Fetal and neonatal outcome of exposure to anticoagulants during pregnancy

Abstract

We studied fetal and neonatal outcome of women maintained on anticoagulants (warfarin and/or heparin) during pregnancy. Among 22 Chinese families, 13 mothers (59%) had a history of recurrent abortion or stillbirth while being maintained on warfarin treatment. Twenty-nine liveborn children (17 boys, 12 girls), ages 0.6-11.3 years at follow-up, were analysed for evidence of embryopathy. These were subdivided into 2 groups. Group 1 consisted of 18 children (12 boys, 6 girls) whose mothers were only given warfarin during pregnancy. Five were small for gestational age, and 12 had features of warfarin embryopathy such as nasal hypoplasia. One had subependymal intraventricular hemorrhage shown on neonatal ultrasonography. Group 2 consisted of 11 children (5 boys, 6 girls) whose mothers were maintained on warfarin and heparin during pregnancy. Three were premature deliveries, and 4 had nasal hypoplasia. One had cleft lip, cleft palate, cataract, microphthalmia, intraventricular hemorrhage, and hydrocephalus. We found that despite the high risk of fetal wastage, there was a relative lower risk of major complications, except for some minor cosmetic defects such as nasal hypoplasia. This might lead to readjustment of advice concerning contraception given to pregnant women who were maintained on anticoagulant therapy.

Infective Endocarditis: A Decade after Ross Procedure

“…Because of the increased thrombogenicity of mechanical prostheses, the choice for this valve substitute implies lifelong anticoagulation and is associated with an increased risk for thromboembolic and bleeding events. The use of anticoagulation may also complicate pregnancy because of the fetal and maternal complications of taking warfarin [5,6] and may require lifestyle adjustments in this relatively young and active patient group. Furthermore, compared with autograft valves, the hemodynamic performance of mechanical valves is less favourable, and mechanical valve noise can negatively affect the patient's quality of life [7].…”

Survival Comparison of the Ross Procedure and Mechanical Valve Replacement With Optimal Self-Management Anticoagulation Therapy

“…Because of the increased thrombogenicity of mechanical prostheses, the choice for this valve substitute implies lifelong anticoagulation and is associated with an increased risk for thromboembolic and bleeding events. The use of anticoagulation may also complicate pregnancy because of the fetal and maternal complications of taking warfarin 23,24 and may require lifestyle adjustments in this relatively young and active patient group. The clinical association between microemboli, generated by mechanical valves, and neurocognitive dysfunction is still a source of controversy.…”

2008 Focused Update Incorporated Into the ACC/AHA 2006 Guidelines for the Management of Patients With Valvular Heart Disease

“…The true incidence of warfarin embryopathy has been difficult to ascertain. This has ranged from less than 5% to as high as 67%, [801][802][803][804] and an estimate of 4% to 10% seems reasonable. 805,806 However, the risk of clinically important embryopathy may be lower if the dose of warfarin is less than or equal to 5 mg per day.…”