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Issues for the mother
Which forms of birth control are safe?
All forms of birth control (medical term: contraceptives) can be used in women with tissue heart valves. In women with mechanical heart valves, contraceptive pills containing estrogen and progestin should be used with caution or not at all because of the risk of blood clot formation on the heart valve. The older style mechanical valves (medical term: Bjork-Shiley or Starr Edwards valves) are particularly high risk for blood clots and combined oral contraceptive pills should not be used. Contraceptive selection should be discussed with a physician who has an understanding of your underlying heart condition. (see Birth Control)
What are my risks if I become pregnant?
In order to determine your risk during pregnancy, you should see your heart specialist before getting pregnant. You may be required to have additional heart tests such as an echocardiogram or a magnetic resonance imaging scan (MRI scan) to better determine the risks of pregnancy.
The most serious risk relates to the formation of blood clots on the mechanical valve (medical term: thrombosis), as this can be a life threatening condition. The risk may be minimized by careful monitoring of the blood thinner (medical term: anticoagulant) during pregnancy, close follow up of the valve function by echocardiography, and reporting concerning symptoms immediately to your physician.
Women with mechanical heart valves are also at risk for, weakening of the heart muscle (medical term: heart failure) or abnormal heart rhythm problems (medical terms: arrhythmias). If you had heart failure or rhythm problems before pregnancy, your risk for complications during pregnancy is higher. Other cardiac characteristics can have an impact on pregnancy outcomes. (see General Considerations) Symptoms may occur even in the setting of a well functioning valve, and may be exacerbated by any degree of malfunction of the mechanical valve.
Some medications are not safe in pregnancy. Do not stop medications without first checking with your doctor, but do check your medications out before pregnancy so you will have a plan. If you did not do that, then do so as soon as you know you are pregnant. The MOTHERISK website is an excellent resource.
