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(Circulation. 2003;107:1240.)
© 2003 American Heart Association, Inc.

Clinician Update

Prosthetic Heart Valves and Pregnancy

Lynne Hung, MD; Shahbudin H. Rahimtoola, MB, FRCP, MACP, MACC, DSc (Hon)

From the Griffith Center, Division of Cardiovascular Medicine, Department of Medicine, Keck School of Medicine, University of Southern California, Los Angeles.

Correspondence to S.H. Rahimtoola, MD, Distinguished Professor, University of Southern California, 2025 Zonal Ave, Los Angeles, CA 90033.

An extract of the first 250 words of the full text is provided, because this article has no abstract.

In patients with prosthetic heart valves (PHV), pregnancy is associated with the risks of warfarin embryopathy in patients with mechanical PHV and of structural valve deterioration (SVD), both early and late, in patients with biological PHV.

Mechanical Valves

Warfarin
The use of warfarin, particularly between the 6th and 12th weeks of pregnancy, is associated with an embryopathy, "warfarin embryopathy,"^1,2 which is characterized by nasal hypoplasia and/or stippled epiphyses.³ Uncommon features, including central nervous system and eye abnormalities, may be due to warfarin exposure during the second and third trimester.³

There is a wide range of the reported incidence of warfarin embryopathy (Table 1).^3–18 Ten studies comprising 427 pregnancies reported the incidence was zero (Table 1). From the patient’s point of view, the incidence per live birth may be more important; four recent (between 1994 and 99) studies reported an incidence of 3/189 (1.6%) live births^7,9,17,18 (Table 1). One group has shown that the risk of warfarin embryopathy was extremely low in the 33 women who needed 5 mg of warfarin to maintain an adequate INR.^14,18

View this table: [in this window] [in a new window]   TABLE 1. Incidence of Warfarin Embryopathy

The incidence of warfarin embryopathy will be lower with use of IV unfractionated heparin in the first 3 months (especially between the 6th to 12th weeks) of pregnancy; one review concluded that this strategy "eliminated the risk."¹⁹ IV unfractionated heparin use in the last 2 weeks of pregnancy is associated with a reduced risk of hemorrhage during delivery and the neonatal period in the mother, as . . . [Full Text of this Article]

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