Valvular Heart Disease and Pregnancy.

Area of Science:

• Cardiology
• Maternal-Fetal Medicine
• Reproductive Health

Background:

• Valvular heart disease is an increasing cause of pregnancy complications due to assisted reproduction, advanced maternal age, and better survival of congenital heart disease patients.
• Stenotic valve lesions are poorly tolerated during pregnancy's hemodynamic changes, while regurgitant lesions are generally better tolerated.
• Prosthetic valves in pregnancy introduce challenges like valve deterioration and thrombosis, complicating anticoagulation management.

Purpose of the Study:

• To review the challenges and current understanding of managing valvular heart disease during pregnancy.
• To discuss the complexities of anticoagulation in pregnant patients with valvular heart disease.
• To highlight the balance between maternal and fetal risks with different anticoagulant strategies.

Main Methods:

• Review of current literature on valvular heart disease in pregnancy.
• Analysis of hemodynamic changes during pregnancy and their impact on valve lesions.
• Examination of anticoagulation options, including warfarin and low molecular weight heparin, and their associated risks.

Main Results:

• Warfarin use throughout pregnancy is associated with the lowest maternal mortality and complications.
• Low molecular weight heparin use is linked to the best fetal outcomes.
• Current guidelines suggest warfarin for doses <5 mg/day even in the first trimester, but fetal risks persist.

Conclusions:

• Managing valvular heart disease in pregnancy requires careful consideration of valve type and anticoagulation strategy.
• Balancing maternal safety (e.g., bleeding risk) and fetal safety (e.g., teratogenicity) is critical in anticoagulation choices.
• Emerging data on anticoagulant strategies, including monitoring low molecular weight heparin, promises improved outcomes for this high-risk population.