Pregnancy Outcomes in Women with Mechanical Heart Valves Receiving Anticoagulation

Objective: The aim of this study was to evaluate the outcome of pregnancy, fetal and maternal complications in pregnant women who have prosthetic heart valves and receiving Warfarin during their pregnancy. Study Design: Forty-six pregnant women with prosthetic heart valves who were receiving Warfarin during their pregnancy period and visited pregnancy clinic at Rajaie heart center from 2008 to 2011 were entered to this study. The mean dose of Warfarin intake in this patients was 5.42 +/- 1.8mg/day. The patients were divided into 2 groups based on the mean dose of warfarin after initial review; group 1(33 cases): the pregnant women who received warfarin <= 5.42 +/- 1.8 mg/day, group 2 (13 cases): the pregnant women who received warfarin > 5.42 +/- 1.8 mg/day and they were evaluated for the incidence of fetal complications[abortion, Coumadin embryopathy, low birth weight (LBW), prematurity and still birth], maternal complications (thromboembolic events, valve thrombosis, massive bleeding and re-do valve surgery). Results: Mean age of the patients was 31 +/- 4.6 years. Fetal complications were reported in 28.26% among total cases; 11 abortion (24%), 1 Coumadin embryopathy (2.17%) and 1 LBW (2.17%). These complications were significantly lower in patients on Warfarin with mean dose <= 5.42 +/- 1.8 mg/day, (p<0.001). Maternal complications did not occur in this study. Conclusion: Warfarin with mean dose <= 5.42 +/- 1.8mg/day in pregnant patients with prosthetic heart valves may be safe for the fetus without increasing fetal complications and may have no effect on maternal events.