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What are you injecting during pregnancy?


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I thought it might be interesting to learn what medications we're all on, what doseage / frequency, when we started it, etc.

I'm not entirely sure of the difference between all the different options ... if anyone has any info on that I'd be grateful! Meanwhile...I'm taking

0.2mg (5,000i/u's) Fragmin

Once per Day

Started at 15wks

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Hi Stephanie

60mg vs 0.2ml seems like a big difference in the amount of stuff being injected ... I wonder if this is to do with the different drug requiring different doseages, or whether you are 'more risky' than I am? I really would like to learn more about this!

Why are you taking the Folic Acid for life? If you don't mind my asking.

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Hello Katybops and Stephanie,

I'm currently doing Lovenox 100mg twice a day. I've been doing this since June 2004 and will continue till 6-8 weeks after delivery maybe longer.

I hope your pregnancies are going well. I'm 25 weeks 2 days today and am so looking forward to June, I will probably be induced the week of June 21st. :(

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I am 12 weeks now. I started on .5ml of heparin daily 3 months before I was pregnant and then at 7 weeks, after an ultrasound, I started .3ml of lovenox twice a day. I also take folic acid, calicum citrate (helps with the osteoporosis and the shots), iron because I am a little anemic, prenatal vitamins and 81mg of aspirin (for life and my high risk says it will not hurt). I feel like a pharmacy!! A small sacrifice for this little baby to make it here. :(

It is nice to see what everyone else is taking.

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It looks like, according toLovenox

Lovenox 30mg = 0.3ml

Lovenox 60mg = 0.6ml

Lovenox 100mg = 1ml

But I'm not sure whether 0.2ml Fragmin corresponds to 20mg Lovenox, I suspect it doesn't as they seem to work differently.

Also I notice Lovenox people are injecting twice daily for the most part. Fragmin people aren't.

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Katie,

I'm not sure how to compare the two measurements (mg vs ml), but I know the 60mg is pretty standard. I've heard of many women taking 30mg twice a day, but I, like you, inject only once/day.

The folic acid is for a hetero MTHFR mutation. Apparently this condition is very common and can occur in as much as 40% of the population within some ethnic groups. Certainly not all individuals with an MTHFR mutation will have blood clotting problems, however a disproportionate number of people with blood clotting issues and recurrent miscarriage *do* have MTHFR mutations. To be honest, I don't know exactly how it impacts the blood, but it does prohibit the absorbtion of folic acid which can lead to heightened homocysteine levels and, hence, to blood clotting problems. A 5mg folic acid supplement is simply a preventative measure to make sure the body has an adequate supply of this vitamin. For those that are interested, I've pasted below an article that I came across recently about the value of folic acid. Worth a glance for those of us with clotting issues. Probably more information than you really needed, but perhaps it will help someone.

Stephanie

Source: United Press International

ATLANTA (United Press International via COMTEX) -- New research from

Emory University in Atlanta suggests folic acid may reduce the risk of

heart attacks and strokes, the Wall Street Journal said Tuesday.

Long associated as a benefit to women of child-bearing age to prevent

certain birth defects, the member of the B-complex family of vitamins

may also have anti-cancer abilities, the report said.

"I think that ultimately we will see that folic acid will prevent 10

times as many cardiovascular deaths a year as birth defects," says

Godfrey P. Oakley Jr., visiting professor of epidemiology at Rollins

School of Public Health of Emory University, Atlanta.

Folic acid helps the body break down carbohydrates into simple sugars

to be used for energy. It is found naturally in a number of foods,

including leafy green vegetables, spinach and bananas.

A 2002 study suggested folic acid can help prevent the recurrence of

blocked arteries in patients who underwent heart-bypass surgery. A

randomized trial whose results were published in the British Medical

Journal indicated increasing folic acid levels to twice the daily

recommended level, or 800 micrograms, significantly reduces risk of

heart disease, stroke and deep vein thrombosis.

Copyright 2004 by United Press International.

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My guess is that the difference in the doseage between the two drugs is due to their potency and not due to some of us being given vastly different doses. That said, you sure have alot more liquid to stick into your body when you're on Lovenox!!

Thanks for the info on Folic Acid. I had wondered what the MTHFR references were when I'd seen them earlier as I didn't know, so now I do! Interesting on the Folic Acid front, I knew that taking it reduces the risk of birth defects (I have been taking 1mg since I began trying for a baby) but the information about it helping with heart issues is very interesting indeed.

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I know that fragmin is a low molecular dose of heparin which means it takes longer than the high molecular doses to be broken down.

This means only one injection is needed per day where as with the low molecular variants more than one injection is needed a day.

It was hinted to me by my GP that fragmin is incredibly expensive so I guess they would prefer us not to take it and have the cheaper equivalent and inject twice a day - as far as I am concerned - tough tittties I only want one injection per day!

I know also some clinics can do a blood test called thromboelestgraph (TEG). It means the elesticity of the blood can be measureed quickly and efficiently giving results withing an hour. This means it is possible to test the blood on a regular basis thus adjusting the levels of anti-coag you are on.

It is very 'cutting edge' science so many heamotologists are not even aware of it yet but it sounds brill to me. It has also been used to show something that was previously not known which is that many of the antiphospholipid clotting disorders only come about whilst pregnant so no amount of testing whilst not pregnant will highlight any problems.

I am not sure on how doses of fragmin are worked out, my consultant said yesterday that all the studies done on fragmin and aspirin in pregnancy use 2,500IUs, so that is the recommended dosage.

The syringes i had before contained 0.5ml of fragmin which accounted for 12,500IU of it. The ones i have now are 0.2ml but only come to 2,500IUs so I am assuming that it is double diluted in the smaller syringes. Perhaps 0.1ml is too small an amount of liquid to inject so they dilute it?!

Who knows and I guess if it works, who cares?!!!......lol

Lynda xx

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That's very interesting stuff.

Fragmin IS expensive. I am a Brit in Canada and here you have to pay for your prescriptions unless you have a Drug Plan (which is a type of insurance). We have one, so I pay 10% of the cost of the drug. I think 30 syringes pre-filled costs me 30 bucks, so 300 bucks is the 'actual' cost for 1 month.

I know it also depends on your weight as to how much they prescribe, the heavier you are the more your body needs.

Think you may be right on the amount of liquid. I have 0.2ml / 5,000 i/u and it's not alot of liquid at all... so half of it, in your case, would be virtually non existent, they must dilute it!

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Well, here in Missouri (St. Louis) I have GHP Insurance. If the doctor calls ahead of time, the Lovenox injection is covered and I do not have to pay anything. THANK GOD. The pharmacy ships it to my house and the paper says it costs the insurance company $1200 per month. WOW!! My appointment last week was wonderful. I lost 4 lbs. (I have had morning sickness for 6 weeks now - really bad) and I hope to lose a little more. Maybe they will not increase the amount of injections since I am losing plus I really don't want to do anymore than I have to.

I had a u/s last week and it was nice to see the baby move all around. This is my third u/s and I get another one Friday.

Here in the US they are not allowed to give u/s for genetic testing until 16 weeks. The u/s tech said that England did a study of 35,000 women and between 11/13 weeks they did a u/s and measured the skin on the back of the babies neck to see if there were any heart problems, etc. In all cases, if the baby measured 2.0 something was wrong. So the US is giving all high risk doctors the chance to do 50 studies to become certified to do this u/s between 11/13 weeks instead of waiting until 16 weeks. I am normal so they want to continue to do u/s for free for the next several weeks for the study. I am really glad since I want to see the baby as much as possible to have that shy of relief.

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That sounds like the nuchal scan. I had it 5 yrs ago when I was pregnant with my son, in England. They measure the nuchal fold (back of neck) as an indicator for Neural Tube Defects & Downs Syndrome.

I had it here (in Canada) too, at 13wks pregnant this time.... combined with the AFP blood test.... much more reliable than the blood test alone which so many people hav ehad false results from.

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  • 4 weeks later...

Query for everyone relating to shots.

I was reading a thread on the 'High Risk Pregnancy' board on Babycenter about Lovenox and c-sections. Most people were coming off at 36wks and switching to Heparin as (to quote) 'Lovenox takes pretty long to come out of your system'.

Does anyone know if it is the same with Fragmin? I was told by my OB (not my Haemo who I'm not seeing again till June) that I could come off the Fragmin 24 hrs ahead of the c/s. These posters said that with Lovenox that's not nearly long enough.

Are these two drugs that different?

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  • 1 month later...

I am on 40mg of Clexane once a day. Is that similar to fragmin????? It does depend on your weight. So at my next visit to hospital I will have all my bloods checked. How do they check the heparin levels? as it is different from Warfarin (INR)

I started injections at 8 weeks until the end, hence 30 weeks. Does the folic acid really help with osteoporis??? According to my medical packaging that is the main risk of prolonged use.

Ciao

leo

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Hey Leo,

Am not an expert but I believe that all these Low Molecular Weight Heparins (clexane, fragmin, lovenox, etc) are similar.

The Anaesthetist I saw at my last appointment (to discuss spinal anaesthesia for a c/section) said they can't measure your pro thromb time with these LMWH's as they can with Heparin/Warfarin but they know that they vacate your system after 24 hours.

I asked my Haeamatologist about Osteoporosis when I started on my Fragmin and he said that there is considerably less risk with these LMWH's than there is with 'real' Heparin and that the duration of a pregnancy is not considered 'prolonged'.

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Quick update on this thread.

I've been taking 5,000 IU's Fragmin daily until today (33wks pregnancy) and the Haematologist has now increased me to 7,500IU's daily until the day before the c/section.

24 hrs after the baby is born I'll be put back on to Fragmin, probably 5,000IU's twice daily, and then increased again for 6 wks post partum at which point I'll hopefully be drug free.

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Guest clairebear

Hi

I have not been around for a while, I moved house 3 months ago and have only just got round to setting my pc back up! It is good to be back and to hear your pregnancies are going well.

With my first pregnancy I had Fragmin injections in first trimester, the middle trimester I was back on warfarin and the third trimester I was put back on fragmin. I stayed on Fragmin for another 3 months as I was b/f. Dr has told me if I become pregnant for a second time, I will be doing the same again.

BTW does anyone know if Fragmin can cause brittle bone disease?

Also I was not allowed an epidural during my first labour, is this something to do with Fragmin?

Thanks

Claire X

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Hi claire!

I'm surprised they put you on Warfarin in the 2nd Trimester! I thought they never did that.... ? Still, I'm no doc!

I asked about the bone thing and was told that Fragmin won't cause it because the molecules in it are far smaller than that of regular Heparin (which can cause it when used over an extended period of time). Also the Haemo said he didn't consider pregnancy to be too long of a time period to be risky.

Epidural - possibly? AFAIK it takes around 24 hours for the Fragmin / other low molecular weight heparins to leave your system and be safe for spinal anaesthesia. If you do it while it's still in your system you are at increased risk for haematoma in the area that it is given which can lead to temporary or permanent paralysis. Also the risks of DVT with an epidural, where they leave a catheter in your spine, are greater than with a spinal tap which is just one shot, so if you hadn't come off the Fragmin in advance, or had a particularly nervy Anaesthetist they might've refused on either of those grounds. Well, that's my best guess!

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  • 2 years later...

Hi,

It's seems this conversation has been reactivated after several years! It's interesting how many different treatments women are on.

I'm 26 weeks pregnant and started taking 1/daily injection of Lovenox 40mg at 10 weeks + baby asprin 81 mg, Calcium suppl., Iron suppl (I'm anemic) and prenatal vits. Last week my dr. increased the Lovenox to 60 mg 1/daily because my blood thiness wasn't as thin as he'd like it to be at this point in the pregnancy. He will switch me to regular Heprin 2/daily at 35 weeks until I'm induced at 37 weeks.

It all seems complicated, but I've been able to keep up the routine, and for a very good cause. :)

Best,

Ufasaha

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