by heather j (4882 Posts), Wed Dec 12, 2012 10:09 pm
Hi! Welcome to the PF!
I also have the PAI-1 gene mutation (mine is 4G/4G). Do you know if you're heterozygous or homozygous? That would likely be the determining factor for whether a physician would proceed with anticoagulants in pregnancy. My MFM prefers to manage 4G/4G, and *sometimes* 4G/5G depending on labwork. The idea behind this mutation and how it plays out in pregnancy is that while the placenta is fighting to implant, you're clotting overtime to stop it (I don't profess to be very science-minded as evidenced by that description, LOL, but hopefully it makes sense); this can result in a shallowly implanted placenta. In my case, it resulted in a 5 lb baby at 36 weeks coupled with an abruption and HELLP syndrome. I've since had two more pregnancies. During my initial visit with my last, the NP who was doing my work-up was looking through my records and was amazed I hadn't experienced a miscarriage with the PAI-1 mutation. Miscarriages and Preeclampsia are possible complications as well as cardiovascular disease and stroke later in life. If you are not comfortable with your doctor, seek a second opinion. My protocol for pregnancy (my most recent was in 2010-11) is low-dose aspirin and lovenox (from weeks 6 through 6 weeks postpartum) with growth ultrasounds starting at 20 weeks (and every four weeks until deliver) and NST/BPP starting at 32 weeks. I'm on low-dose aspirin outside of pregnancy as well. I've had two pregnancies since my first preeclamptic one: #2 was a c-section at 37 weeks (6.2#) and #3 was a 37 weeker at 7#; both were PE-free. My sister, who lives across the country, consulted with an MFM at a very well-known teaching hospital (she also carries the PAI-1 4G/4G along with MTHFR and had PE with her first and only pregnancy) and her doctor didn't recommend any anticoagulants for her. She was dxed with PE around week 34; I was on bedrest by week 30. Feel free to message me privately if you'd like to chat more. There is so much more information available regarding this mutation than there was when I first began researching back in 2005. Best wishes to you for a healthy pregnancy and baby in the future.
Heather (PAI-1 4G/4G) mama to:
Nicolas Edison (6/2004) 36 weeks, PE, HELLP, and placental abruption
Ella Amelia (3/2007) 37 weeks, lovenox, PE-free
Oliver Lyon (1/2011) 37 weeks, lovenox, PE-free
Milo Mason (2/2014) 39 weeks PE-free