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Vit K for baby w/maternal blood clotting disorders?

post #1 of 54
Thread Starter 
Hi,
I did a search here and looked at all of the threads on administering Vit K to newborns but this question didn't seem to be addressed.

I have a blood clotting disorder (where my blood tends to overclot) and I am on blood thinners for this pregnancy. I am thinking about whether or not to have Vit K given to my child when it's born (midwife assisted hospital birth) and am trying to gather info.

I actually have been discussing this with a pediatric hematologist who admits that there have been no studies on this issue at all- she is doing research to see what the protocol is in other countries and will give me her professional opinion (which seems balanced) and studies to read for myself so I can make a decision.

I was curious to know if anyone here has had experience with this-esp providers (pamamidwife?, mwherbs?, doctorjen? others?)

To clarify- my disorder is inherited (faulty gene), which means my child has a 50% chance of inheriting a tendency to overclot...my hunch is that Vit K would not be a good thing in this case. However, if there is some trauma during delivery...maybe it would be a good thing.

I am not comfortable consuming large quantities of Vit K during pg or pp since it isn't a good idea for my body.

The blood thinner I am on does not cross the placenta to the baby, fyi.

Any thoughts?

thanks in advance.
post #2 of 54
Hmm, I'd be interested to know if there is any good consensus on this one. It hasn't come up in my practice.
The vit K dependent factors are II, VII, IX and X. If your clotting disorder is not with one of those, I'm guessing the vit K may not make much difference either way, but I'm really not sure.
post #3 of 54
Thread Starter 
Hey DJ- thanks for responding.

Yup, mine is II and there is absolutely no consensus on this in the field, that's for sure. That's why I'm looking for thoughts from a wide range of people and combining that with my gut feeling. The only thing is that for us to refuse I have to go through a whole lot of hoops (gotta love NYC for that) and I'll need a bit more documentation than my gut to not be put through those hoops, which is the last thing I'd want to deal with after the live birth of my 2nd child, kwim?

I just realized something- I only have one faulty gene, so between the 2 of us (parents) that's actually a 25% chance of inheriting the gene (assuming my dh doesn't have it, which we don't think he does). What's up with my math?
post #4 of 54
I've decided not to do vit K at all. From my research it looks like vit K is just to prevent an extremely rare sudden brain hemmorhage. And when you give a baby vit K, you trade this risk for an equal risk of leukemia when the child is older. I don't know about you guys, but I actually think I'd prefer my baby to die suddenly and young from brain hemmorhage than to have them suffer w/ leukemia later in life. Just my thoughts on the matter.

Oh, and we have the opposite going on here. My dh has von Willebrand Disease, type 1, where he doesn't make enough von Willebrand factor, which affects factor VIII. Ds2 inherited it from him. And when we were at the hematologists in Indy after a botched blood work at the local hospital (this hospital is SO friggin inept!), they were taking a full family history from me, as well, that necessitated a call to my dad. Basically, the local hospital realy screwed up ds's bloodwork and it came back looking like he had HEMOPHILIA! So the hematologist was like, with these times, your ds would have to have worse than vWD type 1, which is all he could have inherited from dh. So I called my dad, b/c his mom always said her dad had hemophilia, and my dad said that he in fact had a bleeding disorder as a child but had "outgrown it." (Not possible, but mild bd's are usuaslly less noticable in adult men than they are in boys and post-pubescent women b/c of the period factor.)

So now I found out that there is also a bd in MY family, that sounds an awful lot like vWD, which makes sense since it's the most common bd! So if I DO have it, our kids have a 1/4 chance of getting type 3, which is equivalent to hemophilia. Luckily ds2 just has type 1 (the local lab really screwed up b/c his clotting times came back normal at the hematologists, which is pretty normal for type1. It's very mild in most cases.), so we're still not sure if I have it. I can't be tested b/c factor levels go up during pregnancy and while nursing. ARG!

I'm still not doing the vit K.
post #5 of 54
We have no knowledge of genetic blood disorders, so this makes our decision-making on this topic a little easier. After reading an article from Midwifery Today on vitamin K we got from our midwife we decided that we are going to give the baby the oral drops rather than the injectable vitamin K, because the baby gets much less vitamin K this way.
post #6 of 54
I've got the Factor II mutation as well, though I've never had a clinically demonstrated clotting problem. I'm intrigued by the question. Hadn't thought about it that way before!

Quote:
Originally Posted by ST
I just realized something- I only have one faulty gene, so between the 2 of us (parents) that's actually a 25% chance of inheriting the gene (assuming my dh doesn't have it, which we don't think he does). What's up with my math?
Each parent gives the child one copy of each gene. So your original math was right. You have two copies, and you'll pass on one of them to this child. Your child has a 50% chance of inheriting the mutation from you and having the clotting disorder.

The math is a little different from other genetic disorders, because the most common Factor II mutation is dominant. That means you only need one faulty gene to be affected. Most of the commonly known genetic disorders are recessive, meaning that both parents need to be carriers in order for their child to be affected.

Carolyn
post #7 of 54
If your med. doesn't cross then you're in the same boat for vit. K as you would be if you weren't on the med, right? With the added possibility that your child will have the disorder too and clot MORE than they should....

-Angela
post #8 of 54
Thread Starter 
My goodness Wendy, I've already had my first child die suddenly right before he was born so given your scenario, the possibility of childhood leukemia looks "good" to me.
Of course it doesn't...neither scenario is one that I'd like to make a choice of. From what I've read the leukemia study hasn't been replicated since the early 90's. Any more info on that connection I'd appreciate looking at. And there is the fact that many children get Vit K and don't get leukemia or other complications.

Zelda'sMom, yes, if you fall into the "normal" range, it's much easier to make these kinds of decisions. And the NCB community in general seems to have so little guidance for those of us who are here, but have particular complications/issues. Sigh.

Carolyn- my only "symptom" of the disorder was the stillbirth of my first son...unfortunately. I'm not sure I understand your explanation though--I am heterozygous so I have one copy of the gene. If my dh has none and I have 1, wouldn't that give my dc a 25% chance of getting it? If it's dominant are you saying that my 1 gene is strong enough to count as 2 for my dc? I think I should've listened better in HS bio. lol.

alegna, yup, that's pretty much what the situation is. I'm not sure if I'd refuse or accept it if I didn't have the disorder, so I'd be going through this exercise regardless just not posting about it, most likely.

At this point I'm leaning towards keeping my options open, seeing what happens with the birth (if there is trauma or anything that would warrant it) and listening to my gut.

I appreciate the thoughts and welcome more!
post #9 of 54
Quote:
Originally Posted by ST
If it's dominant are you saying that my 1 gene is strong enough to count as 2 for my dc?
Hmmm. How to explain.

Simplifying a bit, in each of a human's cells (except egg and sperm cells), there are two copies of every gene. One copy was received from mom and one was received from dad. But the egg and sperm cells are different from all other cells in the body. They have only one copy of each gene, so that if they join to form an embryo, that resulting embryo will have 2 copies of each gene.

Half of your egg cells carry the normal Factor II gene, and half of them carry the mutated Factor II gene. So whether or not your child has this clotting disorder is determined by which copy of the gene was carried by the egg that you ovulated when you conceived him.

If something is dominant, that means that one copy of the mutated gene is enough to override a normal copy of the gene. In this case, you (and I) both have one normal copy and one mutated copy. Both copies make Factor II protein. The normal copy makes normal Factor II protein, which functions normally. The mutated copy makes Factor II protein that is abnormal and that may clot under inappropriate circumstances. So even though you have normal Factor II protein in your blood, the abnormal Factor II protein is capable of screwing things up all by itself. That's why you need only one faulty gene to cause the clotting disorder.
post #10 of 54
If the disease is caused by a dominant gene, then I believe your little one would have a 50% chance of inheriting it. From DH, s/he would definitely get the "normal" gene. Then, from you, s/he could either get a normal gene or the mutated version. Essentially, 50/50. Your mutated gene doesn't count as "2" but your child will either get one or the other. I could be wrong, but this is what I remember from my genetics classes.

X x
x xX xx

x xX xx

If the diagram above shows the mutated gene (the disease causing gene) as X and the normal gene as x then you can see how the 50% chance works out.
post #11 of 54
Oops. LOL. jplain beat me to it.
post #12 of 54
The references I have are

Parker et al., "Neonatal vitamin K administration and childhood cancer in the North of England: retrospective case-control study," BMJ (England) 316, no. 7126 (Jan 1998): 189-93.

S.J. Passmore et al., "Case-control studies of relation between childhood cancer and neonatal vitamin K administration," BMJ 316, no. 7126 (Jan 1998): 178-84.

I have some more, but I am very pregnant and have a terrible cold and just don't feel like typing it all out right now.

I got the info mainly from Baby Matters. I had heard the controversy over vit K w/ my first 2, but I never really found quite enough info to make it seem very important to me either way. My first had the vit K shot and I had written that I didn't want my 2nd to, but honestly, I'm not sure if he did or not. I had a traumatic birth with him and the first hours after it kinda run together. Anyway, according to the author, babies who don't get the vit K shot have a 1.8 in 100,000 chance of having a permanent injury or death due to brain bleeding, which is a very very small chance, and usually happens to babies who are exposed to drugs or alcohol through their mother's milk, or have other health problems. Of the babies who DO get the shot, there are 1.5 more cases of childhood leukemia per 100,000, also a very small number, about the same as the risk for the brain bleed.

I forgot to say in my post that I will be taking vit K orally myself after the birth, most likely in the form of shepherd's purse, but I may take regular supplements. I'm talking about it w/ my mw on Friday when I see her to see what she thinks. This way, the baby will be getting the vit K he needs without getting a huge overdoes, which is what the amount American hospitals give babies is. This should greatly reduce the chance of the brain hemorrhage without giving the baby the huge overdose of vit K that causes cells to grow out of control.
post #13 of 54
And on the clotting disorder thing, vWD is also a dominant disorder, so you only need 1 gene to have it. So if I don't have it, our kids have a 2/4 (1/2) chance of getting the disorder because here's dh: Xx and here's me: xx, so all the different ways we can combine is Xx, Xx, xx, xx. But if I DO have the disorder, the baby has a 2/4 (1/2) chance of having type 1, which is Xx, and a 1/4 chance of having type 3, XX. (I would be Xx and dh would be Xx: XX, Xx, xX, xx.) Type 3 is serious as it is a complete absense of the factor needed. Does that make sense?
post #14 of 54
Thread Starter 
Wendy, thanks for the link to the studies. And please, be thankful that you have the luxury of speaking in hypotheticals when it comes to which loss would be "worse". Trust me, if you experienced either loss I doubt you'd be so interested in trying to convince me or imagine for yourself which would be worse. They'd both be horrendous for different reasons.

Back to the topic at hand:
jplain and Nora, thanks for the info- it does make sense to me. I remember those gene charts from bio...but I also remember them not being that interesting to me at the time I appreciate you simplifying the explanation for my preggo brain.
post #15 of 54
Quote:
Originally Posted by wendy1221
Also, I have to say as the mother of a 6yo and a 2yo that I really think it would be easier to lose a young baby than an older child. Either one is a terrilble terrible thing and I am very sorry for your loss. I can only imagine how hard that was. I am 36 weeks right now and I know I would be devastated if I lost this baby. But the unconditional love you feel for your unborn baby grows tremendously the longer you get to know your child, nursing him at your breast, seeing his first smile, first words, as he grows into a little person with his own personality and has conversations with you. When he looks into your eyes and tells you he loves you. WHen he comforts you in hard times the way you've always comforted him. It becomes so much more than unconditional mother love. You love them in different ways, just like falling in love with your dh or a best friend. You still have that unconditional love you felt before they were born, but so many other kinds of love build on top of that. I don't know how else to explain it. I'm sure some day soon you'll understand exactly what I'm saying. I'm sure it's hard to believe as I couldn't imagine loving anyone more than my new baby when I was pregnant and just after he was born, but honestly, that loves grows tremendously.


I absolutely cannot believe that you just said that. I don't even know what to say to this.
post #16 of 54
Quote:
Originally Posted by wendy1221
Also, I have to say as the mother of a 6yo and a 2yo that I really think it would be easier to lose a young baby than an older child.
As someone who is the mother of a 4 year old DD and recently lost a baby, I can honestly say that the idea of it being "easier to lose her now" simply never occured to me. One of the most devastating things about losing a baby is that you ALSO lose the rest of their life, and all the hopes and dreams you had for their life and your family.

My older DD turned 4 the other day and on her birthday my thoughts were constantly on Leah and realizing that I would never watch her turn 4. I would never see her first steps or hear her first words. Every day my older DD reminds me of all the things that I am missing. Leah is a hole in my life and my heart that will never be filled. The idea that the grief of losing a child at any time is better than at any other time is just so.....I don't even know what to say.....
post #17 of 54
Thread Starter 
Well I'm glad to see that some people who read that felt compelled to respond here and to me privately regarding the incredibly ignorant and insensitive comments that were made.

egoldber, I am so sorry for your loss of Leah (and your other babes). I am almost 2 years past the loss of my ds and I cannot begin to tell you how much that hole will never be filled and the ways my life has been irrevocably changed by his death. My life is completely different in every way. I wish you peace and healing.
post #18 of 54
ok this is a complex one I have thought about this myself because treatment for clotting disorders has increased so much in recent times. Vitamin K has to do with clotting and anti-clotting factors the vitamin K-dependent blood coagulation factors (prothrombin, factor VII, factor IX, and factor X) and coregulators of blood coagulation (protein C, protein S, and protein Z) protein C and protein S are anti-clotting factors . besides clotting factors vitamin k also has a role in everything from laying down of calcium in bones, prevention of hardening of the arteries, insulin regulation to nerve generation.

you could do some searches of lit on pub med.
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?DB=pubmed

since you have a known genetic disorder it is a bit different that the presumed disorders of some women who have had multiple miscarriages

vitamin K is low in all newborns at birth and not much transfers between mom to baby during pregnancy- so probably the baby will be born with normal newborn levels of clotting factors. it is during postpartum where breastfed infants have been having problems with vitamin K levels being low -- so one consideration would be to give your baby oral vitamin K postpartum it is a multi-dose thing so if your baby didn't end up needing it you could discontinue giving it and not put the baby in danger , while you await test results.

this is an abstract about levels transfered in pregnancy--
Lancet 1982 Aug 28;2(8296):460-3

Plasma vitamin K1 in mothers and their newborn babies.

Shearer MJ, Rahim S, Barkhan P, Stimmler L

Plasma vitamin K1 (phylloquinone) was assayed in normal adults and pregnant women at term and their babies by a method based on high-performance liquid chromatography. The mean plasma concentration in 30 healthy, fasting adults was 0.26 ng/ml (range 0.10-0.66). 8 out of 9 healthy mothers at term had a mean K1 concentration of 0.20 ng/ml (range 0.13-0.29), but K1 was not detected in the cord plasma of their babies. 1 mg vitamin K1 given intravenously to 6 mothers shortly before delivery raised their plasma K1 to 45-93 ng/ml: K1 was then detectable in the cord plasma of 4 of the 6 infants but at a much lower concentration which did not exceed 0.14 ng/ml. The large concentration gradient between maternal and neonatal plasma suggests that vitamin K1 does not cross the placenta readily or that the uptake by fetal
plasma is low, perhaps because of low levels of a binding lipoprotein. The low levels of vitamin K in the cord plasma of the normal newborn would explain "physiological" hypoprothrombinaemia and suggest the need to reassess current clinical practice in respect of vitamin K prophylaxis in the early neonatal period.
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post #19 of 54
Quote:
Originally Posted by wendy1221
Also, I have to say as the mother of a 6yo and a 2yo that I really think it would be easier to lose a young baby than an older child.
Wendy, I'm sure you didn't intend to come across as harshly insensitive, but you did. The "whose pain is worse?" game has no winners, only losers. I hope you'll reconsider your statements and apologize to the original poster.
post #20 of 54
Quote:
Originally Posted by jplain
Wendy, I'm sure you didn't intend to come across as harshly insensitive, but you did. The "whose pain is worse?" game has no winners, only losers. I hope you'll reconsider your statements and apologize to the original poster.

and a little shocked
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