MTHFR-STANDARD OF CARE PROTOCOL???

With the debate of exactly how this gene mutation affects fetal death, there does not seem to be a set "stand of care" protocol.  Dr. Stephen Wells, (OBGYN, California, 2009) suggested treatment could include 5mg of folate acid, vitamin B12 and B6, since the MTHFR condition interferes with folate production due to higher homocysteine levels.  This means the patient would take twelve times the average of a multivitamin or six times more than a prenatal vitamin.  Dr. Gapp, (OBGYN Associates, KY,  2010)  feels the previous protocol along with low dose aspirin daily should protect the mother and fetus from utero-placental clot formation.  Some hematologists recommend that low dose aspirin, 81mg. be taken once a day, everyday, for the rest of the patient's life to help prevent other related diseases.  Both physicians agree that women with Homozygous C677T and Compound Heterozygous C677T +A1298C should include the previous protocols with additional aggressive approach by adding daily injections of anticoagulants such as Heparin or Lovenox throughout the pregnancy.  Reproductive immunologist, Dr. Beers (2008) believes the anticoagulant protocol of 40 mg., one time per day should be given on menstrual cycle day six and continue throughout the menstrual cycle.  With a confirmed pregnancy, he believes the protocol should increase to 40mg injections, twice per day throughout the entire pregnancy.  His protocol includes that two weeks prior to birth, the patient changes to a different anticoagulant called Heparin and continues throughout six weeks postpartum or until the first well doctors visit postpartum.  He also adds in additional calcium and vitamin D because anticoagulants can cause a decrease in bone density.  Blood thinners are a category B drug and are considered safe to the unborn child.

Courtney's protocol for hetero A1298C included:

Prepregnancy:
*Prenatal Vitamins
*Progesterone 3times per day
*Low dose Aspirin
*DHA supplement
*Homocysteine levels were not high, therefore, extra folic acid was NOT prescribed

Pregnancy:
*Prenatal vitamins
*Progesterone reduced to one tablet around 10 weeks pregnant
*40 mg. Lovenox shot once per day for the entire pregnancy until 24 hours before induction

Postpartum:
*12 days of Lovenox shots
*Low dose aspirin for the rest of her life

NEWER RESEARCH ON MTHFR

The malfunction of the MTHFR gene homocysteine levels will build up.  This build up can cause problems with the cardiovascular system and in pregnancies.  Research shows that woman with reoccurring pregnancy losses in the first trimester are more likely to have a MTHFR gene mutation.  However, there is a great debate on how this mutation affects recurrent pregnancy loss.  Earlier research points to higher homocysteine levels preventing production of proteins and other compounds necessary for fetal growth.  Newer research points to this mutation as a reason for the formation of blood clots in the placental and uterine wall which would cut off nutrients and oxygen supply to the fetus.....resulting in an early trimester miscarriage.

A LOVENOX BABY IS BORN!

Here's my sweet grandbaby!  She is a Lovenox baby due to Mommy's MTHFR gene mutation blood condition.  Born at 37 weeks, 11:25pm on 3/9/10  7lbs. 8oz.  18 inches long!

Mommy will have to stay on blood thinners for 12 more days and then low dose aspirin for the rest of her life!  Without the blood thinners, we would not have this miracle baby! 

Aunt Caitlin wrote an essay about MTHFR.  The next several posts will be from her research.  We are hoping the information posted will help others.

MTHFR and Pregnancy

Mentioned in the last post, Caitlin's sister Courtney is presently having a successful pregnancy (28w3d!) so far.  She is now into the 3rd trimester, which is a relief after 3 miscarriages.  For those new to this blog, Courtney's OB took an aggressive approach by starting baby aspirin before pregnancy and lovenox blood thinner shots (40mg. once per day) with a positive pregnancy test plus progesterone pills.  He believes the foliate in prenatal vitamins is enough and didn't prescribe more.  You can read more on her pregnancy here: http://barnettbaby2010.blogspot.com/

BLOOD TEST RESULTS

Good News and .....Not So Good News with Caitlin......The good news is that all the other blood disorder test results are normal!!!!  The bad news is that is hematologist is not up on the latest research with MTHFR blood disorder and linkage to miscarriages.  He kept referring to the evidenced based research from the past...whereas extra foliate and baby aspirin should solve her problem when she decides to start a family.  Needless to say, he is not interested in even contacting Courtney's OB regarding his aggressive approach to adding Lovenox (or other blood thinner shots) to the medication regime!  I guess we will have to resort to plan B of flying or driving 7 hours to consult with Courtney's OB.  Right now, Courtney is 5 1/2 months pregnant....only two more weeks to viability!  In the meantime, we will continue on our search for an OB and Hematologist who is willing to be aggressive with Caitlin and lives in OHIO!

STILL WAITING FOR DOCTOR'S VISIT!

I haven't forgotten to post....just waiting on next visit which has been bumped AGAIN to Nov. 25th.  Will post more when I find out......by the way, Caitlin's sister is still progressing nicely with this pregnancy on lovenox shots for the MTHFR.  As I write this post, she is 20 weeks pregnant and the baby is measuring 21 weeks!  YEA! 

At Courtney's last OB visit, I told her doctor how disappointed I was not to find an OB close to us that treated MTHFR patients aggressively like he does.  He said not to worry, I could fly (or drive 7 hours) Caite to his office for a consult when she is ready to try for a baby.  With a family history of this blood disorder and miscarriages, he would be willing to start her on the same medication (blood thinner) regime. Then send her back to her regular OB.  He stated that once a doctor starts a prescribed medication regime, it would be less likely that her regular OB would change it.....Hopefully by the time she is ready to start a family, she will have an OB close to home with this research under his/her belt and willing to do the same so we can avoid the long distance consult.  Time will tell.  At least we have plan B.

Repeat Blood Test!

The doctor's office called and said that the Protein S test is inconclusive. They want to repeat this test and move the appointment back to October 28th! So we are still waiting for results! :-(