CPET performed before conception can predict maternal and neonatal outcomes in pregnant women with CHD. A blunted heart rate response to exercise in women with CHD is associated with a higher risk of maternal cardiac and neonatal 8. If the patient with CHD or their partner is preg- nant, there is an increased risk of CHD in the off- spring and fetal echocardiography can be useful in defining whether CHD is present, and if so, help to determine the course of action at the time of delivery. There are data to suggest a prenatal diagnosis improves neonatal survival, although selection bias (eg, preoperative deaths, family preference) is a limitation for many studies, so benefit has been more difficult than expected to CLINICAL STATEMENTS AND GUIDELINES Recommendations for Contraception Referenced studies that support recommendations are summarized in Online Data Supplement 20. COR LOE Recommendations I C-LD Women of childbearing potential with CHD should be counseled about the risks associated with pregnancy and appropriate III: Harm B-NR Estrogen-containing contraceptives are potentially harmful for women with CHD who are at high risk of thromboembolic events (eg, cyanosis, Fontan physiology, mechanical valves, prior thrombotic events, Synopsis The use of contraceptive agents should be balanced a- gainst the risks of pregnancy in every woman with CHD There are no data on the safety of various contraceptive techniques in patients with ACHD. Recommendation-Specific Supportive Text 1. The individualized benefits and risks of each con- traceptive therapy must be determined based on the patient s anatomy and physiology in consulta- tion with a gynecologist. This counseling should include the expected failure rates of contraceptive options and the anticipated maternal and fetal risks of unplanned pregnancy, with these issues revisited on a regular basis. 