There is an unmet need for safe and accessible contraceptive options among hypertensive individuals at risk of unintended pregnancy, according to a recent study published in the American Journal of Obstetrics & Gynecology.
Takeaways
- Hypertension affects a significant portion of the US population and is linked to adverse pregnancy outcomes, emphasizing the importance of addressing contraceptive needs in this group.
- Black individuals face a disproportionate burden of adverse outcomes related to hypertension, highlighting the necessity for targeted interventions and support.
- Current data on contraceptive counseling and provision among hypertensive individuals is lacking, underscoring the need for further research and awareness.
- Contraceptive counseling rates are higher among hypertensive individuals compared to those without hypertension, suggesting some awareness of the importance of contraception in this population.
- Disparities exist in contraceptive counseling and use among hypertensive individuals, especially among Black patients, indicating a need for more equitable access to contraception and tailored health care services.
Approximately 86 million US adults are impacted by hypertension, making it the most common modifiable risk factor for cardiovascular disease. Hypertension has been linked to poor fetal and maternal outcomes, such as eclampsia, preeclampsia, placental abruption, preterm birth, and fetal growth restriction.
Black patients are disproportionally impacted by adverse outcomes, with the maternal mortality rate among this population increased 2.9-fold compared to non-Hispanic White patients. A hypertensive disorder was reported in 1/3 of deaths during delivery hospitalizations in 2020.
Data about contraception counseling and provision among individuals with hypertension is currently lacking.To evaluate contraceptive counseling and use among patients with hypertension, investigators conducted a retrospective cross-sectional analysis.
The National Survey of Family Growth (NSFG) 2015 to 2017 and 2017 to 2019 cycles were assessed for data. NSFG respondents were aged 15 to 49 years and were stratified using a multistage, probability-based process.
Participants responded to a question asking, “In the last 12 months, did a doctor or other medical care provider tell you that you had hypertension, also called high blood pressure?” Those who replied with “yes” were included in the hypertension group while those who responded “no” were included in the no-hypertension group.
Contraceptive counseling and contraception use were the primary outcomes of the analysis. Data on these factors was obtained from a question asking participants if they received birth control counseling in the prior 12 months and whether they received a birth control method in the prior 12 months.
Cofounders included race, age, educational attainment, parity, smoking, diabetes, body mass index, and social determinants of health (SDH). Age groups included under 35 years and 35 years or older. SDH domains included food insecurity, housing instability, financial insecurity, transportation barriers, and unmet childcare needs.
There were 8625 respondents included in the final analysis, 59% of whom were White, 69% aged under 35 years, 45% overweight or obese, and 33% had experienced difficulty in at least 1 SDH domain.
Hypertension was reported in 9% of the cohort. Black race, age of 35 years or more, overweight, obesity, diabetes, and difficulty in an SDH domain were associated with hypertension, with adjusted odds ratios (aORs) of 1.64, 2.11, 1.87, 3.44, 2.65, and 1.40, respectively.
A proportion of 0.26 was reported for contraceptive counseling among patients with hypertension vs 0.21 for patients without hypertension. Patients with hypertension had a greater proportion of counseling vs those without hypertension in every subcategory except for Black patients and smokers.
The proportion of contraception use was 0.40 among patients with hypertension vs 0.34 among patients without hypertension. Overall, hypertension was associated with increased odds of counseling and contraceptive use, with aORs of 1.64 and 1.55, respectively.
The probabilities of counseling and contraceptive use increased by 8% and 9%, respectively, among patients with hypertension vs those without hypertension. However, while the odds were increased in White patients with hypertension, these differences were not observed in Black patients with hypertension vs those without hypertension.
These results indicated an unmet need for contraceptive options among patients with hypertension, especially Black patients. Investigators recommended additional research to evaluate barriers to contraception use among individuals with hypertension.
Reference
Danvers AA, Gurney EG, Panushka K, et al. Shortcomings and disparities in contraception counseling and use by hypertensive individuals at risk for unintended pregnancy: a comparative analysis of the National Survey of Family Growth 2015–2019. Am J Obstet Gynecol. 2024;230:350.e1-11. doi:10.1016/j.ajog.2023.10.032
