Pregnancy AF and atrial utter are very rare during pregnancy, unless when there is an underlying structural heart disease or hyperthyroidism.417 Lone AF is uncommon in pregnancy and is associated with older age and late In countries where the prevalence of rheumatic heart disease is still high or among immigrants from these areas to Western countries, the prevalence of AF in pregnancy may be commonly related to rheumatic heart disease.418 Peri-partum cardiomyopathy AF is common, with a prevalence that may reach 10%, and may severely impair hemodynamic In a registry of > 250,000 pregnancies in Southern AF was evident in 0.6 per 1,000, more frequently in white women (1.1 per 1,000 pregnancies), and was associated with more advanced age, higher BMI, hypertension, hyperlipidemia, and diabetes. Decision-making on antithrombotic therapy during pregnancy has been reviewed in detail in the 9th Edition of the Antithrombotic Therapy and Prevention Guidelines; here we provide an update with recommendations focused on AF.421 The use of anticoagulant therapy during pregnancy is challenging because of the potential for both fetal and maternal complications. Pregnancy-induced changes in hemostasis lead to a state of hypercoagulability, so in a woman with AF at risk of stroke/thromboembolism in the non-pregnant state, pregnancy will increase this risk threefold to fourfold.421,422 VKAs cross the placenta and have the potential to cause fetal wastage, bleeding in the fetus, and teratogenicity. 