Analysis of the adverse fetal/neonatal outcomes of pregnant women after mechanical heart valves replacement under different anticoagulation methods

Zhao Ziwen; Dong Yun; Li Yi; Wang Jiqiu; Liu Guiying

doi:10.3760/j.issn.1673-4777.2025.06.015

Abstract：Objective Objective to analyze the adverse fetal/neonatal outcomes of pregnant women after mechanical heart valves(MHVs)replacement under different anticoagulation methods.Methods Data of 105 pregnant women(137 pregnancies)and their fetuses/newborns after MHVs replacement in Beijing Anzhen Hospital,Capital Medical University from December 2015 to December 2023 were retrospectively collected.According to the anticoagulation mode during pregnancy,they were divided into three groups:warfarin group(96 cases),low molecular weight heparin(LMWH)group(28 cases),and sequential treatment group(13 cases).The relevant data of pregnant women and fetuses/newborns in the three groups were analyzed and compared.Results The gestational age of warfarin group was less than that of LMWH group and sequential treatment group(P＜0.001),and the number of pregnancies was more than that of LMWH group and sequential treatment group(P=0.045).There were 56 live births in total,28 cases(29.2％)in the warfarin group,18 cases(64.3％)in the LMWH group,and 10 cases(76.9％)in the sequential treatment group.The live birth rate in the warfarin group was lower than that in the other two groups(P＜0.001).There were no significant differences in the stillbirth/spontaneous abortion rate(P=0.549)and fetal/neonatal malformation rate(P=0.337)among the three groups.Among the live births,there were 7 premature infants,5 low birth weight infants,2 small for gestational age infants,2 neonatal asphyxia,6 respiratory failure,3 sepsis,3 neonatal encephalopathy,and 6 bleeding events(2 cases of gastrointestinal bleeding,2 cases of intracranial hemorrhage,1 case of cranial hematoma,and 1 case of disseminated intravascular coagulation).The international normalized ratio(INR)(P=0.004),prothrombin time(P=0.001)and activated partial thromboplastin time(P=0.004)of newborns in warfarin group were higher/longer than those in the other two groups.A total of 22 neonates in the warfarin group and sequential treatment group were admitted to the pediatric ward.The INR of neonates on the first day after birth was significantly higher than that of their mothers within 24 h before delivery[(2.5±1.5)vs(1.5±0.6)](P=0.008).Conclusions After MHVs replacement with continuous oral warfarin during pregnancy,pregnant women have more pregnancies,but the live birth rate is lower,the gestational age is smaller,and their early neonatal coagulation function is poor,which is more vulnerable to warfarin.Prenatal consultation for women after MHVs replacement in childbearing age should be strengthened,and multidisci-plinary joint management should be carried out in tertiary hospitals to try to avoid unplanned pregnancy.