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Special populations
Original research
Preconception counselling in women of reproductive age attending cardiology clinics in Scotland
  1. Joanna Osmanska1,
  2. Alice M Jackson1,
  3. Joanne Simpson2,
  4. Carly Adamson1,
  5. Daniel Doherty3,
  6. Helene Mamet4,
  7. Lynsey Moir5,
  8. Niki L Walker6,
  9. Duncan Hogg7,
  10. Maggie Simpson6
  1. 1 University of Glasgow, Glasgow, UK
  2. 2 Department of Cardiology, Queen Elizabeth University Hospital, Glasgow, UK
  3. 3 Department of Cardiology, Glasgow Royal Infirmary, Glasgow, UK
  4. 4 Department of Cardiology, Aberdeen Royal Infirmary, Aberdeen, UK
  5. 5 Pharmacy Services, NHS Greater Glasgow and Clyde, Glasgow, UK
  6. 6 Scottish Adult Congenital Cardiac Service, Golden Jubilee National Hospital, Clydebank, UK
  7. 7 Cardiology Department, University of Aberdeen, Aberdeen, UK
  1. Correspondence to Maggie Simpson, Scottish Adult Congenital Cardiac Service, Golden Jubilee National Hospital, Clydebank G81 4DY, UK; maggiesimpson{at}doctors.org.uk

Abstract

Background Guidelines for the management of cardiovascular disease (CVD) recommend preconception risk stratification and counselling in all women of childbearing age. We assessed the provision of preconception counselling (PCC) among women of reproductive age attending general cardiology outpatient clinics over a 12-month period in two large health boards in Scotland.

Methods and results Electronic health records were reviewed and data on patient demographics, cardiac diagnoses, medication use and the content of documented discussions regarding PCC were recorded. Women were classified according to the modified WHO (mWHO) risk stratification system. Among 1650 women with a cardiac diagnosis included (1 January 2016–31 December 2016), the mean age was 32.7±8.6 years, and 1574 (95.4%) attended a consultant-led clinic. A quarter (402, 24.4%) were prescribed at least one potentially fetotoxic cardiovascular medication. PCC was documented in 10.3% of women who were not pregnant or were unable to conceive at the time of review (159/1548). The distribution of mWHO classification, and proportion of patients within each mWHO category who received any form of PCC, was 15.0% and 6.0% in mWHO class I, 20.2% and 8.7% in mWHO class II, 22.6% and 10.6% in mWHO class II–III, 9.5% and 15.7% in mWHO class III and 3.9% and 19.7% in mWHO class IV.

Conclusion PCC is documented infrequently in women of reproductive age with CVD in the general outpatient setting. Education relating to the risks of cardiac disease in pregnancy for clinicians and patients, and tools to support healthcare providers in delivering PCC, is important.

  • Pregnancy
  • Cardiomyopathies
  • Heart Valve Diseases
  • Heart Defects, Congenital
  • Heart Failure

Data availability statement

No data are available.

https://doi.org/10.1136/heartjnl-2023-323666

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    Data availability statement

    No data are available.

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    Footnotes

    • X @jo_osmanska, @m4ggiesimpson

    • Contributors AMJ, JS and MS: Concept; JO, AMJ, JS, CA, DD, HM, LM and MS: Data collection; AMJ, JS and MS: data adjudication; JO and AMJ: Data analysis; JO, AMJ, JS and MS: Full manuscript development; NLW and DH: Manuscript review. MS is guarantor of this study. Scottish Obstetric Cardiology Network (SOCN) lived experience sub-group were consulted on the concept and design of this study.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Patient and public involvement Patients and/or the public were involved in the design, or conduct, or reporting, or dissemination plans of this research. Refer to the Methods section for further details.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.