Human Reproduction, Vol. 14, No. 11, 2876-2880,
November 1999
© 1999 European Society of Human Reproduction and Embryology
Bone density changes in pregnant women treated with heparin: a prospective, longitudinal study
1 Departments of Obstetrics & Gynaecology, 2 Clinical Physics & Bone Densitometry and 3 Medical Statistics & Evaluation, ICSM at St Mary's and 4 Hammersmith Hospital, Praed Street, London W2 1PG, UK
Heparin plus aspirin significantly improves the live birth rate of women with primary antiphospholipid syndrome. Osteopenia is a major concern of long-term heparin therapy. We studied prospectively the bone mineral density (BMD) changes during pregnancy and the puerperium in 123 women with primary antiphospholipid syndrome treated with low-dose aspirin and subcutaneous low-dose heparin (46 women took unfractionated heparin and 77 took low-molecular-weight heparin). Lumbar spine, neck of femur and forearm BMD were measured, using dual energy X-ray absorptiometry, at 12 weeks gestation, immediately postpartum and 12 weeks postpartum. The mean heparin duration was 27 weeks (range 22–29). During pregnancy, BMD decreased by 3.7% (P < 0.001) at the lumbar spine and by 0.9% (P < 0.05) at the neck of femur with no significant change at the forearm. Lactation was associated with a significant decrease in the lumbar spine and neck of femur BMD. There was no significant difference in BMD changes between the two heparin preparations. No woman suffered a symptomatic fracture. Long-term heparin treatment during pregnancy is associated with a small but significant decrease in BMD at the lumbar spine and neck of femur. This decrease is similar to that previously reported to occur in untreated pregnancies.
Key words: bone density/heparin/pregnancy/prospective study
5 To whom correspondence should be addressed at: Department of Obstetrics & Gynaecology ICSM at St Mary's, Mint Wing, South Wharf Road, London W2 1NY, UK
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