Fetal risks due to warfarin therapy during pregnancy

Area of Science:

• Obstetrics and Gynecology
• Cardiology
• Teratology

Background:

• Prosthetic heart valves necessitate anticoagulation therapy, often with warfarin, during pregnancy.
• Managing anticoagulation in pregnant women with cardiac conditions presents significant risks to both mother and fetus.

Observation:

• Two cases of pregnant women with prosthetic heart valves treated with warfarin are presented.
• One infant experienced fatal cerebral and pulmonary hemorrhage; the other exhibited warfarin-induced embryopathy.

Findings:

• The second infant displayed nasal hypoplasia and stippled epiphyses (chondrodysplasia punctata), consistent with warfarin embryopathy.
• A probable causal association exists between first-trimester warfarin exposure and nasal hypoplasia in 11 reported infants.

Implications:

• Warfarin embryopathy, including nasal hypoplasia, is a significant teratogenic risk associated with first-trimester warfarin use.
• Therapeutic abortion should be considered the primary alternative for pregnant women with prosthetic cardiac valves due to risks.
• Alternative anticoagulation strategies or careful risk-benefit assessment are crucial for managing these high-risk pregnancies.