Abstract
Objective An increase in opioid use disorder and subsequent intravenous drug use has led to
an increase in sequalae that may complicate pregnancy, such as infective endocarditis.
Infective endocarditis has the potential for significant maternal and neonatal morbidity
and mortality. We sought to examine the management considerations and clinical implications
of intravenous drug use-related infective endocarditis in pregnancy from our center's
experience.
Study Design Retrospective study of management of pregnancies complicated by infective endocarditis
as a result of active intravenous drug use at an academic tertiary care hospital from
January 2012 through December 2019.
Results Twelve women with active intravenous drug use histories were identified as having
clinical and echocardiographic features consistent with infective endocarditis. Six
women were discharged against medical advice and did not complete the full course
of recommended antibiotic regimen. Eight women were started or continued on opioid
agonist therapy during their hospitalization. Four neonates required neonatal intensive
care unit admission for pharmacologic treatment for neonatal abstinence syndrome.
Conclusion Management of intravenous drug use-associated infective endocarditis in pregnancy
involves more than treating the acute condition. In pregnant women with opioid use
disorder and infective endocarditis, addiction and chronic psychosocial conditions
need to be addressed to optimize care.
Keywords
infective endocarditis - pregnancy - intravenous drug use - bacteremia - opioid use
disorder
