help deciding on meds?

[kati_kati]

Hi - I'm not sure if this is right place to post. I'm 6.5 weeks along right now. I have had a bunch of miscarriages in the past (4 m/c at about 4-4.5 weeks, plus 1 blighted ovum), plus complications with my last delivery (pregnancy was fine, but was way overdue and had some placenta issues and baby was in the NICU). The doc is telling me I need to go on Lovenox, Prometrium, baby aspirin, vit B complex, and high dose DHA, all right away. I'm quite intimidated by the drugs because I want to do everything natural so I'm having a hard time deciding. My search for info has not yielded anything that conclusive, just that there _are_ side effects from Lovenox, Prometirum and aspirin...and in some studies they are really not all that effective in preventing problems, but they could affect the baby. Plus, I'm still nursing my DS (occasionally).

Advice please?? How do I go about making a decision here? I'm tempted to just do the vitamins because I'm scared of side effects but I really want to understand things better. I feel pressured to decide soon. I am already doing acupuncture and moxibustion by the way.

-Kati

[cameragirl]

Can they get you a perinatology consult to go over the meds? It might help to have someone go over them with you. That being said, OB's are very conscious of covering their butts. If they feel you need the meds this early, there is a good chance that you might.

[1love4ever]

Your mommy senses are tingling for a reason:)   You are obviously smart to be cautious of these meds, and personally I would only take whole foods based prenatals(they have the B-vitamins) such as Garden of Life http://www.vitacost.com/Garden-of-Life-Vitamin-Code-RAW-Prenatal  (Amazon has this for slightly cheaper) or MegaFood brand vitamins.  I do agree with taking DHA, that is certainly a good thing, I would go with Carlson Labs brand  http://www.vitacost.com/Carlson-Elite-Omega-3-Gems-Fish-Oil-BOGO 

It also comes in liquid form, and I think the calamari DHA supps have even a higher amount of DHA.

Ther I totally agree with doing everything all natural.  Have you looked at your life and tried to eliminate every source of synthetic hormones that could be coming into your body?  Such as not eating foods from cans as they contain BPA http://www.ewg.org/bisphenol-a-info.   

BPA is a synthetic estrogen and cancer causing agent and has been linked to many other health problems including miscarriage, birth defects, heart disease, ETC.  It is also the coating on smooth thermal paper reciepts http://www.ewg.org/bpa-in-store-receipts/release  (unless the reciept has little red fibers on the back, that company does not use BPA).  Another source is dental sealants (and dental Fillings have mercury, another cause for concern!). 

Phthalates is another chemical similar to BPA.  It is found in plastic shower curtains, any #3 plastic, PVC including the pipe, and it is found in #1 plastic although it is thought to be less problematic in this type of plastic.  Never heat food in plastic BTW!

Anyway, that is a total crash course, there are so many other things that are so harmful and can cause miscarriage (including genetically modififed foods).  I apologize if you already know all these things!!  Not trying to tell you what to do, but many people I know have benefitted from eliminating these and many other harmful things from their lives,  Congrats on your pregnancy!  And please dont let Drs intimidate you or try to pressure you into doing something that you dont think is good for you or your baby.  You would be surprised at what your body is capable of.  And it looks like you are past when you normally miscarry... so that is certainly a good sign.   Along with what I mentioned above I believe that a good diet is crucial including fresh organic fruits and veggies, and lots of protein from organic foods.  I recommend to everyone I know to drink raw goats milk:)

Another thing that I learned in being a nursing student is that doctors will prescribe meds just to keep themselves from being blamed if something goes wrong, and to keep the patient happy and thinking that the doctor is doing something to help them.  The doctor also often recieves incentives for putting patients on meds so they are very likely to recommend them even if you really dont need them.  The whole medical system is so messed up and I am glad I have chosen not to work in it!

Edited by 1love4ever - 8/11/11 at 11:19pm

[cameragirl]

I second the whole-food prenatals. Aside from not containing anything synthetic, they are a lot easier to digest. I take Carlson cod liver oil for both the vitamins and omega 3's.

[1love4ever]

I would also drink red raspberry leaf tea.  My midwife recommended equal parts of red raspberry leaf, alfalfa, and peppermint tea:)

Other chemicals to avoid are parabens(has a prefix at beginning such as methylparaben. Found in cosmetic products such as lotions and mascaras), chlorine, and triclosan. 

I love prenatal yoga for all pregnant women and would recommend that too, I have found Shiva Reas prenatal yoga to be a good video to follow if you do not have classes in your area or do not have the time/money to attend.  It is a very gentle program, and you can choose to do just one section, 2 or all 3.

Good luck mamma, feel free to PM me with questions.  The things I have been telling you is an area of great interest to me, and I have done SO MUCH research into these things, it is unreal.

[mambera]

I guess this depends on how strongly you want to avoid another miscarriage.

Do you have a diagnosed thrombophilia or is the Lovenox/ASA just a shot in the dark?  If you know for sure you are thrombophilic I'd think it would make sense to take the Lovenox/ASA - it can't be worse for the baby than disseminated clotting causing fetal demise.  If not it's more of a soft call, again how badly do you want to avoid another miscarriage? 

I'd have the same question on the Prometrium (although I think the evidence that it helps is weaker than for Lovenox/ASA) - were your progesterone levels low for your prior losses? 

Regarding the vitamins, I'm opposed to indiscriminate use of dietary supplements personally (they've been shown to correlate with all-cause mortality).  I just don't think micronutrients work the same way when you take them out of their food context, concentrate them like crazy and stick them in a pill. 

[kati_kati]

thanks for the responses and advice!! i'm also really conscious of chemicals etc so we don't have any BPA and we don't use canned foods and I get only 'natural' household products and cosmetics. also I'm vegetarian, mostly vegan, almost all organic food etc. the main thing i can't get rid of is the stress in my life! :) i do yoga once a week, but it's not enough! I have Shiva Rea's video already - I should go back to it again!

i have not been diagnosed with anything - we did a bunch of coagulation tests and everything was normal. so i think the lovenox is a shot in the dark.

i asked about checking progesterone levels this time but they told me they vary day by day so it's not helpful. is that true? i was never checked during a m/c before.

thanks for the whole food vitamin recommendation. i've been on a Solgar multi-vitamin for years now. do they have any with higher vitamin B doses? they also wanted me to take Folgard for vit B but my multivitamin already has almost that much of the B's.

and of course i want to avoid another miscarriage, but side effects of bleeding or birth defects are pretty scary too!! ack. not sure what to do.

[cameragirl]

Yes they can vary, but my OB said that progesterone is one of the first things she checks for when it comes to miscarriages. Did they test your homocysteine levels? I carry a genetic mutation that causes higher levels, and high levels cause heart disease in the long run, infertility and miscarriages in the short run. Taking B6, B12, and omega 3's can help with that. Exercise helps as well.

After reading that the blood tests were normal, I'd ask again about the Lovenox. You may not actually need that. Taking a good prenatal, extra B6 and B12 if you need it, red raspberry leaf, and a good omega 3 supplement should help with any inflammation, autoimmune, or homocysteine levels.

[MarineWife]

I've had numerous 1st trimester miscarriages. I take 81 mg aspirin daily until 36w, progesterone suppositories for the 1st trimester (the MFM doc I saw this last time prescribed Prometrium capsules but I prefer the suppositories), Folgard and flaxseed oil for omega-3 fatty acids the entire pg. If I don't take the progesterone and aspirin, I miscarry. I have done it for 3 babies now and have not had any problems. I'm not one to jump on the prescription drug bandwagon, either, but when it comes down to it, I'll do whatever it takes to not miscarry again.

[1love4ever]

I would recommend taking the garden of life prenatals as well as their vitamin B complex, it is also whole foods based, no bad ingredients and of course no chemical isolates as vitamins, they are all from food so your body will actually absorb them.  http://www.vitacost.com/Garden-of-Life-Vitamin-Code-RAW-B-Complex-60-Vegetarian-Capsules-1 

If you are vegetarian or vegan are you opposed to taking the DHA supps from fish?  As I said before I think those are best. 

One thing that bothers me a lot about prescription drugs is the commercials that I see on TV "if you have taken this during pregnancy and your baby was born with birth defects, call...."  What bothers me is that all of those drugs were said to be safe during pregnancy at one time...  And it seems like every few weeks I am seeing a new drug with a lawsuit against it for causing birth defects when at one time it was prescribed to pregnant women.... 

And like PPs said, the Lovenox  sounds pointless to me....  Did you need any of these medications with your last pregnancy?  Sounds like you have done some research that has said the drugs can effect the baby so I would certainly only take them if I was absolutely sure that I needed them and that they would help.  You also said that they may not even be effective?  This would make me very cautious!!  Like I had said before, a Dr is going to prescribe meds so he/she is not blamed if you do miscarry, because they will say they did everything they could (whereas if they had not prescribed meds you could say Its all your fault for not giving me meds).  If the drug causes a problem for you, it is not the doctors fault(legally, in the eyes of a lot of people, and the hospitals), it is the drug companies fault, so by prescribing meds the Dr gets out of being blamed for anything at all....

[thencamehenry]

I am attempting to relay secondhand info here so keep that in mind...

I have a friend who is prone to miscarriage and has been diagnosed with a clotting disorder.  After her last one the doctor advised her to avoid foods containing too much vitamin K because it can contribute to clotting.  I think my friend said blueberries and spinach were on the list, and maybe cashews, and I can't remember what else.  It seems counterintuitive to avoid such healthy foods but it might be something to consider if you want to do something proactive re: clotting but not take the drugs. 

Of course I would encourage you to research the topic and talk to your HCP since this is based on what I recall from a conversation a few weeks ago.

Hoping for a healthy pregnancy!

[1love4ever]

vitamin K is what you need in order to make your blood clot, but it will not cause your blood to clot if you have a lot of it.  But not having it can make your blood unable to clot, which is like taking an asprin so that is what that is about.

Mainly green, especially leafy veggies have vitamin K, I didnt know and I dont think that those other things have K, but maybe I have not looked into it.  Rainbow Light Certified Organics prenatals that are whole foods based do not have any vitamin K if that is the route you think you need to take, but since you have been tested and do not have any clotting problems I would not worry about it, unless you think they missed a clotting disorder but I doubt it.  My dad was having problems with blood clots in his legs and Drs ran every clotting disorder test on him so I imagine if they would run every test on you too, and as far as I know they are pretty accurate.

[APToddlerMama]

I'm in a similar boat and have opted to take vitamins, DHA, and progesterone.  I fully believe the progesterone helped me remain pregnant (I'm 19 weeks).  I was on a low dose aspirin but stopped against the advice of my OB around 15 weeks because I noticed I was getting bruises easily.  I was tested for clotting disorders and did not come up positive, but as I am sure you know, they can't test for all of them.  Like you, I had placenta issues with my son...actually a placental abruption.  This was another reason I opted to quit the aspirin as past twenty weeks it can increase risk of abruption.  In addition to thining the blood if you have a clotting disorder, aspirin can tone down your immune system in case that is the cause of your miscarriages.  Personally, if I had it to do over again, I would do the same thing and stop the aspirin around 13 weeks.  Without a diagnosed clotting disorder, I would not take Lovenex.  All those early miscarriages are a sign your progesterone could be low.  Did you temp?  What was the length of your luteal phases?  What exactly happened with your placenta in your last delivery?  I have heard from two separate OBs that progesterone tests are unreliable, so given all the signs I had of low progesterone, we just went for it.  I didn't have the same level of cramping/bleeding I had with my son in the first trimester and I didn't have a chemical pregnancy so I assume it worked.  I did a ton of research and was reasonably comfortable with progesterone to 13/14 weeks.  I wasn't comfortable with it after that point and opted not to have the p17 progesterone shots which my doctor had suggested to me. 

Lots of tough decisions for you, but I would strongly consider the progesterone at the very least and trying aspirin for a while.  It is highly unlikely to cause issues if you stop by 20 weeks.  Good luck with your choices. 

[kati_kati]

Thanks for the replies. You gals are awesome.
 

Originally Posted by 1love4ever 

If you are vegetarian or vegan are you opposed to taking the DHA supps from fish?  As I said before I think those are best. 

I prefer to avoid the fish supplements. They make vegan DHA from algae, the problem is getting 3 g a day! That means I'd have to take 1/3 of a whole bottle each day (30 caps!!!). Any other ideas?

Originally Posted by cameragirl 

Yes they can vary, but my OB said that progesterone is one of the first things she checks for when it comes to miscarriages. Did they test your homocysteine levels?

Yes, I think homocysteine was fine.

Originally Posted by APToddlerMama 

 Without a diagnosed clotting disorder, I would not take Lovenex.  All those early miscarriages are a sign your progesterone could be low.  Did you temp?  What was the length of your luteal phases?  What exactly happened with your placenta in your last delivery?  I have heard from two separate OBs that progesterone tests are unreliable, so given all the signs I had of low progesterone, we just went for it.  I didn't have the same level of cramping/bleeding I had with my son in the first trimester and I didn't have a chemical pregnancy so I assume it worked.  I did a ton of research and was reasonably comfortable with progesterone to 13/14 weeks.  I wasn't comfortable with it after that point and opted not to have the p17 progesterone shots which my doctor had suggested to me. 

Lots of tough decisions for you, but I would strongly consider the progesterone at the very least and trying aspirin for a while.  It is highly unlikely to cause issues if you stop by 20 weeks.  Good luck with your choices. 

My luteal phases are normally 11 days. For all those early miscarriages, I went to 14-18 days post ovulation. Is that called a chemical pregnancy? (or what is that?) I was temping and my temps get reasonably high (98.7) so that's a good sign isn't it?

For the last delivery I went to 42 weeks and had to be induced. I think the placenta was getting old, there were local infarcts (dying tissue), brown staining, and there was also old maternal blood (and meconium) in the amniotic fluid and they have no idea where the blood came from. No signs of abruption. I also got an infection during labor.  Ended up with a c-section. I had some clotting issues right after the surgery but only for a few hours and things went back to normal.

Did you find anything about using progesterone that late? I was looking at research articles and found that most stopped it by 7 weeks or so when doing it for luteal phase support. Do I need to use different key words? I'd love pointers to what you read. I also had a hard time finding stuff about aspirin.

Thanks!!

[APToddlerMama]

Originally Posted by kati_kati 

My luteal phases are normally 11 days. For all those early miscarriages, I went to 14-18 days post ovulation. Is that called a chemical pregnancy? (or what is that?) I was temping and my temps get reasonably high (98.7) so that's a good sign isn't it?

For the last delivery I went to 42 weeks and had to be induced. I think the placenta was getting old, there were local infarcts (dying tissue), brown staining, and there was also old maternal blood (and meconium) in the amniotic fluid and they have no idea where the blood came from. No signs of abruption. I also got an infection during labor.  Ended up with a c-section. I had some clotting issues right after the surgery but only for a few hours and things went back to normal.

Did you find anything about using progesterone that late? I was looking at research articles and found that most stopped it by 7 weeks or so when doing it for luteal phase support. Do I need to use different key words? I'd love pointers to what you read. I also had a hard time finding stuff about aspirin.

Thanks!!

That is most definitely a short luteal phase and very very suggestive of low progesterone.  I did quite a bit of research on google scholar and now it has been about four months so I don't have it all with me, but it seems that for short luteal phase, progesterone is suggested through about 12 weeks.  I would start asap if I could.  I know this is what saved my pregnancy.  And yes, sounds like you were having chemical pregnancies (miscarriages) as well.  The aspirin info was even more difficult to find than the progesterone.  Much more difficult.  Are you ANA positive?  Do you have any autoimmune disorders?  I have read a ton of anecdotal info on aspirin helping women with repeat miscarriages especially with autoimmune disorders and/or clotting disorders.  In your situation, I would personally do both and think about stopping both around 12 weeks.  You've suffered a lot of losses...  At the very least I would do the progesterone suppositories.  11 day luteal phase is very indicative of low progesterone. 

ETA...I have heard of women starting progesterone late...like 8 or 9 weeks due to a low progesterone test and/or spotting and it was successful many times. 

[1love4ever]

Wow that is a lot of pills.  Flax is the only other thing I can think of.  It does not  actually have DHA in it, but your body converts the APA that is in it to DHA.  I have not actually done a lot of research on this because in my area there are not a lot of women looking for nutritional advice who are vegan so I am not prepared for this, I am sorry!  So I am not sure about how much DHA you end up getting from flax, but I do recommend ground flax to especially pregnant women who seek my advice, but anyone really.  I think it is a healthy food.  DD and I both eat about a tbsp ground every day.  Make sure it is ground, (if you do it yourself it retains more of its nutrients, but it is more time consuming), you will get more benefit from it.

It sounds much better if you only had to take these meds in your first trimester!  That is a lot less exposure than if you were to take them throughout your entire pregnancy.