Pregnant women with mechanical prosthetic heart valves (MPHV) have adverse effects on the growth and development of the fetus. This study investigated the outcomes and correlations of MPHV pregnant women under different anticoagulation methods. Data on MPHV pregnant women and their offspring from our hospital from 2014 to 2020 were retrospectively collected. Various indicators of the offspring were analyzed, using single factor logistic regression and multi-factor Tobit regression to identify

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... e main influencing factors of spontaneous abortion/stillbirth and malformation. There were 137 pregnancies, 96 in the warfarin group, 28 in the low-molecular-weight heparin (LMWH) group, and 13 in the sequential treatment group. Among these, there are 27 cases of spontaneous abortion, 3 cases of stillbirth and 56 live births. The international normalized ratio (INR, P < 0.001), prothrombin time (PT, P = 0.014), activated partial thromboplastin time (APTT, P = 0.035) of the neonates in the warfarin group were increased compared with the other two groups. Multivariate Tobit regression analysis showed that the probability of spontaneous abortion/stillbirth was positively correlated with INR before delivery (OR 1.13, P = 0.009) and valve usage time (OR 1.13, P = 0.009). The probability of malformation was positively correlated with heart function level (OR 1.20, P = 0.025) and INR (OR 1.18, P = 0.011) before delivery. Conclusion: The offspring of MPHV pregnant women who continuously take warfarin have poor outcomes and a significantly higher risk of early bleeding. Prenatal consultations for MPHV women should be strengthened to avoid unplanned pregnancy.