(1028) Maternal and Fetal Outcomes and Anticoagulation Use in Pregnancies Affected by Mechanical Heart Valves

Patients with mechanical heart valves in pregnancy are at a substantially higher risk of adverse maternal and fetal outcomes. Management of patients with mechanical heart valves poses a unique challenge, and strategies for anticoagulation in these patients remain controversial. The goal of this project was to evaluate rates of adverse outcomes and types of anticoagulation used in pregnancies affected by mechanical heart valves.

Study Design:

A query was performed using Epic Cosmos to evaluate pregnancies affected by mechanical heart valves between 12/13/2021 and 12/12/2024. Patient demographics and rates of adverse cardiac outcomes in the perinatal period, including heart failure, arrhythmia, and stroke were assessed. The rates of anticoagulation with enoxaparin and coumadin were evaluated. Perinatal outcomes, including the rate of preterm delivery (< 37 weeks), cesarean delivery, and neonatal demise were also evaluated. Rare outcomes were reported as < 10 to protect patient privacy.

Results:

A total of 398 patients with 486 pregnancies were identified. The majority of patients were white (72.9%), with 11.6% Hispanic. Regarding cardiac outcomes, the presence of a mechanical heart valve in pregnancy was associated with maternal arrhythmia (54.0%), heart failure (31.9%), and stroke (10.1%). Maternal death occurred in fewer than 10 patients. The preterm birth rate was 19.3%, and the cesarean delivery rate was 30.9%. Overall, 55.8% of patients received enoxaparin and 43.2% received coumadin during the pregnancy.

Conclusion:

The presence of a mechanical heart valve in pregnancy is associated with high rates of adverse maternal and fetal outcomes, including heart failure and stroke. Further larger studies are needed to delineate the timing and the type of anticoagulation used in pregnancy, as well as risk factors associated with worsened outcomes in this population.