Hum. Reprod. Advance Access originally published online on April 7, 2004
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Human Reproduction, Vol. 19, No. 5, 1211-1214,
May 2004
© 2004 European Society of Human Reproduction and Embryology
Prospective observational study of bone mineral density during pregnancy: low molecular weight heparin versus control
1 Department of Obstetrics and Gynaecology, Liverpool Women’s Hospital, Crown Street, Liverpool L8 7SS and 2 Department of Clinical Biochemistry, Royal Liverpool University Hospital, Prescot Street, Liverpool L7 8XP, UK
3 To whom correspondence should be addressed. e-mail: rgfarquharson{at}lwh-tr.nwest.nhs.uk
BACKGROUND: The aim of this study was to assess the effect of long-term low molecular weight heparin (LMWH) on bone mineral density (BMD) during pregnancy. METHODS: Fifty-five patients with recurrent miscarriage and known thrombophilia (antiphospholipid syndrome) were followed through pregnancy in an ethically approved prospective observational study. All women had dual energy X-ray absorptiometry (DEXA) scans at the lumbar spine (L1–L4) performed within 6 months prior to conception and in the immediate post-natal period, within 6 weeks of delivery. LMWH (5000 U/day) plus low-dose aspirin was commenced after a positive urine pregnancy test and continued throughout pregnancy and after delivery until 6 weeks post-partum. A group of 20 volunteers with recurrent miscarriage, not requiring any treatment intervention, acted as controls and were monitored in an identical fashion. RESULTS: Characteristics were not significantly different between treated patients and controls. Both groups showed a similar loss in lumbar spine (L1–L4) BMD by the end of the pregnancy [LMWH 4.17% or 0.045 g/cm3, 95% confidence interval (CI) 0.036–0.062 versus control 3.56% or 0.043 g/cm3, 95% CI 0.027–0.059]. However, the difference in bone loss between the groups was not statistically significant (0.002 g/cm3, CI –0.0124 to 0.00865; P = 0.88). No patient suffered vertebral fracture. CONCLUSIONS: Bone loss associated with the use of long-term LMWH is not significantly different from physiological losses during pregnancy.
Key words: bone/heparin/thrombophilia
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