BACKGROUND: Guidelines recommend tailored reproductive health counseling for women with congenital heart defects (CHDs) beginning in adolescence, yet provider adherence to recommendations remains understudied, particularly outside specialized cardiac care settings. STUDY DESIGN: We conducted a cross-sectional cohort study among women aged 19 to 38 with CHDs, identified from active population-based birth defects registries in three states. Participants completed surveys from 2016 to 2019, including questions about contraception, pregnancy counseling, concerns, and experiences. Multivariable Poisson regression, adjusted for sociodemographic and health characteristics, assessed associations between CHD severity, counseling, and reproductive health outcomes. RESULTS: Of 765 women, those with severe CHDs, compared with non-severe, were more likely to report receiving clinician counseling about safe contraceptive methods (44.0% and 13.7%
adjusted prevalence ratio [aPR] = 3.0
95% confidence interval [95% CI] [2.2, 4.0]), pregnancy, (63.3% and 16.5%
aPR = 3.6
95% CI [2.7, 4.6]), and pregnancy avoidance (32.0% and 6.4%
aPR = 4.3
95% CI [2.9, 6.6])
be concerned about ability to have children (40.9% and 31.2%
aPR = 1.4
95% CI [1.1, 1.8]), and delay/avoid pregnancy (26.6% and 10.7%
aPR = 2.2
95% CI [1.5, 3.2]). No disparity was found in ever being pregnant (30.0% vs. 37.2%
aPR = 1.0
95% CI [0.7, 1.2]). One-third of the respondents with any CHD reported concerns about their ability to have children (33.6%). CONCLUSION: We found that only a minority of women with CHDs reported receiving counseling on safe contraception and pregnancy, and about a third reported concerns about their ability to have children. These findings highlight a gap between guideline recommendations and clinical practice, underscoring the need for improved reproductive health discussions for women with CHDs.