<p>Women with congenital heart disease (CHD) are at elevated risk for morbidity and mortality during childbirth. Pediatric cardiologists are in a unique position to provide reproductive counseling to their patients with CHD. We evaluated contraception use in adolescents and young adults with CHD seen in a pediatric cardiology practice. Utilizing retrospective chart review, we evaluated all encounters for female patients aged 14 – 21&#xa0;years with CHD between January 2017 and June 2023 at a tertiary care center. Female patients without CHD seen over the same period were included as a comparator group. Logistic regression was used to evaluate predictors of contraception use. There were 12, 368 visits included in our study. Of the 9924 visits in patients without CHD, 23% were on contraception, and of the 2444 visits in patients with CHD, 22% were on contraception. There was an increase in contraception use over time. Controlling for age at visit, later visit year was associated with contraception use (OR 1.09 [95% CI 1.04–10.9] per year). CHD was associated with lower likelihood of contraception use [OR 0.79 [95% CI 0.70 – 0.88]). Those with single ventricle (SV) CHD and complex CHD used long-acting reversible contraception more often (54% and 46% respectively) compared to those with simple or moderate CHD (17% and 16% respectively) or no CHD (18%). Patients with CHD are receiving contraception at a lower rate than those without CHD. Given the risks that women with CHD face with pregnancy, there should be a dedicated effort to increase the percentage of women with CHD on contraception.</p>