warfarin and Infant--Newborn--Diseases

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.

Topics: Abortion, Habitual; Child; Child, Preschool; Female; Fetal Diseases; Follow-Up Studies; Heparin; Humans; Infant; Infant, Newborn; Infant, Newborn, Diseases; Male; Pregnancy; Pregnancy Complications, Cardiovascular; Prenatal Exposure Delayed Effects; Warfarin

Two mothers with heart valve prosthesis were treated with warfarin during pregnancy. In the first case a caesarean section was done one week after replacement of warfarin with heparin. The baby died of cerebral and pulmonary hemorrhage. The second mother had a male infant by caesarean section. The baby showed warfarin-induced embryopathy with nasal hypoplasia and stippled epiphyses (chondrodysplasia punctata). Nasal hypoplasia with or without stippled epiphyses has now been reported in 11 infants born to mothers treated with warfarin during the first trimester, and a causal association is probable. In view of the risks to both mother and fetus in women with prosthetic cardiac valves it is recommended that therapeutic abortion be advised as the first alternative.

Topics: Abnormalities, Drug-Induced; Adult; Cerebral Hemorrhage; Cesarean Section; Chondrodysplasia Punctata; Female; Fetus; Heart Valve Prosthesis; Hemorrhage; Heparin; Humans; Infant, Newborn; Infant, Newborn, Diseases; Lung Diseases; Maternal-Fetal Exchange; Pregnancy; Pregnancy Complications, Cardiovascular; Warfarin

Topics: Adult; Aged; Angiography; Brain Edema; Cerebral Hemorrhage; Cerebral Ventriculography; Corpus Striatum; Diagnosis, Computer-Assisted; Female; Hematoma; Humans; Hypertension; Infant, Newborn; Infant, Newborn, Diseases; Intracranial Arteriovenous Malformations; Male; Phlebitis; Thalamus; Tomography, X-Ray; Warfarin

Topics: Adult; Aortic Valve; Female; Head; Heart Valve Prosthesis; Hematoma; Heparin; Humans; Infant, Newborn; Infant, Newborn, Diseases; Mitral Valve; Pregnancy; Warfarin

Topics: Animals; Blood Coagulation Disorders; Blood Coagulation Factors; Cats; Factor IX; Factor V; Factor VII; Factor VIII; Factor X; Female; Humans; Infant, Newborn; Infant, Newborn, Diseases; Liver; Liver Function Tests; Maternal-Fetal Exchange; Phenytoin; Pregnancy; Prothrombin Time; Thromboplastin; Vitamin K; Warfarin

Topics: Anticoagulants; Asphyxia Neonatorum; Female; Hemorrhage; Humans; Hypothyroidism; Iatrogenic Disease; Infant, Newborn; Infant, Newborn, Diseases; Iodides; Maternal-Fetal Exchange; Pregnancy; Pregnancy Complications; Toxicology; Warfarin