Adverse effects of warfarin in the fetus Warfarin embryopathy
(6-12 weeks) Nasal hypoplasia Stippled epiphyses Saddle-nose deformity Mental retardation Optic atrophy Frontal bossing Hypertelorism High-arched palate Short neck Short stature Fetal effects (all trimesters and delivery) Ocular abnormalities-blindness Neurological abnormalities-microcephaly, mental retardation, low intelligent quotients Fetal loss Bleeding Table 6.
The most popular management strategy in the United States entails a switch from warfarin to unfractionated heparin as soon as pregnancy is diagnosed, with a switch back to warfarin at 13 weeks' gestation, after the risk of embryopathy is over.
Warfarin throughout pregnancy is a particularly attractive strategy in a high-risk woman who was well controlled on the anticoagulant at 5 mg/day or less prior to pregnancy, which might lessen the risk of warfarin embryopathy, she continued.
accounts for about 40% of deaths of infants of diabetic mothers.
was usually caused by oral anticoagulant use during the first trimester, whereas anticoagulant use during the second and third trimesters was associated with a high fetal loss rate.
5 times the risk of having this embryopathy
as do epileptic women not taking anticonvulsants.
Although MMI offers the advantage of a longer half-life and, thus, single daily dosing, it has been associated with rare cases of congenital fetal abnormalities, including scalp defects and methimazole embryopathy
The chief downside of warfarin use in pregnancy is the risk of embryopathy
with fetal exposure during weeks 6-9.
Accutane does not affect sperm, and there is no evidence from studies that Accutane embryopathy
can result from exposed sperm.
The key issue is which drug is better able to prevent valve thrombosis and still avoid embryopathy
and fetal wastage.
This explanation, rather than inflammatory or metabolic mechanisms, clarifies the specificity of thalidomide embryopathy
and has significant implications for its therapeutic application.