Likelihood of miscarriage from lda?

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jean
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Re: Likelihood of miscarriage from lda?

Postby jean » Fri Oct 05, 639246 8:38 am

That would be wonderful if you could find it-thanks so much!
Our first son was born and passed in Feb of 2010. Born at 29 weeks due to HELLP and passed due to NEC. We miss him every day. :~(

Our second son was born at 39 weeks gestation in Nov of 2011. No HELLP or pre-e! Took LDA starting at week 12 and went off of it at week 38!

http://findingtherainbowconnection.blogspot.com/

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caryn
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Re: Likelihood of miscarriage from lda?

Postby caryn » Sat Sep 22, 639246 9:07 pm

No, I don't remember, but I can look it up later. It only appeared in that one trial which means that it was probably a statistical artifact - but it is hard to ignore the possibility that it was real since it was statistically significant (as one of the docs says, hard to "endorse a weaker effect while ignoring a stronger one".)
Science! The articles you don't want to miss:
The Preeclampsia Puzzle (New Yorker) and Silent Struggle: A New Theory of Pregnancy (New York Times)
Looking for recent articles and studies?
A chance to participate in research? For us on Facebook or Twitter?

Caryn, @carynjrogers, who is not a doctor and who talks about science stuff *way* too much
DS Oscar born by emergent C-section at 34 weeks for fetal indicators, due to severe PE
DD Bridget born by C-section after water broke at 39 weeks after a healthy pregnancy

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jean
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Re: Likelihood of miscarriage from lda?

Postby jean » Sat Sep 22, 639246 5:26 pm

That is interesting. Thank you for the info! Do you by any chance know how much of a percentage was shown for miscarriage with the use of lda in that particular trial/case? I'm just curious.
Our first son was born and passed in Feb of 2010. Born at 29 weeks due to HELLP and passed due to NEC. We miss him every day. :~(

Our second son was born at 39 weeks gestation in Nov of 2011. No HELLP or pre-e! Took LDA starting at week 12 and went off of it at week 38!

http://findingtherainbowconnection.blogspot.com/

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caryn
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Re: Likelihood of miscarriage from lda?

Postby caryn » Sat Sep 01, 639246 7:02 am

In a great many cases prescription of *anything* happens as a consequence of doctor intuition. To actually detect an effect here takes monsterously huge study populations and for most things the studies simply have not been done properly to enable us to draw evidence-based conclusions. Often it isn't possible to answer these sorts of questions unless you just give up and bullshit. :)

The Experts discussion is something we posted because it shows how very arcane these discussions get, and how technical they get, and how very little reason there is to believe that there is actually a benefit from anything we could supplement. The docs who would scrip it believe that they have seen other studies that would imply a benefit for some smaller set of women at risk of preeclampsia because they have an underlying condition - and who knows which one! - that made PE less likely with aspirin. The docs who would not scrip it believe that they have seen other studies that would imply that the very small benefit that shows up in the existing big trials is a statistical artifact of the mathematics used to evaluate the data from the big trials. (They also all know that's called confirmation bias; they are reading the studies in such a way that the studies agree with what they wanted to believe was true anyway!) I know all agree that PE is too complex for a single molecule to have very much effect on the problem.

It's possible to go poking around PubMed and find a study that says, hey, in this study, administering both Low Molecular Weight Heparin and Low Dose Aspirin lowers PE rates really significantly, so we conclude that doing so is a good idea for women at high risk of preeclampsia. But then, if you take a look at the study populations, you realize that they enrolled like 23 women into each group. With populations that size, any effect they find is a freak accident; severe PE happens to one in one hundred women. Studies with 400 women in the control arm can easily have only 4 cases of PE in the control arm if they're using the "severe" definition of PE to call it PE For Sure. So a study with 23 women that has one case in the treatment arm and no cases in the control arm didn't necessarily find anything; they could just accidentally enroll women who were going to get it anyway into the group who tried the therapy they were testing.

The vast vast majority of studies are like this. Preliminary. Interesting, but preliminary. IIRC the concerns about miscarriage stem from a slightly higher rate of miscarriage in the population assigned to aspirin therapy in the NICHD trial for LDA to prevent PE (and since it's one of the two big multicenter trials we actually have testing this idea that aspirin might help, the docs tend to take the possibility seriously.)
Science! The articles you don't want to miss:
The Preeclampsia Puzzle (New Yorker) and Silent Struggle: A New Theory of Pregnancy (New York Times)
Looking for recent articles and studies?
A chance to participate in research? For us on Facebook or Twitter?

Caryn, @carynjrogers, who is not a doctor and who talks about science stuff *way* too much
DS Oscar born by emergent C-section at 34 weeks for fetal indicators, due to severe PE
DD Bridget born by C-section after water broke at 39 weeks after a healthy pregnancy

angieb
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Re: Likelihood of miscarriage from lda?

Postby angieb » Fri Aug 31, 639246 9:17 am

Interesting. On other fertility forums, I've seen many women prescribed LDA early on to help *prevent* miscarriage, and like rebecca said, it's typically prescribed for IVF cycles and I think most fertility doctors have IVF patients take it for the first 12 weeks or so.
Me (29) DH (30)
#1-Olivia Caetlyn-9-28-09-9-28-09, 23+2 wks, emergency classic c-section, class I HELLP, IUGR
#2- Lucas Oliver (rainbow baby)- April 2011, 36+2 wks, HELLP and pre-e free! (lovenox and LDA pregnancy)
#3-Matthew, late October 2012...mostly normal, 37 wks, (lovenox and LDA again)
My blog: http://www.butterflies-and-rainbows.blogspot.com/

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riehlism
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Re: Likelihood of miscarriage from lda?

Postby riehlism » Sun Aug 19, 639246 2:57 pm

My peri told me "no" to lovenox, but it seems like so many women here take it. Can't help but make me wonder if there's really a reason why I personally shouldn't take it (or should wait until 12 weeks to take aspirin in your case) or if the doctor is just being overly cautious. I find the lack of agreement about everything in the MFM community so frustrating!

Keri, I am so with you! The good news is, many ladies go on to have babies with fewer complications (if any), WHILE differing in medicine regimen. There are positive stories for: Lovenox only, baby aspirin only, combinations of medication, starting while ttc, waiting until x weeks to start medicating. So that is hopeful in itself. A major study published last year did say that medication should start prior to 16 weeks, before the umbilical blood vessels are fully formed, to have a positive effect. And I think that is something most MFMs do anyway.

The pool of women here show there is no one hard and fast rule to having a PE-free baby. Really, it's nice to have options.
Jasmin: Severe PE/HELLP and delivered at 24+6 & PCOS (29) Hubby Bubby, Frank (29)
Baby Blue stopped in to say hello and goodbye on 6/3/10
Baby Lucas was born on 10/13/11, PE and HELLP-free! Thank you baby aspirin and Lovenox
http://www.ehd.org/pregnancy-calendar.php?id=18192

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kerisue
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Re: Likelihood of miscarriage from lda?

Postby kerisue » Sun Aug 19, 639246 1:35 pm

My peri told me "no" to lovenox, but it seems like so many women here take it. Can't help but make me wonder if there's really a reason why I personally shouldn't take it (or should wait until 12 weeks to take aspirin in your case) or if the doctor is just being overly cautious. I find the lack of agreement about everything in the MFM community so frustrating!
Mama to Millie
born June 2010 @ 24 wks. gestation due to my severe PE and CHF
lived 25 days, loved and missed

rebecca2
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Re: Likelihood of miscarriage from lda?

Postby rebecca2 » Wed Aug 08, 639246 5:41 pm

I don't have any stats or articles to site, but my on personal opinion is that there really is no *conclusive* evidence that LDA increases the risk of miscarriage. I say this because a lot of reproductive endocrinologists include it in their protocols when treating infertility patients. I took it during all my IVF procedures. With that said, I think LDA's use in fertility treatment is very similar to its use to prevent PE--there is probably some research to show it helps, some that shows it doesn't, and no one really knows whether it helps or not, but a lot think it can't hurt.

Don't get me wrong, I don't mean to imply that your peri is wrong. I'm only trying to point out that I think this is one of those topics where there is mixed opinions amongst the *experts*. Also, those same experts' opinions might vary from patient to patient depending on her underlying conditions and history. Does that make sense?
Becky
Mom to...
baby girl Addison 3/11/09-3/11/09 (severe preeclampsia 26w5d)
baby boy Aden 5/25/10 (35w6d low amniotic fluid)
baby boy #2 due 7/4/11

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jean
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Re: Likelihood of miscarriage from lda?

Postby jean » Wed Aug 08, 639246 8:28 am

It's not that I'm not comfortable...I'm just afraid with the whole situation. And I second guess everything and everyone tells me to be honest-whether it be a doctor or someone else. After all, I was told I probably had food poisoning or the flu when indeed it was HELLP. I find it best to inform myself as best as possible so that if a crisis were to arise, I would have a better understanding of how to handle things/what to do. There is only 1 perinatologist in my area, so I do not have choices on who to work with.
I was not informed of statistics regarding the use of lda and miscarrage, so I thought I'd pose the question on this board to others who seem knowledgable. I am not basing any of my thoughts or decisions on what people say on this board, just putting information into my thought process so I can discuss it later with my doctor if need be.
I was told to start lda on week 12 and intend on waiting until that time to do so. I have read of many ppl on here that started it when they get a +, and when I asked my ob why we were waiting until 12 weeks, he told me because there is a slight risk of miscarriage with taking lda. That just raised my curiosity and I thought I'd inquire about it.

I did read that link you provided, to be honest I find it very confusing. I don't understand a lot of what they are talking about. I can see that they feel lda does not help that much, and there is some disagreement with it. Other than that, it mentions that lda can cause abruption (they did not state any statistics of the likelihood of that) and a lot of it seems very vague and confusing to me. :(
Our first son was born and passed in Feb of 2010. Born at 29 weeks due to HELLP and passed due to NEC. We miss him every day. :~(

Our second son was born at 39 weeks gestation in Nov of 2011. No HELLP or pre-e! Took LDA starting at week 12 and went off of it at week 38!

http://findingtherainbowconnection.blogspot.com/

blythe
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Re: Likelihood of miscarriage from lda?

Postby blythe » Tue Aug 07, 639246 9:50 pm

Jean, you can also read this link where our Experts - top researchers and clinicians in hypertensive pregnancies - discuss LDA.

http://www.preeclampsia.org/forum/viewt ... 19&t=40560

If you want to look at more Expert answers from our archives, the Ask the Experts section is a bit hidden at the moment because of some technical issues with our redesign, but you can do a passable job searching Experts from this link:
http://www.preeclampsia.org/forum/viewforum.php?f=19 (thank you again to member "flori" for finding it!)
Heather, mom to
#1 7-18-03 - 5#8oz 37 weeks PE/PIH
#2 8-11-06 - 6#14oz 37 weeks PE/PIH
#3 9-10-09 - 5#10oz 37 weeks PE/PIH


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