Which statement about anticoagulation in pregnancy is true?

Which statement about anticoagulation in pregnancy is true?

• A. Low molecular weight heparin does not cross the placenta, making it preferred
• B. Warfarin is preferred due to ease of monitoring
• C. Direct oral anticoagulants are safest in pregnancy
• D. Heparin and warfarin are both equally safe in pregnancy

Answer: (A)

In pregnancy, choosing an anticoagulant hinges on fetal safety as well as maternal protection. Low molecular weight heparin does not cross the placenta in any meaningful amount, so it provides the needed anticoagulation for the mother while minimizing fetal exposure. This is why it is preferred over warfarin, which does cross the placenta and can cause fetal harm, especially during organ formation, leading to birth defects and bleeding in utero or after birth. Direct oral anticoagulants lack solid safety data in pregnancy and are generally avoided because of potential fetal risks. Saying that heparin and warfarin are equally safe is not correct, since warfarin carries significant fetal risks despite its effectiveness for the mother.

In pregnancy, choosing an anticoagulant hinges on fetal safety as well as maternal protection. Low molecular weight heparin does not cross the placenta in any meaningful amount, so it provides the needed anticoagulation for the mother while minimizing fetal exposure. This is why it is preferred over warfarin, which does cross the placenta and can cause fetal harm, especially during organ formation, leading to birth defects and bleeding in utero or after birth. Direct oral anticoagulants lack solid safety data in pregnancy and are generally avoided because of potential fetal risks. Saying that heparin and warfarin are equally safe is not correct, since warfarin carries significant fetal risks despite its effectiveness for the mother.