Variation in Preferences of Pregnant Women for Outcomes Related to the Use of Anticoagulants in Pregnancy [16K]

INTRODUCTION: Women requiring anticoagulants in pregnancy face increased maternal and fetal risks. The trade-offs women are willing to make to ensure optimal pregnancy outcomes are not known. This study was conducted to compare preferences of pregnant women with and without cardiac disease, for maternal and fetal outcomes resulting from anticoagulant use in pregnancy. METHODS: A cross-sectional study was conducted on pregnant women with cardiac or non-cardiac medical disorder. Study participants were presented with seven vignettes that described a combination of maternal and fetal outcomes related to the use of anticoagulants during pregnancy. Participants were asked to rank these vignettes and assign them with “utility values” (preferences) on a visual analogue scale (VAS), by the standard gamble (SG) and time trade-off (TTO) methods. These were presented on a scale of 0-100 where 0 represented maternal and fetal death, the worst outcome, and 100 represented perfect maternal-fetal health, the best. RESULTS: 90 pregnant women (40 with and 50 without cardiac disease) completed the interviews. The median age was 32 [29-36] years and the median gestational age was 29.5 [22-34.3] weeks. The cardiac and non-cardiac groups had similar demographic characteristics. While no consistent trends were observed with VAS and TTO methods, with SG, women with cardiac disease consistently assigned higher utility values for the seven outcomes as compared with those without cardiac disease. CONCLUSION: Women with cardiac disease value adverse pregnancy outcomes more favorably than non-cardiac patients. Whether this finding is related to risk-taking attitudes among cardiac patients, needs to be further explored.