Can an adolescent with a history of surgically repaired Ventricular Septal Defect (VSD) and Atrial Septal Defect (ASD) receive birth control?

From the Guidelines

Yes, adolescents with a history of surgically repaired ventricular septal defect (VSD) and atrial septal defect (ASD) who have no further complications can generally be prescribed birth control. Combined hormonal contraceptives (containing estrogen and progestin) such as pills, patches, or vaginal rings are typically safe options if the patient has had successful repair with no residual cardiac issues, normal blood pressure, and no evidence of pulmonary hypertension. Progestin-only methods like the mini-pill, implant (Nexplanon), or hormonal IUD (Mirena, Kyleena, Liletta, or Skyla) may be even safer alternatives as they don't carry the small increased risk of thromboembolism associated with estrogen-containing methods. Before prescribing, a thorough cardiovascular assessment should be conducted, including blood pressure measurement and review of any recent cardiac evaluations. The patient should be counseled about warning signs that require immediate medical attention, such as chest pain, severe headache, leg pain or swelling, or shortness of breath. The safety profile is excellent because surgically repaired congenital heart defects without complications are generally not considered contraindications to hormonal contraception, as the repair has restored normal cardiac function 1. Some key points to consider when prescribing birth control to adolescents with a history of VSD and ASD repair include:

• The American Academy of Pediatrics recommends that pediatricians develop a working knowledge of contraception to help adolescents reduce risks of and negative health consequences related to unintended pregnancy 1.
• The CDC has published the “US Medical Eligibility Criteria for Contraceptive Use,” which summarizes the literature on safety and efficacy of different contraceptive methods by medical condition 1.
• Progestin-only methods may be a safer alternative for adolescents with a history of VSD and ASD repair, as they do not carry the increased risk of thromboembolism associated with estrogen-containing methods 1.
• A thorough cardiovascular assessment should be conducted before prescribing birth control, including blood pressure measurement and review of any recent cardiac evaluations 1.
• The patient should be counseled about warning signs that require immediate medical attention, such as chest pain, severe headache, leg pain or swelling, or shortness of breath 1. It is also important to note that the risk of blood clots associated with combined hormonal contraceptives is increased, but this risk is still relatively low, and the benefits of hormonal contraception often outweigh the risks 1. Ultimately, the decision to prescribe birth control to an adolescent with a history of VSD and ASD repair should be made on a case-by-case basis, taking into account the individual patient's medical history, current health status, and personal preferences.

From the Research

Adolescent Birth Control with History of Neonatal VSD and ASD Surgical Repair

There are no direct studies that address the use of birth control in adolescents with a history of neonatal VSD and ASD surgical repair. However, we can look at the available evidence on the long-term effects of VSD and ASD repair, as well as the risks associated with certain types of birth control.

• The study by 2 found that patients who underwent VSD repair had impaired right ventricular function and exercise capacity, even after successful surgical correction.
• The study by 3 discussed the diagnosis and treatment of VSDs in neonates, including minimally invasive surgical repair, but did not address birth control use in adolescents with a history of VSD repair.
• The study by 4 investigated the long-term biopsychological effects of early surgical VSD repair on children and found that maternal anxiety and proactive parenting behavior played a crucial role in the child's mental health.
• The study by 5 examined the risk of sexual dysfunction associated with progestin-based contraceptives in women of child-bearing age, but did not specifically address adolescents with a history of VSD and ASD repair.
• The study by 6 reviewed the current practice in ASD occlusion in children and adults, but did not discuss birth control use in adolescents with a history of ASD repair.

Considerations for Birth Control Use

When considering birth control options for an adolescent with a history of neonatal VSD and ASD surgical repair, it is essential to weigh the potential risks and benefits.

• The use of progestin-based contraceptives, such as levonorgestrel IUD or EE-levonorgestrel COC, may be associated with an increased risk of sexual dysfunction, as found in the study by 5.
• However, the study by 5 also noted that the risk of contraceptives did not differ significantly when compared with oral levonorgestrel, suggesting a minimal impact of progestin-based contraceptives on sexual dysfunction.
• The adolescent's individual health status, medical history, and potential risks associated with certain types of birth control should be carefully evaluated by a healthcare provider.