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Valvular Heart Disease and Pregnancy

  • Valvular Heart Disease (J Dal-Bianco, Section Editor)
  • Published:
Current Treatment Options in Cardiovascular Medicine Aims and scope Submit manuscript

Abstract

With improving reproductive assistive technologies, advancing maternal age, and improved survival of patients with congenital heart disease, valvular heart disease has become an important cause of morbidity and mortality in pregnant women. In general, stenotic lesions, even those in the moderate range, are poorly tolerated in the face of hemodynamic changes of pregnancy. Regurgitant lesions, however, fare better due to the physiologic afterload reduction that occurs. Intervention on regurgitant valve preconception follows the same principles as a non-pregnant population. Prosthetic valves in pregnancy are increasingly commonplace, presenting new management challenges including valve deterioration and valve thrombosis. In particular, anticoagulation during pregnancy is challenging. Pregnancy is a hypercoagulable state and the risks of maternal bleeding and fetal anticoagulant risks need to be balanced. Maternal mortality and complications are lowest with warfarin use throughout pregnancy; however, fetal outcomes are best with low molecular weight heparin use. ACC/AHA guidelines recommend warfarin use, even in the first trimester, if doses are less than 5 mg/day; however, adverse fetal events are not zero at this dose. In addition, it is unclear if better monitoring of low molecular weight heparin with peak and trough anti-Xa levels would lower maternal risks as this has been inconsistently monitored in reported studies. Fortunately, with the emergence of newer data, our understanding of anticoagulant strategies in pregnancy is improving over time which should translate to better pregnancy outcomes in this higher risk population.

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Authors and Affiliations

  1. Massachusetts General Hospital, 55 Fruit Street, Boston, MA, 02114, USA

    Emily S. Lau MD & Nandita S. Scott MD

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  1. Emily S. Lau MD
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  2. Nandita S. Scott MD
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Correspondence to Emily S. Lau MD.

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Emily S. Lau declares no potential conflicts of interest.

Nandita S. Scott is a section editor for Current Treatment Options in Cardiovascular Medicine.

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This article does not contain any studies with human or animal subjects performed by any of the authors.

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This article is part of the Topical Collection on Valvular Heart Disease

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Lau, E.S., Scott, N.S. Valvular Heart Disease and Pregnancy. Curr Treat Options Cardio Med 20, 46 (2018). https://doi.org/10.1007/s11936-018-0643-x

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