The implications to women ofchildbearing age taking Warfarin Anticoagulation

[摘要] The oral anticoagulant, warfarin, when administered in pregnancy, can cause warfarinembryopathy, fetal central nervous system abnormalities, spontaneous abortion and fetalintrauterine death. Women with prosthetic heart valves usually require warfarin in pregnancybecause of their high risk for thromboembolic complications. Anticoagulation regimens inpregnancy in these women aim to balance the fetal effects of warfarin with maternal risks ofthromboembolism.This study was conducted by structured interview of 124 black urban South African womenof childbearing age, who had at least one warfarin-exposed pregnancy. The study aimed todetermine the pregnancy outcomes in this cohort, their awareness of the effects of warfarin inpregnancy, and what management practices, as reported by them, had occurred with regard totheir anticoagulation in pregnancy and what genetic counselling they had received. There wasa significant difference in outcome between warfarin-exposed and non-exposed pregnancies;55.2% (123/223) of warfarin-exposed pregnancies ended in the birth of an abnormal baby,spontaneous abortion or intrauterine death. The warfarin embryopathy rate was estimated at4.5 – 5.4%. Most women reported having been given information about warfarin inpregnancy, though their awareness about the personal and fetal effects of warfarin was ofteninaccurate. Of warfarin-exposed pregnancies, 95% were reportedly exposed during criticalweeks six to ten of pregnancy, and >50% after 36 weeks. Only 5/124 (4%) interviewees hadgenetic counselling. Poor pregnancy outcomes, lack of awareness about the effects ofwarfarin in pregnancy, and management practices at odds with international regimens are allareas highlighted by this study that require urgent attention in this high-risk group of women.

[发布机构] University of the Witwatersrand