Mechanical Heart Valves and Pregnancy to Patients Admitted at Jakaya Kikwete Cardiac Institute, Dar es Salaam-Tanzania

Pregnancy presents a unique set of problems for women with prosthetic heart valves. Patients with mechanical prosthetic valves require therapeutic long-term anticoagulation. In contrast, patients with bio prosthetic valves generally do not require long-term anticoagulation but face a higher long term risk of developing valve dysfunction. Less than 1% of pregnant women have prosthetic heart valves. They are an important group as they require specialist care during pregnancy. A retrospective hospital-based matched cohort study was conducted at Jakaya Kikwete Cardiac Institute (JKCI), Dar es Salaam-Tanzania. Encompassed were all women of child-bearing age who had bio prosthetic or mechanical replacement. Between January 2018 and April 2021 a total of 600 patients received a speciality care during pregnancy. There were more than 50 live births among 22 women with the mechanical prosthetic valves and more than 500 live births among the 367 women in the matched community comparison group who were created by non-random method during the study. Severe maternal morbidity occurred in 20 pregnancies (13.3%) in the mechanical prosthetic valve group and 9 (6.0%) in the community comparison group. There were no maternal deaths. Pregnant women with mechanical prosthetic valves were more likely to experience severe maternal morbidity, as well as prolonged hospital length of stay, than matched counterparts without heart disease. This information can enhance shared decision making about the timing of valve replacement and pregnancy planning in young and middle-aged women.