title: Low-dose maternal warfarin intake resulting in fetal warfarin syndrome: In search for a safe anticoagulant regimen during pregnancy.
abstract: BACKGROUND
  Fetal exposure to maternal ingestion of warfarin is known to produce certain dysmorphic features in the neonate, known as fetal warfarin syndrome (FWS). There is a general consensus that maternal intake of warfarin at a daily dose of 5 mg or less is safe both for the infant and the mother.
  
  
  METHODS
  We report four cases of FWS born to mothers with rheumatic heart disease on warfarin prophylaxis during pregnancy at a dose less than 5 mg/day.
  
  
  RESULTS
  Along with typical facial features of FWS and multiple epiphyseal stippling in skeletal x-ray, Case 1 had Dandy-Walker malformation and Case 2 had laryngo-tracheomalacia and patent ductus arteriosus.
  
  
  CONCLUSIONS
  We emphasize the need for optimizing the choice and dosage schedule of anticoagulants during pregnancy, least harmful for the mother and her developing fetus.
authors.affiliation: Neonatology Unit, Department of Pediatrics, Institute of Medical Sciences, Banaras Hindu University, Varanasi, India.
authors.forename: Sriparna
authors.initials: S
authors.lastname: Basu
authors.affiliation: Neonatology Unit, Department of Pediatrics, Institute of Medical Sciences, Banaras Hindu University, Varanasi, India.
authors.forename: Priyanka
authors.initials: P
authors.lastname: Aggarwal
authors.affiliation: Neonatology Unit, Department of Pediatrics, Institute of Medical Sciences, Banaras Hindu University, Varanasi, India.
authors.forename: Neha
authors.initials: N
authors.lastname: Kakani
authors.affiliation: Neonatology Unit, Department of Pediatrics, Institute of Medical Sciences, Banaras Hindu University, Varanasi, India.
authors.forename: Ashok
authors.initials: A
authors.lastname: Kumar
mesh_terms: D000014:Abnormalities, Drug-Induced / Q000473:pathology*; D000015:Abnormalities, Multiple / Q000139:chemically induced; D000328:Adult; D000925:Anticoagulants / Q000009:adverse effects*; D003616:Dandy-Walker Syndrome / Q000139:chemically induced; D004374:Ductus Arteriosus, Patent / Q000139:chemically induced; D005260:Female; D006350:Heart Valve Prosthesis; D006801:Humans; D009295:Nasal Bone / Q000002:abnormalities* / Q000473:pathology; D011247:Pregnancy; D011297:Prenatal Exposure Delayed Effects; D012214:Rheumatic Heart Disease; D014859:Warfarin / Q000009:adverse effects*
chemical_list: D000925:Anticoagulants; D014859:Warfarin
keywords: anticoagulants; fetal warfarin syndrome; heart valve prosthesis; neonate; pregnancy; warfarin