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General Principles
3.8. Reproductive Health, Pregnancy, and Contraception
COR LOE
Recommendations
1 B-NR
1. In adults with congenital heart disease of childbearing age,
counseling on contraceptive options is recommended to
inform pregnancy-related shared decision-making.
1 B-NR
2. Adults with congenital heart disease interested in pregnancy
should receive preconception counseling, in collaboration
with an ACHD cardiologist, about the maternal cardiac,
obstetric, and fetal risks associated with pregnancy and the
potential long-term risks to the pregnant individual.
1 C-LD
3. Screening fetal echocardiography is indicated to detect
congenital heart disease if either parent has ACHD to
optimize delivery planning and access to care.
1 C-LD
4. In pregnant patients with ACHD AP classifications IB–D,
IIA–D, and IIIA–D, an individualized care plan, including
mode of delivery, need for cardiac monitoring, and anesthetic
support, should be documented in the medical record and
communicated to the patient and care team, to reduce
maternal risks for morbidity and mortality.
1 C-LD
5. In pregnant patients with ACHD AP classifications IB–D,
IIA–D, and IIIA–D, management should be provided by, or
in collaboration with, a cardio-obstetrics team with expertise
in ACHD and maternal-fetal medicine, to improve clinical
outcomes.
1 C-LD
6. Patients with ACHD who have high risk for maternal
morbidity and mortality should be counseled to avoid
pregnancy and given guidance on effective contraception to
improve outcomes.
1 C-LD
7. For pregnant patients with ACHD who have high risk
for morbidity and mortality, the option of terminating
pregnancy should be discussed to reduce that risk.
