Contraception Practices and Pregnancy Outcome in Patients after Fontan Operation

Kavitha N. Pundi, Krishna Pundi, Jonathan N. Johnson, Joseph A. Dearani, Crystal R. Bonnichsen, Sabrina D. Phillips, Mary C. Canobbio, David J. Driscoll, Frank Cetta

Research output: Contribution to journalArticle

27 Citations (Scopus)

Abstract

Objective: The feasibility and safety of pregnancy after the Fontan operation is not well understood. We sought to determine contraception practices and early and late outcomes of pregnancy after the Fontan operation. Design: We performed a retrospective review of medical records to identify women of childbearing age from the Mayo Clinic Fontan database. A follow-up questionnaire was mailed to all patients not known to be deceased at the time of study. Patients with available contraception and pregnancy data were included in the study. Results: Of the 138 women with available contraception data, 44% used no contraception, 12% each used barrier methods, combination hormone therapy or sterilization, 8% used Depo-Provera, 7% had intrauterine devices, 4% had a partner with a vasectomy and 1% used progestin pills. Six women had thrombotic complications (only one using oral contraceptives). Thirty-five women had pregnancy data available. Prior to the Fontan operation there were 10 pregnancies (8 miscarriages, 2 therapeutic abortions, and no live births). After the Fontan operation there were 70 pregnancies resulting in 35 miscarriages (50%), 29 live births (41%), and 6 therapeutic abortions (9%). There were no maternal deaths during pregnancy. During long-term follow up (26 ± 6 years since the Fontan), 1 death, and 1 cardiac transplant occurred. Mean gestational age of the newborns (n = 22/29) was 33.1 ± 4.0 weeks; mean birth weight (n = 20/29) was 2086 ± 770g. There was 1 neonatal death because of prematurity and two children were born with congenital heart disease (one patent ductus arteriosus and one membranous ventricular septal defect). Conclusions: Pregnancy after the Fontan operation is associated with a high rate of miscarriages, preterm delivery, and low birth weight. Further studies are needed to identify specific variables influencing risk stratification of pregnancy in this patient population.

Original languageEnglish (US)
Pages (from-to)63-70
Number of pages8
JournalCongenital Heart Disease
Volume11
Issue number1
DOIs
StatePublished - Jan 1 2016

Fingerprint

Fontan Procedure
Pregnancy Outcome
Contraception
Pregnancy
Spontaneous Abortion
Therapeutic Abortion
Live Birth
Vasectomy
Maternal Death
Medroxyprogesterone Acetate
Intrauterine Devices
Patent Ductus Arteriosus
Time and Motion Studies
Ventricular Heart Septal Defects
Low Birth Weight Infant
Progestins
Oral Contraceptives
Birth Weight
Gestational Age
Medical Records

Keywords

  • Abortion
  • Contraception
  • Fontan Operation
  • Miscarriage
  • Pregnancy
  • Prematurity

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Surgery
  • Radiology Nuclear Medicine and imaging
  • Cardiology and Cardiovascular Medicine

Cite this

Pundi, K. N., Pundi, K., Johnson, J. N., Dearani, J. A., Bonnichsen, C. R., Phillips, S. D., ... Cetta, F. (2016). Contraception Practices and Pregnancy Outcome in Patients after Fontan Operation. Congenital Heart Disease, 11(1), 63-70. https://doi.org/10.1111/chd.12291

Contraception Practices and Pregnancy Outcome in Patients after Fontan Operation. / Pundi, Kavitha N.; Pundi, Krishna; Johnson, Jonathan N.; Dearani, Joseph A.; Bonnichsen, Crystal R.; Phillips, Sabrina D.; Canobbio, Mary C.; Driscoll, David J.; Cetta, Frank.

In: Congenital Heart Disease, Vol. 11, No. 1, 01.01.2016, p. 63-70.

Research output: Contribution to journalArticle

Pundi, KN, Pundi, K, Johnson, JN, Dearani, JA, Bonnichsen, CR, Phillips, SD, Canobbio, MC, Driscoll, DJ & Cetta, F 2016, 'Contraception Practices and Pregnancy Outcome in Patients after Fontan Operation', Congenital Heart Disease, vol. 11, no. 1, pp. 63-70. https://doi.org/10.1111/chd.12291
Pundi KN, Pundi K, Johnson JN, Dearani JA, Bonnichsen CR, Phillips SD et al. Contraception Practices and Pregnancy Outcome in Patients after Fontan Operation. Congenital Heart Disease. 2016 Jan 1;11(1):63-70. https://doi.org/10.1111/chd.12291
Pundi, Kavitha N. ; Pundi, Krishna ; Johnson, Jonathan N. ; Dearani, Joseph A. ; Bonnichsen, Crystal R. ; Phillips, Sabrina D. ; Canobbio, Mary C. ; Driscoll, David J. ; Cetta, Frank. / Contraception Practices and Pregnancy Outcome in Patients after Fontan Operation. In: Congenital Heart Disease. 2016 ; Vol. 11, No. 1. pp. 63-70.
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abstract = "Objective: The feasibility and safety of pregnancy after the Fontan operation is not well understood. We sought to determine contraception practices and early and late outcomes of pregnancy after the Fontan operation. Design: We performed a retrospective review of medical records to identify women of childbearing age from the Mayo Clinic Fontan database. A follow-up questionnaire was mailed to all patients not known to be deceased at the time of study. Patients with available contraception and pregnancy data were included in the study. Results: Of the 138 women with available contraception data, 44{\%} used no contraception, 12{\%} each used barrier methods, combination hormone therapy or sterilization, 8{\%} used Depo-Provera, 7{\%} had intrauterine devices, 4{\%} had a partner with a vasectomy and 1{\%} used progestin pills. Six women had thrombotic complications (only one using oral contraceptives). Thirty-five women had pregnancy data available. Prior to the Fontan operation there were 10 pregnancies (8 miscarriages, 2 therapeutic abortions, and no live births). After the Fontan operation there were 70 pregnancies resulting in 35 miscarriages (50{\%}), 29 live births (41{\%}), and 6 therapeutic abortions (9{\%}). There were no maternal deaths during pregnancy. During long-term follow up (26 ± 6 years since the Fontan), 1 death, and 1 cardiac transplant occurred. Mean gestational age of the newborns (n = 22/29) was 33.1 ± 4.0 weeks; mean birth weight (n = 20/29) was 2086 ± 770g. There was 1 neonatal death because of prematurity and two children were born with congenital heart disease (one patent ductus arteriosus and one membranous ventricular septal defect). Conclusions: Pregnancy after the Fontan operation is associated with a high rate of miscarriages, preterm delivery, and low birth weight. Further studies are needed to identify specific variables influencing risk stratification of pregnancy in this patient population.",
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