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PRACTICE: Anselm Uebing, Philip J Steer, Steve M Yentis, and Michael A Gatzoulis Pregnancy and congenital heart disease BMJ 2006; 332: 401-406 [Full text]

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Pregnancy and Congenital Heart Disease

Gillian E Robinson   (18 February 2006)

Pregnancy and Congenital Heart Disease 18 February 2006
Gillian E Robinson, Associate Specialist Sexual and reproductive Health Southwark London SE17 Send response to journal: Re: Pregnancy and Congenital Heart Disease	The authors appear unduly pessimistic about the currently available contraceptive options. Progestogen only methods are particularly suitable in women with congenital heart disease. Implanon has very good efficacy and is particularly suitable for adolescents because there are no concerns about bone density. In contrast Depoprovera may reduce oestradiol levels and is no longer recomended as a first line method in young women. The latest Progestogen only pill, Cerazette, inhibits ovulation and hopefully will provide as effective in effiacy as the combined preparations (this awaits demonstration in randomised trials). The Mirena device has been an important advance but the newer copper IUDs (inter uterine devices) which contain 380mm2 are nearly as effective in efficacy terms and do not have the problems of irregular bleeding. All of the long acting methods (Implanon, Mirena and copper IUDs) are as good if not better than sterilisation at preventing pregnancy. They avoid the surgical risks of the procedure and perhaps some of the psycological problems asociated with sterilisation in young women who must avoid pregnancy because of their medical condition. Competing interests: None declared