Pregnancy

[theman]

Has anyone here with a mechanical valve recently gone through a pregnancy? Were you switched to lovenox for weeks 6-12? I ask because I have been doing some research (not for me as you probably could tell from my screen name) and have found some interesting articles that seem to suggest that the odds of fetal warafrin syndrome and other coumadin related defects are much, much lower than the prevailing school of thought would suggest and staying on coumadin until the final weeks of pregnancy has a similar statistical output for the child while greatly benefiting the mother.

theman

 

[Karlynn]

Warfarin in the 1st trimester should be greatly avoided. Some women have done Lovenox the entire pregnancy. However, lately it seems like more drs. are having women do 1st and 3rd trimesters on Lovenox and the 2nd on warfarin.

 

[hensylee]

recently one of our members reported her successful delivery but I don't recall her name nor if she had a valve. Search 'pregnancy' and you may locate it. someone else might recall her name and stop in here.

 

[Tgamble]

pregnancy

pregnancy

Hi my name is Terressa, I went through a pregnancy 11 months ago. I had my mitral valve replacement in 2001. I had a healthly baby boy dec 05 2007. I had problems before I got pregnant with the shots, so I decided on my own and of course with my doctors to stay on coumadin the whole entire pregnancy. I heard so many story about women getting blood clots and having to get their valve replaces again I just couldn't go through that again. So I stayed on coumadin, went to the coumadin clinic to get check once a week, and also check by my obgyn doctor every 2 weeks starting from 5 weeks pregnant to the very end which my doctors decided to take him 3 weeks early and on top of that I had to go to the cardiologist every 2 weeks also. So my weeks consisted of me going to the doctors just about every week also due to fetal testing too. The nomal person gets about 2 to 3 ultrasounds I got 1 every month of my pregnancy except the last month I got a total of 3. You know if you decide to go through with a pregnancy with a heart problem please be prepare to give up alot, but if you want that baby to come out healthly you will do what every it takes. I went to John Hopkins and I had a team of doctors maybe about 10 different doctors but one special doctor stood by me through everything her name was Dr. Ruiz she was the best she really did her research along with me and we both made it happen. But yes it's very possible to have a successful pregnancy with a mechcanical valve, I did, and next month my son will be a year old.

 

[Eva]

Hi my name is Terressa, I went through a pregnancy 11 months ago. I had my mitral valve replacement in 2001. I had a healthly baby boy dec 05 2007. ...
But yes it's very possible to have a successful pregnancy with a mechcanical valve, I did, and next month my son will be a year old.

What a beautiful inspiring story, Terressa.

 

[A New Beginning]

my gosh...

your story teressa is inspiring. i am right now so upset because i hear so many bad things about warafin and babies and death. you make me want to try. i already have a wonderful toddler, but i had her before i had a mechanical valve. so many questions, so many unanswered. thank you, you gave me some hope that things can be possible.

Aja

 

[Ross]

Aja that's the problem. The medical community is not and has not been on the same page since the beginning of use of Coumadin. Some are more educated now and aren't living in the dark anymore, so they don't treat like the medievil days anymore, yet there are still more that do.

If they'd all bother to sit down and learn about the new (which isn't really new) and proper dosing and follow up of Coumadin, I guarantee at least 80% of the horror stories are going to go away.

My own recent encounter with Lovenox bridging taught me something. Your much more likely to bleed on Lovenox then on Coumadin. MUCH MORE. To me, it only makes sense to stay on Coumadin throughout the pregnancy, but I'm not a doctor, so that is only my own opinion.

 

[Mary]

I just did a search for coumadin and infant birth defects and I'm not finding the lower numbers, theman, that you suggest. Would you mind sharing your source so we can read them too? Thanks.

 

[A New Beginning]

thanks Ross

medicine is not a confirmed science and that is why every case is different. oh well, i am sure i will be ok. my husband will have to just get the snip to keep me from having the urge to have more.



Aja

 

[gijanet]

I would not begin to try and answer the question of pregnancy for anyone, but I would encourage anyone with a mechanical valve seriously considering pregnancy to weigh all the risks involved and read the following threads as well:

http://www.valvereplacement.com/forums/showthread.php?t=23884&highlight=willow

http://www.valvereplacement.com/forums/showthread.php?t=23203&highlight=willow

Hugs. J.

 

[kerri73]

I don't remember if I shared this, but when I was in the hospital recently for my cath, the cardiologist who was following me to determine my release talked about how Lovenox now has warnings on it to not be used in patients with artificial valves (and I don't know if there's a duration attached to it, but he didn't recommend it in a pregnancy situation). I too have looked into the whole pregnancy thing, and both my regular cardiologist and high risk OB recommended just staying on coumadin if your dose was low enough (less than 5mg a day was the dose I had been told). I've heard so many stories about women using lovenox either for a trimester at a time or the whole pregnancy and developing clots. You can also develop antibodies with heparin drips if you went that route. It all just sounds scary. I think for me, if I pursued a pregnancy (right now I have other heart issues that won't allow me to unless I fix them, and that's a maybe that it would work) I'd go the coumadin route, myself.

 

[Ross]

In any event, just to make things perfectly clear, pregnancy while on any anticoagulant is NOT encouraged. That's the bottom line.

 

[Ross]

I don't remember if I shared this, but when I was in the hospital recently for my cath, the cardiologist who was following me to determine my release talked about how Lovenox now has warnings on it to not be used in patients with artificial valves (and I don't know if there's a duration attached to it.

http://products.sanofi-aventis.us/lovenox/lovenox.html#8.6

8.6 Patients with Mechanical Prosthetic Heart Valves

The use of Lovenox has not been adequately studied for thromboprophylaxis in patients with mechanical prosthetic heart valves and has not been adequately studied for long-term use in this patient population. Isolated cases of prosthetic heart valve thrombosis have been reported in patients with mechanical prosthetic heart valves who have received enoxaparin for thromboprophylaxis. Some of these cases were pregnant women in whom thrombosis led to maternal and fetal deaths. Insufficient data, the underlying disease and the possibility of inadequate anticoagulation complicate the evaluation of these cases. Pregnant women with mechanical prosthetic heart valves may be at higher risk for thromboembolism [see Warnings and Precautions (5.7)].

5.7 Pregnant Women with Mechanical Prosthetic Heart Valves

The use of Lovenox for thromboprophylaxis in pregnant women with mechanical prosthetic heart valves has not been adequately studied. In a clinical study of pregnant women with mechanical prosthetic heart valves given enoxaparin (1 mg/kg twice daily) to reduce the risk of thromboembolism, 2 of 8 women developed clots resulting in blockage of the valve and leading to maternal and fetal death. Although a causal relationship has not been established these deaths may have been due to therapeutic failure or inadequate anticoagulation. No patients in the heparin/warfarin group (0 of 4 women) died. There also have been isolated postmarketing reports of valve thrombosis in pregnant women with mechanical prosthetic heart valves while receiving enoxaparin for thromboprophylaxis. Women with mechanical prosthetic heart valves may be at higher risk for thromboembolism during pregnancy, and, when pregnant, have a higher rate of fetal loss from stillbirth, spontaneous abortion and premature delivery. Therefore, frequent monitoring of peak and trough anti-Factor Xa levels, and adjusting of dosage may be needed [see Use in Specific Populations (8.6)].

 

[TXGal]

I had my mitral valve replaced at age 20. First they tried repairing my valve since I was so young and wanted children, but one week later they had to replace my valve and put me on coumadin. After marriage, my husband and I talked to my cardiologist about the possibility of me getting pregnant. He introduced me to another woman who had a mitral valve replacement in the same small city as myself. She had a successful pregnancy and has a beautiful little girl. But, after hearing some of the nightmare stories of things that happened during her pregnancy, I decided it was too risky. She strongly suggested that I not chance it. She has recently adopted for her second child.

As for myself, I decided to go the surrogacy route. I have a 14 month old son who was given to me through the beautiful gift of surrogacy. We had a gestational surrogate (my egg and my husband's sperm).. It was the best option for us I think. I didn't want to risk any damage to my valve..

 

[Lisa in Katy]

My own recent encounter with Lovenox bridging taught me something. Your much more likely to bleed on Lovenox then on Coumadin. MUCH MORE. To me, it only makes sense to stay on Coumadin throughout the pregnancy, but I'm not a doctor, so that is only my own opinion.

Ross, you know if it's going to happen, it's going to happen to you!

How can you be sure that you would have been any better on Coumadin? I've been through two surgeries with Lovenox and never had a bleeding issue. I've also been through a single extraction with Coumadin and didn't have a bleeding issue. You just seem to always draw the short stick when it comes to health!

According to Al Lodwick, our Warfarin expert, there are serious issues with Warfarin and pregnancy, including birth defects, bleeding, maternal death, and miscarriage. However, Lovenox doesn't seem to be any better. I think TXGal had the right idea.

 

[Duff Man]

I emailed Mr. Al Lodwick regarding the warfarin issue and pregnancy and he graciously responded the same night, and he said the greatest risk is that the baby will be born with a deformed face. I'm not making that up. He didn't necessarily give a time frame, but I think the first trimester is the most crucial for avoiding warfarin. I take what the man has to say seriously because he is the ACT authority.

 

[Karlynn]

Chance for deformities from warfarin occur in the first trimester, I believe. This is why people thinking about considering it are told to plan plan plan because it's advantageous to do Lovenox the first trimester. After that, I think it's more the risk to the mother with complications.

We have members here who have done it, with varying degrees of difficulty and success. Personally, I wouldn't want to risk it. But much like the tissue vs. mechanical debate - we all have our own personal choices and reasons for those choices.

Kristen - our member Gnusal is expecting twin girls through gestational surrogacy. I'm sure she'd like to compare notes. Congratulations on your baby boy!

 

[TXGal]

Kristen - our member Gnusal is expecting twin girls through gestational surrogacy. I'm sure she'd like to compare notes. Congratulations on your baby boy!

Thank you! I will look her up to say hello!