Use of Contraception by Women with Hypertension or Cardiovascular Disease

Reproductive age women with hypertension (HTN) or cardiovascular disease (CVD) are faced with challenges of using safe and effective contraception, an important component of their preconception health. In a California integrated managed care setting, it was unknown what types of reversible contraception women with HTN or CVD used. A retrospective study of 459,181 women aged 15-44, 25,115 women with chronic medical conditions, including 19129 women with HTN or CVD were compared to 122, 921 women with no known chronic condition (“healthy” women). Electronic data abstraction for contraceptive services was conducted between 1/1/2006-6/30/2007. A detailed medical record review was included for 240 randomly chosen women who had no database documentation for family planning. Long-acting reversible contraception (LARC: levonorgestrel IUD, copper IUD, subdermal implant) were used by 7.5% women with HTN/CVD and 6.5% healthy (p<0.001). Reversible hormonal methods (levonorgestrel IUD, subdermal implant, oral contraceptive, patch, ring, injectable) were used by 21.2% of women with HTN/CVD compared to 35.4% of healthy women (p<0.001). No contraception was found for 48.5% of women with HTN/CVD compared to 38% of healthy women (p<0.001). The chart review confirmed abstinence in 12.3% of women with HTN/CVD compared to 0% in healthy women. Women with HTN and CVD were less likely to have a method of contraception compared to healthy women. A significant proportion of women with HTN or CVD used reversible hormonal contraception or LARC. Assessing contraceptive need in women with hypertension and CVD is an important part of preconception care.