Racial disparities in reliable contraceptive use in women with heart disease*

Abstract

Objective

The aim of the study was to investigate the differences in reliable contraceptive use between black women and white women with maternal cardiac disease.

Methods

The study comprised a retrospective cohort of women with maternal cardiac disease managed by the University of Alabama at Birmingham (UAB) Comprehensive Pregnancy and Heart Program (CPHP). Women were included if they had attended one or more prenatal visits at the UAB CPHP and delivered at the UAB hospital between March 2015 and June 2019. The primary outcome was reliable contraceptive use within 2 months postpartum, defined by receipt of long-acting reversible contraception (i.e., an intrauterine contraceptive device or an etonogestrel implant) or female sterilisation. All outcomes were compared based on self-reported race.

Results

One hundred and forty-nine women met the inclusion criteria. Black women (n = 63) were more likely than white women (n = 86) to use reliable contraception (65% vs 43%; p = 0.008). 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). There was no difference in reliable contraceptive use between black women (n = 20, 63%) and white women (n = 23, 72%) with modified World Health Organisation (WHO) class III/IV lesions (p = 0.42).

Conclusion

Black women with maternal cardiac disease were more likely than white women to receive reliable contraception. Interventions to prevent unintended pregnancy in women with maternal cardiac disease should focus on improving reliable contraceptive use, especially for women with modified WHO class III/IV lesions.

摘要

目的：本研究的目的是调查患有母体心脏病的黑人女性和白人女性在应用可靠避孕措施方面的差异。

方法：本研究包括由阿拉巴马大学伯明翰分校（UAB）综合怀孕和心脏计划（CPHP）管理的母体心脏病女性的回顾性队列。如果女性在2015年3月至2019年6月期间在UAB CPHP进行过一次或多次产前检查并在UAB医院分娩, 则纳入研究。主要结局是在产后2个月内可靠避孕, 即接受长效可逆避孕（即宫内避孕器或依托孕烯植入）或女性绝育。所有结局都基于自我报告的种族进行了比较。

结果：149名女性符合纳入标准。黑人女性（n=63）比白人女性（n=86）更有可能应用可靠避孕措施（65% vs 43%；p=0.008）。与白人女性相比, 黑人女性在入院时犹豫不决或拒绝避孕的可能性较小（13% vs 27%；p=0.037）。患有改良世界卫生组织（WHO）III/IV级病变的黑人女性（n=20, 63%）和白人女性（n=23, 72%）在可靠避孕用具方面没有差异（p=0.42）。

结论：患有母体心脏病的黑人女性比白人女性更有可能接受可靠避孕措施。预防患有母体心脏病的女性意外怀孕的干预措施应侧重于改善可靠避孕措施的应用, 特别是对患有WHO III/IV类病变的女性。

Keywords:

• Bilateral tubal ligation
• cardiovascular risk
• immediate postpartum long-acting reversible contraception
• maternal cardiac disease
• racial disparities
• reliable contraception

Disclosure statement

The authors declare that there is no conflict of interest associated with this article and no financial disclosures to report.