-seeking behaviour. The findings revealed that pregnancy experiences of women with CHD are usually associated with many difficulties, negative emotions, and challenges.

CONCLUSION AND IMPLICATIONS FOR PRACTICE

The findings indicated the need for increased awareness and the importance of social support amongst both Jordanian women with CHD and healthcare providers. Also, the study provides new information to healthcare providers and policymakers to better understand the lived experiences of pregnant with CHD from their perspectives as it was associated with many difficulties, negative emotions, and challenges.

Patient perspectives on clinician-patient partnerships to achieve comprehensive pregnancy care in adult congenital heart disease

Background

Because adverse events are more common than in the general population, pregnancy is a high-risk experience for some patients with adult congenital heart disease (ACHD). Guidelines for pregnancy are based on published literature, informed by adverse clinical outcomes with less priority given to patients' lived experiences. This study aims to describe ACHD patients' expectations for and experiences with pregnancy, including factors that influenced patients' perceived quality of care."

Methods

We conducted a qualitative study of 25 patients who received care between 2010 and 2019. Purposive sampling was used to gain diversity in ACHD lesion complexity, race, age at pregnancy, and marital status. Semi-structured telephone interview data were analyzed using thematic analysis.

Results

Mean age at pregnancy was 29 years (range 15-41 years), and 84% had more than one completed pregnancy. ACHD was simple in six participants (24%), moderate in 11 (44%), and complex in eight (32%). Participants' perceptions of pregnancy care were influenced by their experiences in four domains: 1) their existing expectations, derived from prior clinicians' counsel and from observations of others' pregnancies; 2) clinicians' ability and willingness to partner with the patient to address their individual needs, including pre-pregnancy testing, pregnancy education, and planning for birth and delivery; 3) clinicians' recommendations that account for logistical reality and patients' unique life situations; and 4) the importance of clinician confidence and communication in providing care for patients with ACHD.

Conclusion

To achieve positive pregnancy outcomes, ACHD patients favor partnerships with clinicians centered on education, realistic recommendations, and good communication.

Exploring the lived experiences of pregnancy and early motherhood in Italian women with congenital heart disease: an interpretative phenomenological analysis

OBJECTIVE

This study explored the lived experiences of women with congenital heart disease (CHD) during pregnancy and early motherhood.

DESIGN

Qualitative study using semistructured interviews. Data were analysed according to interpretative phenomenological analysis.

SETTING

San Donato Milanese, Italy.

PARTICIPANTS

12 adult women during pregnancy or early motherhood.

RESULTS

Three main themes emerged from the analysis that were labelled as follows: 'Being a woman with CHD'; 'Being a mother with CHD'; and 'Don't be alone'. Mothers described both positive and negative feelings about their pregnancies and transitions from childless women to mothers with CHD. They needed supportive care to improve the management of their health during pregnancy and early motherhood.

CONCLUSION

This study explored the lived experiences of women with CHD during pregnancy and early motherhood. The emerged themes represent an initial framework for implementing theory-grounded educational and supportive strategies that improve self-care, engagement and quality of life for women with CHD. Furthermore, the study's results provide guidance for operationalising the described experiences into items and domains for future cross-national surveys.

Psychosocial situation in adults with congenital heart defects today and 20 years ago: Any changes?

BACKGROUND

While diagnosis and treatment of congenital heart diseases have improved over the last two decades, data regarding the course of psychosocial parameters is missing.

METHODS

In a cross-sectional study, 283 adults with congenital heart disease completed a slightly modified questionnaire that was applied in a comparable study twenty years ago. Significant differences between the two populations as well as possible predictors of psychosocial burden for the recent population were sought.

RESULTS

Despite the presence of more complex heart defects in the current cohort (p < 0.001), both populations exhibited similar values in the Ability Index. Furthermore, the current cohort reported significantly improved outcomes regarding school performance, employment, and sports. Regarding psychosocial functioning, the current cohort showed better outcomes in the domains of sadness (p < 0.01), independence (p < 0.01), understanding (p < 0.001), and acceptance (p < 0.01) of heart disease. Predictors for a worse psychosocial situation in a multiple regression analysis were anxiety, lack of curiosity, and age over 33. In the current study women, as opposed to men, reported significantly more dissatisfaction with too little information provided about their illness (p < 0.05), higher anxiety levels (p < 0.01), and heightened illness-connected burden (p < 0.05). However, women showed higher levels of independence (p < 0.01) and lower alcohol consumption (p < 0.001).

CONCLUSION

The psychosocial situation of adults with congenital heart disease has improved over the span of 20 years. However, particular needs and concerns should be addressed individually via doctor-patient communication. The findings here suggest that especially female patients appear to have a higher demand for counselling information, e.g. reproduction issues.