Deruelle Philippe, Coulon Capucine
Clinique d'Obstétrique. Hôpital Jeanne de Flandre, CHRU de Lille, France.
Curr Opin Obstet Gynecol. 2007 Dec;19(6):573-7. doi: 10.1097/GCO.0b013e3282f10e33.
Low-molecular-weight heparins are in widespread use during pregnancy. As with every treatment in pregnant patients, concerns have been raised about the safety of Low-molecular-weight heparins. The purpose of the present article is to review recent advances, published during the past year, that have studied the maternal, fetal, and neonatal safety of Low-molecular-weight heparins in pregnant women.
Low-molecular-weight heparins do not increase the risk of maternal bleeding during pregnancy. Closed management is needed during the peripartum period, and discontinuing Low-molecular-weight heparins at least 12 h before delivery seems sufficient to prevent post-partum haemorrhage. The incidence of Low-molecular-weight heparins-induced immune reaction is low. Fondaparinux or danaparoid may be used as an alternative option in pregnant women with heparin-induced thrombocytopenia. Long-term Low-molecular-weight heparins therapy may be associated with osteopenia. Calcium vitamin D supplementation during pregnancy may reduce the risk of Low-molecular-weight heparins-induced osteoporosis. As Low-molecular-weight heparins do not cross the placenta, no fetal or neonatal complication has been reported. Beyond the safety question, Low-molecular-weight heparins have the potential to improve the live-birth rate in high-risk pregnancies (antiphospholipid syndrome, thrombophilia, or recurrent fetal loss).
Recent studies have confirmed the safety of Low-molecular-weight heparins therapy during pregnancy. The risk of potential side effects is low for both the mother and the neonate.
低分子量肝素在孕期广泛应用。与针对孕妇的所有治疗一样，人们对低分子量肝素的安全性提出了担忧。本文旨在回顾过去一年发表的最新进展，这些进展研究了低分子量肝素在孕妇中的母体、胎儿及新生儿安全性。
低分子量肝素不会增加孕期母体出血风险。围产期需要严密管理，在分娩前至少12小时停用低分子量肝素似乎足以预防产后出血。低分子量肝素诱导的免疫反应发生率较低。磺达肝癸钠或达那肝素可作为肝素诱导的血小板减少症孕妇的替代选择。长期使用低分子量肝素治疗可能与骨质减少有关。孕期补充钙和维生素D可能降低低分子量肝素诱导的骨质疏松风险。由于低分子量肝素不会穿过胎盘，尚未有胎儿或新生儿并发症的报道。除了安全性问题，低分子量肝素还有可能提高高危妊娠（抗磷脂综合征、血栓形成倾向或复发性流产）的活产率。
最近的研究证实了孕期使用低分子量肝素治疗的安全性。母亲和新生儿出现潜在副作用的风险都很低。
