808 Racial disparities in reliable contraception use in women with heart disease

Abstract

Reliable contraception (RC) is encouraged for women with maternal cardiac disease (MCD) to allow for counseling and medical optimization before pregnancy. Since MCD is a leading cause of pregnancy-related deaths and unduly affects Black women, we sought to investigate differences in RC use between Black and White women with MCD. Retrospective cohort of women with MCD managed by the UAB Comprehensive Pregnancy & Heart Program (CPHP). Women were included if they attended ≥ 1 prenatal visit at the UAB CPHP and delivered at UAB Hospital between March 2015 and June 2019. The primary outcome was RC use within 2 months postpartum (PP) by receipt of long acting reversible contraception (e.g. intrauterine device or etonogestrel implant) or PP sterilization (immediately PP or up to 2 months PP). Secondary outcomes included RC use in women with modified World Health Organization maternal cardiovascular risk classification (mWHO Class) III/IV, non-RC choices, and PP follow-up. All outcomes were compared based on self-reported race. One hundred forty-nine women met inclusion criteria (Table 1). Black women were more likely than White women to use RC (65% vs 43%, p=0.008) (Table 2). There was no difference in RC use between Black and White women with mWHO Class III/IV (37% vs 28%, p=0.42). Black women were less likely than White women to be undecided or decline contraception at the time of admission (13% vs 27%, p=0.037). Tubal ligation performed before hospital discharge was the most common form of contraception for all women (p=0.41). There was no difference in PP follow-up attendance (p=0.42). Black women with MCD were more likely than White women to receive RC. However, over 25% of women with mWHO Class III/IV did not receive RC PP. Interventions designed to address disparities in unintended pregnancy in patients with MCD should focus on improving RC use among all women, especially those with mWHO III/IV. Increasing use of RC in women with MCD may mitigate maternal morbidity and mortality.View Large Image Figure ViewerDownload Hi-res image Download (PPT)