Low‐dose maternal warfarin intake resulting in fetal warfarin syndrome: In search for a safe anticoagulant regimen during pregnancy

Basu, Sriparna; Aggarwal, Priyanka; Kakani, Neha; Kumar, Ashok

doi:10.1002/bdra.23435

Cited by 33 publications

(23 citation statements)

References 14 publications

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“…Recent prospective studies merely detected fetal malformation, and warfarin embryopathy was only observed in a twin among the cases included in our meta‐analysis, the risk of the teratogenic effect of warfarin might be overestimated. Nevertheless, Basu reported four cases of fetal warfarin syndrome born to mothers with rheumatic heart disease on warfarin prophylaxis during pregnancy at a dose <5 mg/d, the incidence of warfarin embryopathy differed perhaps because the diagnoses were based on autopsies.…”

Section: Discussionmentioning

confidence: 99%

Comparison of anticoagulation regimens for pregnant women with prosthetic heart valves: A meta‐analysis of prospective studies

Wang

et al. 2017

Cardiovascular Therapeutics

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Section: Discussionmentioning

confidence: 99%

Comparison of anticoagulation regimens for pregnant women with prosthetic heart valves: A meta‐analysis of prospective studies

Wang

et al. 2017

Cardiovascular Therapeutics

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“… Based on RCOG; Wallace and Swallow; Nelson‐Piercy; Meacham et al; Jeffery et al; RCOG; Basu et al; Esposito et al; Rosendahl et al …”

Section: Cancer and Pregnancymentioning

confidence: 99%

“…Antepartum and postpartum hemorrhages are more common in anticoagulated patients. Anesthetic and operative complications can occur and spinal or epidural anesthesia are often contraindicated 112,114 Recurrence or secondary malignancy in pregnancy Treatment in pregnancy Increased pregnancy loss if treated in embryonal stage 113 Ovarian tissue cryopreservation and transplant, and reintroduction of primary cancer risk Patients with ovarian tissue cryopreserved before treatment who then receive this tissue back to restore fertility are at risk of the reintroduction of their primary cancer from the transplanted tissue 115 Based on RCOG; 105 Wallace and Swallow; 108 Nelson-Piercy; 109 Meacham et al; 110 Jeffery et al; 111 RCOG; 112 Basu et al; 113 Esposito et al; 114 Rosendahl et al 115 be systemically healthy enough to cope successfully with the physiological changes of both the antenatal and postnatal periods. In both sexes, there are multiple potential sites for disruption and damage to occur in the process of reproduction and different treatments and modalities may impact fertility at different sites and in different ways.…”

Section: Diabetesmentioning

confidence: 99%

“…No direct increase is reported, 117 although there are increased rates of congenital abnormalities among women with preexisting diabetes 119,120 Teratogenicity Anticoagulants such as warfarin are known to cause teratogenicity and fetal warfarin syndrome 113 Treatment for recurrence or secondary cancers may also lead to teratogenic effects Potential risk of congenital malformations or long-term health effects in offspring conceived with assisted reproductive technologies (ART).…”

Section: Congenital Abnormalitiesmentioning

confidence: 99%

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Survival from cancer in young people: An overview of late effects focusing on reproductive health

Newton

Friend

Feltbower

et al. 2019

Acta Obstet Gynecol Scand

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This paper provides a summary of the areas of survival from childhood, teenage and young adult cancers and the significant late effects that can arise from treatment; with particular focus on the area of reproductive health and the impact on both fertility and pregnancy. To complete this review, Web of Science and MEDLINE were used. Search terms included: “"survival AND childhood OR teenage OR young adult cancer", "late effects", "childhood cancer", "teenage AND/OR young adult cancer", AND "fertility after cancer" OR "pregnancy AND cancer" OR "fertility preservation”. Additionally, the clinical expertise of the authors was drawn upon. Childhood cancer is a thankfully rare occurrence; however, the incidence is increasing. Survival rates remain high and this means that a growing population of childhood and young adult cancer survivors are reaching adulthood. For some of these adults, although cured of their cancer, they are now facing a future with lasting effects on their health from their treatments. These effects, commonly referred to as late effects, are defined as health problems related either directly to the underlying cancer or to its treatment and which occur months or years after treatment has finished. Reproductive health is an important consideration for these patients, and although many will be able to conceive naturally, some will exhibit impaired fertility after their treatments. This can include difficulties at all points along the path from conception to delivery of a live, healthy offspring. High‐quality, large‐population evidence is sparse in many areas relating to fertility risk from treatment and the maternal and fetal health of childhood cancer survivors. Yet given the potential for complications, the authors advocate consideration of fertility at the time of diagnosis and before potentially gonadotoxic treatment.

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“…Teratogenic effect is dose-correlated and doses inferior to 5 mg/day seem to be safer, although teratogenic effect has been described also for these doses. [156][157][158] The greatest risk of teratogenic effects is present when warfarin is assumed between 6 th and 12 th week of gestation, 150 although toxicity is possible before or after this period. [159][160][161][162] Typical abnormalities caused by warfarin assumption are chondromalacia punctata, with stippled epiphyses and nasal and limb hypoplasia 150 and central nervous system abnormalities (e.g., optic atrophy, microcephaly, mental retardation, spasticity, and hypotonia).…”

Section: Warfarin and New Oral Anticoagulantsmentioning

confidence: 99%

Pregnancy and heart disease: what Internists should know

Gerloni

Panuccio²

2017

Ital J Med

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Cardiac disease can rarely complicate pregnancy (e.g., only 1 to 4% of pregnancies in the United States), but it still remains a major cause of non-obstetric maternal morbidity and mortality. 1 During pregnancy, a woman can suffer from heart failure because of a pre-existing heart disease or a new onset cardiopathy pregnancy correlated. Approximately 2% of pregnancies involve cardiac disease, and in the current era, most maternal disease is due to congenital heart disease (CHD).2 Currently cardiac surgery improvement of the last 50 years has permitted an increased number of survivors. Instead, in the past, rheumatic heart disease was the leading cause of heart failure in pregnancy.3,4 Further, with increasing maternal age, other etiologies of heart disease should not be ignored and, particularly, ischemic and hypertensive heart disease should be considered in an over forty pregnant women. 5 Physiology of normal pregnancyImportant hemodynamic changes appear during pregnancy and are responsible for heart failure in pregnant women with pre-existing heart disease. These changes begin early in pregnancy, generally during the first eight weeks, reach their peak during the late second trimester, and then remain relatively constant until delivery. 6 The plasma volume and red cell mass are the first major cardiocirculatory modification, actually they expand in the 8 th week and peak around 30 th week, with a net plasma volume gain of 1000-1600 mL, corresponding to 30-50% above baseline.7 A greater increase in intravascular volume compared to red cell mass results in the dilutional anemia of pregnancy. This aspect generally results at 30-34 weeks when plasma volume peaks in relation to red cell mass and is associated with sodium and water retention. Actually 1000 mEq of sodium and 6 liters of water are retained and distributed among amniotic fluid, fetus and intra and extracellular spaces.8 Further cardiac output increases to satisfy increase fetal and maternal metabolic needs. It can be estimated 30-50% above baseline levels during the entire pregnancy, but half of this change occurs by 8 th week. This relevant change is a consequence of blood volume augmentation, afterload reduction and maternal heart rate rise.9 Systemic Pregnancy and heart disease: what Internists should know ABSTRACTPregnant women with heart disease are increasing due to medical and surgical progress and, nowadays, congenital heart disease is the most frequent heart disease affecting these women. Pregnancy represents a considerable effort for an altered heart with negative consequences for life quality, disease progression and mortality. Risk differs a lot among patients and depends not only on the type of heart disease. Clinician should stratify risk and offer patients a correct pre-counselling and accurate follow-up. At the same time Clinician should be able to diagnose rapidly heart failure as some cardiopathies, such as peripartum cardiomyopathy, are related to pregnancy and produce symptoms that can be confused with normal pregnancy progression...

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Low‐dose maternal warfarin intake resulting in fetal warfarin syndrome: In search for a safe anticoagulant regimen during pregnancy

Abstract: We emphasize the need for optimizing the choice and dosage schedule of anticoagulants during pregnancy, least harmful for the mother and her developing fetus.

Cited by 33 publications

References 14 publications

Comparison of anticoagulation regimens for pregnant women with prosthetic heart valves: A meta‐analysis of prospective studies

Comparison of anticoagulation regimens for pregnant women with prosthetic heart valves: A meta‐analysis of prospective studies

Survival from cancer in young people: An overview of late effects focusing on reproductive health

Pregnancy and heart disease: what Internists should know

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