Bluehep Use In Pregnancy & Lactation

Pregnancy: Heparin does not cross the placenta and has not been related to congenital defects. However, its use during pregnancy has been associated with a 13 to 22% risk of fetal mortality or prematurity. It is not clear whether severity of maternal disease or an indirect effect of heparin is responsible. Coumarin anticoagulants have been associated with a 31% incidence of unfavourable outcome and a definite drug-induced pattern of malformations has been demonstrated (fetal warfarin syndrome). However, the incidence of warfarin-induced fetopathic effects in the second and third trimesters is very low. In general, heparin is considered to be the anticoagulant of choice in pregnancy. Long-term usage (>3 to 5 months) of therapeutic doses of heparin during pregnancy increases the risk of osteoporosis and warrants careful monitoring of patients.
Heparin therapy during the last trimester and immediate postpartum period is associated with a risk of maternal hemorrhage. Changes in pharmacokinetics during pregnancy require caution and close patient monitoring if heparin is used. Reports of therapeutic failure with adjusted-dose heparin therapy in pregnant patients with prosthetic heart valves may have been due to inadequate dosing and/or monitoring, or to an inherent lack of efficacy in these patients. The American College of Chest Physicians recommends that if subcutaneous heparin is used in pregnant patients with mechanical heart valves, it be administered every 12 hours and the dose adjusted to keep the mid-interval APTT at least twice the control, or an anti-Xa heparin level of 0.35 to 0.7 U/mL. In addition, some clinicians suggest an initial dose of 17,500 to 20,000 units s.c. every 12 hours.
Lactation: Heparin is not excreted in breast milk because of its high molecular weight.