Contraception Guidance for Women with Pre-eclampsia History

Introduction to Contraception Risks

Women with a history of pre-eclampsia have a 2-fold or greater increased risk of both ischemic heart disease and stroke, and a 4-fold increased risk of heart failure compared to women without this history, according to the American College of Obstetricians and Gynecologists 1, 2, 3
The American Heart Association notes that these risks persist years after the pregnancy and represent permanent vascular endothelial dysfunction that does not resolve 1

The American College of Cardiology recommends that combined oral contraceptives are associated with a 1.5-1.9-fold increased risk of both ischemic stroke and ischemic heart disease 1, 2, 3
The relative risk of myocardial infarction with COC use is 1.6-1.7, and for ischemic stroke is 1.7-1.9, as stated by the European Society of Cardiology 2, 3

The World Health Organization states that progestogen-only contraceptives show no association with myocardial infarction or stroke, with risk ratios of 0.98-1.02 (essentially no increased risk) 2, 3, 4
Progestogen-only contraceptives do not significantly affect blood pressure, avoiding the hypertensive effects sometimes seen with estrogen-containing formulations, according to the American College of Obstetricians and Gynecologists 4

The American College of Obstetricians and Gynecologists recommends explaining to patients that their pre-eclampsia history indicates underlying vascular changes that permanently increase their cardiovascular risk, making estrogen-containing contraception unsafe 1, 2
The Centers for Disease Control and Prevention advises that condoms should be used consistently for STI protection regardless of hormonal contraceptive choice 5