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. 1999 Jul;40(7):980-4.
doi: 10.1111/j.1528-1157.1999.tb00806.x.

Prothrombin and PIVKA-II levels in cord blood from newborn exposed to anticonvulsants during pregnancy

A M Howe  1 , D J Oakes, P D Woodman, W S Webster
Affiliations

Prothrombin and PIVKA-II levels in cord blood from newborn exposed to anticonvulsants during pregnancy

A M Howe et al. Epilepsia. 1999 Jul.

Abstract

Purpose: To determine whether anticonvulsant exposure during human pregnancy caused an increase of the abnormal form of prothrombin, known as PIVKA-II (prothrombin induced by vitamin K absence for factor II), and a decrease in total prothrombin, in the blood of the newborn.

Methods: Cord blood was collected from the placenta at the time of parturition from 12 women who had received anticonvulsant therapy during pregnancy and from 11 control women.

Results: PIVKA-II was present in cord blood from control mothers at low or nondetectable levels. In the same samples, total prothrombin concentrations were approximately 50% of adult levels, but there was wide variation between individuals. Exposure to carbamazepine (CBZ) alone during pregnancy was associated with markedly increased PIVKA-II levels in four of six samples and decreased total prothrombin levels for the whole group. High PIVKA-II levels also were recorded in one cord blood sample from a mother who received phenytoin (PHT) and vigabatrin (VGB). Two cases of PHT alone and one of valproic acid (VPA) alone were not associated with increased PIVKA-II levels.

Conclusions: These results are consistent with the hypothesis that some anticonvulsants (particularly CBZ) interfere with vitamin K metabolism during pregnancy and may result in hematologic signs of vitamin K deficiency in the newborn.

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