Preliminary Observation on the Impact of Pregnant Women Taking Warfarin after Mechanical Valve Replacement on Children’s Physical and Mental Development_Chinese Journal of Evidence-Based Medicine

Authors：

JIANG Lu ¹ , YANG Fan ² , LI Yongbo ¹ , ZHU Xiliang ¹ ,  XIAO Xijun ¹

1. Department of Thoracic and Cardiovascular Surgery, West China Hospital, Sichuan University, Chengdu 610041, China;2. Department of Child Health Care, West China Second University Hospital, Sichuan University, Chengdu 610041, China;

Corresponding author：

XIAO Xijun, Email: xijun.xiao@yahoo.com.cn

Keywords：

Mechanical valve replacement; Pregnancy; Warfarin; Child; Physical development; Mental development

DOI：

10.7507/1672-2531.20120082

Video：

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Objective 　To explore the impact of the women taking warfarin throughout pregnancy after mechanical valve replacement on the children’s physical and mental development.
Methods 　A total of 12 children whose mothers had taken mechanical valve replacement before pregnancy were enrolled in the experimental group in this study, for determination of their physical and mental development. The following indicators were measured: a) Physical development indexes: height, weight, sitting height, head circumference, chest circumference; b) Mental development indexes: intelligence quotient (IQ), and development quotient (DQ) which included adaptability, big movement, fine motor, language, and individual-society. According to the 1?∶?2 matching ratio, 24 children of the healthy women were selected in the control group, and then the difference of each index between the two groups was analyzed.
Results 　In the aspects of both physical development indexes and mental development indexes, there were no significant differences in the children aged 0 to 3 yrs, 4 to 6 yrs, and 6 to 12 yrs in the two groups (P gt;0.05).
Conclusion 　After mechanical valve replacement, women taking oral anticoagulant warfarin in daily dose not exceeding 5mg are safe, and there are no negative effects on children’s physical and mental development.

Citation： JIANG Lu,YANG Fan,LI Yongbo,ZHU Xiliang,XIAO Xijun. Preliminary Observation on the Impact of Pregnant Women Taking Warfarin after Mechanical Valve Replacement on Children’s Physical and Mental Development. Chinese Journal of Evidence-Based Medicine, 2012, 12(5): 516-519. doi: 10.7507/1672-2531.20120082 Copy

1.	Hall JG, Pauli RM, Wilson K. Maternal and fetal sequelae of anticoagulant during pregnancy. Am J Med, 1980, 68(1): 122-140.
2.	Stevenson RE, Burton M, Ferlauto GJ, et al. Hazards of oral anticoagulants during pregnancy. JAMA, 1980, 243(15): 1549-1551.
3.	Wesseling J, Van Driel D, Heymans HS, et al. Coumarins during pregnancy: long-term effects on growth and development of school-age children. Thromb Haemost, 2001, 85(4): 609-613.
4.	Bonnar J. Hemostasis and coagulation disorders in pregnancy. In: Bloom AL, Thomas DP, editors. Haemostasis and Thrombosis. London: Churchill Livingstone, 1994: 570-583.
5.	Suri V, Keepanasseril A, Aqqarwal N, et al. Mechanical valve prosthesis and anticoagulation regimens in pregnancy: a tertiary centre experience. Eur J Obstet Gynecol Reprod Biol, 2011, 159(2): 320-323.
6.	Jeejeebhoy FM. Prosthetic heart valves and management during pregnancy. Can Fam Physician, 2009, 55(2): 155-157.
7.	Chan WS, Anand S, Ginsberg JS. Anticoagulation of pregnant women with mechanical heart valves: a systematic review of the literature. Arch Intern Med, 2000, 160(2): 191-196.
8.	McLintock C. Anticoagulation therapy in pregnant women with mechanical prosthetic heart valves: no easy option. Thromb Res, 2011, 127 Suppl 3: S56-S60.
9.	Kawamata K, Neki R, Yamanaka K, et al. Risk and pregnancy outcome in women with prosthetic mechanical heart valve replacement. Circ J, 2007, 71(2): 211-213.
10.	边策. 李涛, 刘兴会. 心脏瓣膜置换术后华法林抗凝治疗围产结局的影响. 现代妇产科进展, 2008, 17(9): 690-692.
11.	Van Driel D, Wesseling J, Rosendaal FR, et al. Growth until puberty after in utero exposure to coumarins. Am J Genet, 2000, 95(5): 438-443.
12.	Vitale N, De Feo M, De Santo LS, et al. Dose-dependent fetal complications of warfarin in pregnant women with mechanical heart valves. J Am Coll Cardiol, 1999, 33(6): 1637-1641.
13.	Vahanian A, Baumgartner H, Bax J, et al. Guidelines on the management of valvular heart disease: The Task Force on the Management of Valvular Heart Disease of the European Society of Cardiology. Eur Heart J, 2007, 28(2): 230-268.
14.	Hung L, Rahimtoola SH. Prosthetic heart valves and pregnancy. Circulation, 2003, 107(9): 1240-1246.

1. Hall JG, Pauli RM, Wilson K. Maternal and fetal sequelae of anticoagulant during pregnancy. Am J Med, 1980, 68(1): 122-140.
2. Stevenson RE, Burton M, Ferlauto GJ, et al. Hazards of oral anticoagulants during pregnancy. JAMA, 1980, 243(15): 1549-1551.
3. Wesseling J, Van Driel D, Heymans HS, et al. Coumarins during pregnancy: long-term effects on growth and development of school-age children. Thromb Haemost, 2001, 85(4): 609-613.
4. Bonnar J. Hemostasis and coagulation disorders in pregnancy. In: Bloom AL, Thomas DP, editors. Haemostasis and Thrombosis. London: Churchill Livingstone, 1994: 570-583.
5. Suri V, Keepanasseril A, Aqqarwal N, et al. Mechanical valve prosthesis and anticoagulation regimens in pregnancy: a tertiary centre experience. Eur J Obstet Gynecol Reprod Biol, 2011, 159(2): 320-323.
6. Jeejeebhoy FM. Prosthetic heart valves and management during pregnancy. Can Fam Physician, 2009, 55(2): 155-157.
7. Chan WS, Anand S, Ginsberg JS. Anticoagulation of pregnant women with mechanical heart valves: a systematic review of the literature. Arch Intern Med, 2000, 160(2): 191-196.
8. McLintock C. Anticoagulation therapy in pregnant women with mechanical prosthetic heart valves: no easy option. Thromb Res, 2011, 127 Suppl 3: S56-S60.
9. Kawamata K, Neki R, Yamanaka K, et al. Risk and pregnancy outcome in women with prosthetic mechanical heart valve replacement. Circ J, 2007, 71(2): 211-213.
10. 边策. 李涛, 刘兴会. 心脏瓣膜置换术后华法林抗凝治疗围产结局的影响. 现代妇产科进展, 2008, 17(9): 690-692.
11. Van Driel D, Wesseling J, Rosendaal FR, et al. Growth until puberty after in utero exposure to coumarins. Am J Genet, 2000, 95(5): 438-443.
12. Vitale N, De Feo M, De Santo LS, et al. Dose-dependent fetal complications of warfarin in pregnant women with mechanical heart valves. J Am Coll Cardiol, 1999, 33(6): 1637-1641.
13. Vahanian A, Baumgartner H, Bax J, et al. Guidelines on the management of valvular heart disease: The Task Force on the Management of Valvular Heart Disease of the European Society of Cardiology. Eur Heart J, 2007, 28(2): 230-268.
14. Hung L, Rahimtoola SH. Prosthetic heart valves and pregnancy. Circulation, 2003, 107(9): 1240-1246.

Chinese Journal of Evidence-Based Medicine

Preliminary Observation on the Impact of Pregnant Women Taking Warfarin after Mechanical Valve Replacement on Children’s Physical and Mental Development

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