Blood Clotting Risks During Pregnancy and Delivery – The Balancing Act

If you’re pregnant or a new mom,
congratulations to you and your growing family, but listen up,
because we have some information on a rare and dangerous blood
clotting disorder that’s important for anyone diagnosed
with it, but most of all, for you expectant moms out there.
Joining me to talk about this is maternal-fetal medicine
specialist, Dr. Christopher Robinson.
Good morning doctor, thank you for joining me.
Thank you very much for having me today.
So, let’s talk about this blood clotting disorder.
What is it? You know, I think a lot of
people, when they think of blood clotting, we think of a good
thing. We think of, for instance, I cut
myself, I stopped bleeding, and that’s great.
It’s awesome. The problem is, there are some
people who actually clot too easily.
In other words, they actually have clots that can put their
lives at danger, and the specific clotting disorder we’re
going to talk about today is the anti-thrombin 3 deficiency.
It’s a hereditary type of blood clotting.
Okay. And so it’s important to
recognize that it’s very different than the clotting that
we think about in our everyday lives.
Yes, because when I think of clotting, I’m not thinking so
something so dangerous. So, how rare is this?
It is a rare condition, but not as rare as people think.
Okay. In other words, we believe
there’s probably around 60,000-600,000 people in the
United States that have this condition.
We believe that probably only a fraction of those individuals
actually know they have the disorder.
And where is the danger behind it?
This scenario is dangerous because it predisposes a woman
who is going through the most special time of her life, she’s
in pregnancy, she’s planning her family, she’s planning for a
healthy baby, she’s looking to the future.
She wants to ensure she does everything to get there, but at
the same time, she has this deficiency in her blood that
causes her to clot spontaneously.
It can happen in her arteries. It can happen in her veins.
And the risk with that is? Well, the worst case scenarios
is that clot sets up on one of those vessels and actually moves
into her lungs, preventing her from getting adequate oxygen,
and placing her life at risk, as well as her baby.
Unfortunately, that event is not 100% predictable, so we can’t
actually tell her when it’s going to happen, or how it’s
going to happen, but these women are at very elevated risk.
In fact, 70% of women who have this deficiency in pregnancy
will develop a clot, and they can have a life-threatening
event in that pregnancy. Now, you mention, doctor, that
it’s inherited. So, are there signs that someone
can look for, maybe in terms of maybe recognizing that they
could have this? That’s important.
So, since it’s inherited, it means we have to look at our
whole family. We have to step back and not
only think about ourselves, but think about what happened to my
mother, what happened to my father, do I have sisters?
The family tree. Exactly.
We need to look at everyone in the family.
Have we had individuals with early heart disease?
Have we had other individuals that have had these clots?
Maybe they’ve happened in their leg, maybe they had clots that
went to their lungs, sometimes called a pulmonary embolus.
Exactly. That caused them to be admitted
to the hospital. Maybe we have individuals in our
family who are taking blood thinners.
We call those anti-coagulants in medicine, but what we hear them
called in our family is maybe grandfather, or maybe my sister
or brother, is on a blood thinner.
A blood thinner is there to protect that person from these
types of clots. The question is, what caused
their clot? and understanding why did this
person have this event in the first place.
Now, the good news, and I know I have to toss to a break right
now, but there is a blood test that one can get to determine if
they have this, correct? There is.
There’s a reliable blood test. It’s a blood test that’s
accessible really across the United States, and across the
world, to find out if a person has this disorder.
I want to talk about that blood test, so stay right there,
doctor. We’re going to tell you more
about the very dangerous connection between this
disorder and child birth. We also have some information to
share with you about how to reduce the risk of blood clots.
Very important. Especially if you’re pregnant.
Stick around. (music).
Welcome back to The Balancing Act.
I’m rejoined by maternal-fetal medicine specialist, Dr.
Christopher Robinson, and we’re in the middle of a very
important discussion about a rare and dangerous blood
clotting disorder. Dr. Robertson, let’s continue
the conversation here and talk about why this condition is not
only dangerous, but especially dangerous when you are pregnant.
First of all, pregnancy is a very special time in a woman’s
life. She’s planning for the normal.
She’s planning for her future family.
She’s anticipating a healthy child, a healthy delivery, and
really we’re not focused on the complications, but we know that
sometimes complications do creep in to these scenarios.
We do things in obstetrics to try to elicit this information,
to try to find out, is there a risk in this family?
For instance, we might ask a woman, do you have any family
history of things like blood clots.
We may refer to terms like thrombophilia, meaning that a
person clots too easily. We may ask those questions.
Sometimes patients don’t actually know.
They don’t know the answer to that.
They may not know their family history completely.
As we talked about before, it’s important to dig in the family
history to find out if there’s a history of thrombophilia, or is
there a history of a hereditary type of blood clotting, and very
importantly, this type of blood clotting, hereditary
anti-thrombin 3 deficiency is particularly dangerous in
pregnancy. So, I can only imagine for a
woman who is hearing that they’re expecting a child, and
of course that’s a wonderful and exciting moment, but nerve
wracking as well, and this diagnosis, it’s got to be tough.
It’s challenging any time we have to give a person
information that could potentially suggest they are at
risk. It changes their perception.
It changes their feelings. It induces, sometimes, feelings
of just being frightened or scared of the actual event.
One of our jobs is to try to alleviate that, to make a plan,
to make a plan to minimize the risk of a thrombophilia upon
that pregnancy. To minimize the risk of clotting
too easily, and in the case of anti-thrombin 3 deficiency, it’s
very important to know if this deficiency exists in the patient
so that we can make a plan for how to care for that pregnancy.
And you can make a plan, and here’s the good news, because
you can reduce the risks of blood clots.
What are they? Absolutely.
When we look at these women who have hereditary anti-thrombin 3
deficiency. We’re talking about women who
have low amounts of this protein, anti-thrombin 3.
So, the reason they’re clotting is not just accidental.
It’s occurring because they have a deficiency of something that
normal people have enough of, and that protein is important in
balancing clotting versus anticoagulation.
If you don’t have enough of that protein, you’re more likely to
clot. In fact, as that protein gets
lower and lower, you’re clotting risk is going higher and higher.
So, the key is we have the ability to donate this molecule,
this anti-thrombin 3, we can get it off of the shelf from other
patients, and give it to a patient to replace their ability
to prevent clots, to keep them in a normal balance that they
should have in pregnancy, and thus protect their pregnancy, as
well as their outcome for that pregnancy.
Doctor, I know you’re very passionate about this, and
especially about raising awareness about this disorder,
and even letting people know that their are resources out
there. There are many resources a
person can go to. For instance,
and it’s actually put out by physicians, and it actually
gives you reliable information on how to diagnose a condition
like this, how to look at your family history, and what things
we would do to respond, so it gives you information.
When you go in, talking to your physician should be a two-way
discussion. You should be providing
information, they should be providing you information, and
you should both make a plan together, and that’s the most
important thing we do. So, to really sum this up, the
most important thing is to recognize first of all that this
is anti-thrombin deficiency. This is a very special type of
clotting disorder that really places a person at a very
different degree of risk than the other clotting disorders.
I think the second thing is to really take a hard look at one’s
family history to see is there anything in my family that might
suggest that I am at risk for this.
Things like recurrent miscarriage, previous clots in
family members, early cardiac disease, and then talk to your
doctor, because there is a test, and there’s treatment, so
there’s things can be done for this condition.
Thank you so much for raising awareness this morning with us,
and teaching me a great lesson this morning.
Thank you very much for having me, I really appreciate it.
Come back anytime. Thank you.
And of course you can log onto our website,
right now to find all of the symptoms, treatment and resource
information about AT deficiency, and of course join us on
Facebook and Twitter, as always.

4 Replies to “Blood Clotting Risks During Pregnancy and Delivery – The Balancing Act”

  1. my wife has anti thrombin 3 and is in the process of fertility treatment. Our doctor has her take blood thinner shots once a day prior to getting pregnant, then throughout the entire pregnancy, and then a month or so after the pregnancy. She will be a pin cushion! Feel Free to reach her Wendy Weilbacher

  2. i have a protein c deficiency and i had one kid i found out after having my kid but i walk 3 mile to and from work everyday when i was pregnant i guest that help me lower my chance

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