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Longitudinal study of the effect of heparin during pregnancy on bone mineral density and bone markers

Longitudinal study of the effect of heparin during pregnancy on bone mineral density and bone markers

American Journal of Obstetrics and Gynecology 184(1): S189

OBJECTIVE: To assess the effect of heparin administered during pregnancy on bone density and bone turnover markers. STUDY DESIGN: This pilot study included pregnant women who were treated with heparin for prophylactic or therapeutic indications from 20 weeks of pregnancy to term (n = 24) or to the postpartum period (n = 18, 12, and 8 at, respectively, 6, 26, and 52 weeks post partum). Bone mineral density (BMD) of hip and spine with standard lunar DPX technique was determined at each visit. At these visits plasma was tested for calcium, phosphorous, osteocalcin, and 1-25 OH vitamin-D, as well as 24-hour urine hydroxyproline levels. The data were analyzed by use of generalized estimation equations with the identity link (normality) and the independence working correlation matrix. The actual follow-up times were used and defined as the number of weeks post partum. RESULTS: Spine BMD did not change significantly during the study period (P = .61). Hip BMD showed a tendency for decrease at a rate of 0.0006 g/cm2/wk (P = .26). Plasma total calcium did not change significantly during the study period (P = .91). Plasma phosphorous and urine hydroxyproline showed significant linear decreases at respective weekly rates of 0.0061 mg/dL and 1.3336 mg/24 hours. Both 1-25 OH vitamin-D and osteocalcin had significant nonlinear trends that showed a significant net change from visit 1 to 4, respectively, ltoreq -16.12 ng/mL (P = .03) and ltoreq 6.51 ng/mL (P = .02). CONCLUSIONS: Compared with historical controls and published reports, these results suggest that treatment with heparin during pregnancy is associated with augmented bone turnover, as well as with measurable slight decrease in hip BMD, and that these effects may continue into the early postpartum period.

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