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