Factor V Leiden & Pregnancy: Risks & Management

Question
I am 42 years old, I have one child (boy 15yrs-born 10 weeks early from placenta abruptio).  I am newly married (4 yrs) and would like to have child with new husband.  A year and a half ago I was diagnoised with Factor V Leiden after a doppler scan on my right leg found a DVT from ankle to hip.  (I had a sore calf muscle pain that moved up my leg to the thigh when I called the doctor).  After a week in the hospital on heparin, I suffered a pulmonary embolism. I have been on warfarin since then and have a vena cava filter implanted.  I have had a previous history of pregancy losses from 9 weeks to 28 weeks.  I have lost 6 babies over the last 20 years, two of them 27& 28 weeks.  My last lost was in summer of 1999.  Now that I know I have this Factor V Leiden disorder, it is believe by my doctor that this could have resulted in all of my losses.  I have been told now that if I want to become pregnant (I currently have IUD), that I would have to go off of the warfarin for at least 3 months and immediately start on the Lovenox and stay on it throughout pregnancy.  My husband and I are still weighing the pros and cons of pregnancy.  I want to do it however he is highly concerned with my loss of life.  Do you have any history concerning anyone with my condition and pregnancy?  Do you have any recommendations (doctors, hospitals, research, etc)

Sincerely,

Brenda

Answer
I have had three patients in the last year who have had many pregnancy losses and were diagnosed with Factor V Leiden. They did use Lovenox throughout the pregnancy with no untoward effects, and continued the Lovenox post partum, as well. They were followed with Hematologists as well as myself throughout the pregnancy. (We used to use Heparin throughout the pregnancy, but it is really inconvenient to the patient and Lovenox has vastly improved compliance and results. There can still be losses, but in the three patients I had, healthy babies were the result of the pregnancy. I would give you the same recommendations as your doctor. Good luck to you.