Neurological sequelae of intrauterine warfarin exposure

Cardiovascular Management in Pregnancy

“…10,11 Warfarin use in the second and third trimester is associated with possible neurological sequelae including seizures, developmental delay, and hypotonia in the developing fetus attributable to intracranial microhemorrhages. 12 Increased fetal risk for hemorrhage has been attributed to the greater affinity of albumin for bilirubin than warfarin, high serum bilirubin concentration, reduced hepatic drug metabolism, and poor synthesis of vitamin K-dependent factors. 10 Because of this embryopathy, warfarin is Food and Drug Administration category X (Table 1).…”

Mechanical Heart Valves in Pregnancy

“…4 Furthermore, warfarin use in the second and third trimester has been associated with neurological sequelae and increased risk of fetal hemorrhage. 5 In the postpartum period, however, warfarin is the preferred choice for its superior anticoagulant properties and its safety in breastfeeding.…”

Natural history and management of cervical spine disease in chondrodysplasia punctata and coumarin embryopathy

“…Spasticity was mentioned by several reports as an unreliable marker for neurological compromise in these patients as it may not reflect cervical spine abnormality [23,24]. In addition, Raghav et al reviewed the neurological sequelae resulting from CE which include mental retardation, seizures, spasticity, hydrocephalus, microcephaly, Dandy-Walker malformation, and agenesis of corpus callosum [9], thereby making it difficult to assess these patients for neurological changes.…”

“…Coumarins pass through the placenta and influence fetal organogenesis [6] by inhibiting vitamin K-dependent proteins [7,8] utilized in the synthesis of clotting factors, bone morphogenesis, and CNS development [9]. The first case of pregnancy-related complications with coumarins and the central nervous system (CNS) was documented in 1959 [10], and several studies have since illustrated a critical period in the sixth through ninth gestational weeks during which fetuses are at highest risk of developing complications with coumarins [11].…”