A Systematic Review of the Incidence, Risk, and Management of Thromboembolic Events in Atrial Fibrillation During Pregnancy [ID 3623]

INTRODUCTION: Atrial fibrillation (AF) during pregnancy has life-threatening complications. No risk scale for thromboembolic events in AF is intended for use during pregnancy, leading to an underestimation of risk considering the hypercoagulable state. Given the absence of specific guidelines, this study reviews pregnancy-specific AF assessment and management approaches reported in the literature. METHODS: A systematic review was conducted using PubMed, Scopus, and Web of Science, covering articles published between 2010 and 2025. The search strategy combined keywords associating “atrial fibrillation” with “pregnancy” together with either “thromboembolism” or “anticoagulation” or “stroke” or “risk score” or “incidence” or “prevalence.” RESULTS: Thirty eligible studies were assessed. Prevalence of AF in pregnancy ranged between 0.027% and 0.3% in the general population and 1.3% to 3% among women with structural heart disease. Thromboembolic complications occurred in 2–4% of those with structural heart disease, while extremely uncommon in normal anatomy. CHA 2 DS 2 -VASc underestimates risk according to a nationwide cohort study. Unfractionated heparin and low-molecular-weight heparin achieved anticoagulation in pregnancy. Warfarin was associated with embryopathy, especially during weeks 6–12 and greater than 5 mg daily dosage. CONCLUSIONS/IMPLICATIONS: The use of safe anticoagulants is recommended in AF in pregnant women with structural heart disease. The lack of pregnancy-specific validated risk assessment instruments and limited therapeutic options emphasizes the importance of further cardio-obstetrics research to establish evidence-based guidelines for the care of pregnant patients with AF.