Contraception in patients with medical conditions

Four in ten pregnancies in the UK are unplanned. An unintended pregnancy can have serious health consequences in women with chronic medical conditions. Certain diseases can be worsened by pregnancy or are associated with adverse outcomes. Moreover, medications used to treat many chronic conditions are potentially teratogenic.The maternal immune system during pregnancy undergoes adoptive changes and these physiological changes quite often affect the natural history of the maternal illness. Furthermore changes in the cardiovascular and haematological systems are exaggerated in certain chronic illnesses. Therefore pregnancy in women with coexistent medical conditions is associated with an increase in both maternal and foetal morbidity (such as women with epilepsy and on medical treatment have an increased risk of foetal developmental abnormalities and the pill may prevent an untimed pregnancy) and mortality (such as those patients with cyanotic heart disease). There are various methods of female contraception now available as tablet, implants, injectable and intrauterine systems. It is important that an informed discussion takes place between the clinician and the patient to decide upon the best possible method on an individualized basis.