Risks from aortic valve stenosis during pregnancy

Women who want to have children and who also have aortic valve stenosis have some special considerations, because stenosis (with or without symptoms) increases the risk to the mother and the fetus.

Most women of childbearing age who have the condition have it primarily because they were born with a bicuspid aortic valve, which has two flaps instead of the normal three.

If you have mild or moderate stenosis and your left ventricle is functioning normally, you should have a normal pregnancy with careful medical supervision. Simple measures such as getting plenty of bed rest and avoiding lying on your back can play important roles in successfully managing your pregnancy. Sometimes balloon valvuloplasty can be done to relieve symptoms. After delivery, a valve replacement surgery may be done.

If your stenosis is severe and you have symptoms, you should delay conception until you have had surgery to replace your heart valve. If you are considering pregnancy and you have aortic valve stenosis, you should gather more advice from a multidisciplinary medical team who can provide more information about your individual risk factors and long-term outcome.

If you plan to or may become pregnant after heart valve replacement, you need to consider the following:

• Your aortic valve can be replaced with either a mechanical or tissue (biological) valve.
• Anticoagulants, also called blood-thinning medications, may be necessary after valve replacement surgery to prevent blood clots. Anticoagulants are needed over the long term if the replacement valve is mechanical.
• If you choose a mechanical valve, you should avoid using the anticoagulant warfarin (for example, Coumadin) because it can cause birth defects. Work with your doctor to choose an anticoagulant (such as heparin) that is safe for you to use during pregnancy.
• Anticoagulants are not needed long-term with tissue replacement valves. However, tissue valves do not last as long as mechanical valves; a tissue valve will last only 10 to 15 years.

Antibiotics during pregnancy

Many doctors routinely provide antibiotics to pregnant women who have aortic valve stenosis to guard against the possibility of a heart infection (endocarditis). However, this is not recommended for women who will have an uncomplicated vaginal delivery or a cesarean section unless your doctor suspects that you have an infection. Antibiotics are also optional for pregnant women who have a prosthetic heart valve, a history of endocarditis, or complicated congenital heart disease.¹

Citations

1. Bonow RO, et al. (2006) ACC/AHA 2006 guidelines for the management of patients with valvular heart disease. A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing committee to revise the 1998 guidelines for the management of patients with valvular heart disease). Circulation, 114(5): e84–e231.