Pregnancy outcomes in women with prosthetic heart valves: A single-center study in China

Accurate information on pregnancy outcomes in women with prosthetic heart valves (PHVs) is essential for preconception counseling and prenatal care. This study aims to determine the maternal and fetal outcomes in women with PHVs. A total of 138 pregnant women with PHVs admitted into a tertiary center between November 2007 and February 2020 were included in the study, and the data were analyzed retrospectively. Patients were divided into the mechanical heart valves (MHVs) group, 118 patients with MHVs, and the tissue heart valves (THVs) group, 20 patients with THVs. The 2 groups were compared. There was 1 maternal death in the MHV group patients (0.8%). There was no difference between the 2 groups regarding maternal mortality (P = 1.000), valve thrombosis (P = .376), and hemorrhagic events (P = .692). Only 66.9% of patients in the MHV group had a live birth compared to the live birth rate of 100% in the THV (P = .002). Mechanical valve thrombosis (MVT) occurred in 3.2% of patients who used warfarin only; no MVT occurred in patients using a regimen called "sequential therapy", which utilizes low-molecular-weight heparin (LMWH) during the 1st trimester and warfarin during the 2nd and 3rd trimesters. MVT occurred in 33.3% of patients using LMWH throughout gestation (P < .001). The difference was statistically significant. Compared to patients using other regimens, the patients using the regimen of "warfarin only " was correlated with the highest rate of miscarriage (38.1%, 3.4%, and 16.7%, P < .001). Women with MHVs have a lower rate of live birth. The anticoagulation regimen of "sequential therapy" was superior to other regimens in terms of the weighted effects of regimens on maternal MVTs and fetal loss.