PubMed · 9136414
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P Carroll-Frey. 1997. Lost babies.. https://pubmed.ncbi.nlm.nih.gov/9136414/
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This paper presents several models for investigating whether the HLA allogenotypes DR1/Br, DR3 and DR10 are genetic markers for a predisposition of experiencing unexplained recurrent foetal losses. A total of 199 women from 113 families answered questionnaires concerning their pregnancies and 145 of these women were HLA typed. The analysis of the data is complicated as dependencies between pregnancy outcomes are expected. The main purpose of the paper is to illustrate how such analyses can be performed using Bayesian graphical models and Gibbs sampling. The analyses are made using the programs BUGS and CODA. Markov chain Monte Carlo analyses within a Bayesian framework have become easier with the introduction of these programs. However, experience shows that some caution is required so we recommend making some initial analyses using very simple models and perhaps approximative methods, followed by a model development introducing increasing complexity.
Anticoagulant therapy during pregnancy is problematic. Patients are frequently treated with long-term low-molecular weight heparin despite a lack of evidence for its effectiveness, and in the absence of validated dosing recommendations. The objectives of this investigation were to characterize the safety and pharmacokinetic behavior of a low-molecular weight heparin (reviparin) administered throughout pregnancy. Forty-two patients followed in a tertiary-care rheumatology clinic who received prophylactic doses of reviparin (4900 anti-Xa units subcutaneously once daily) were enrolled in this investigation. Anti-Xa heparin levels, weights, and gestational ages of the patients were obtained on up to four occasions distributed throughout their pregnancy. The achieved anti-Xa heparin levels were highly correlated with the patient's weight, irrespective of the gestational age. No toxicity other than injection site hematomas was observed. The achieved intensity of anticoagulation with reviparin varies during pregnancy in direct proportion to the patient's weight. This variability may mandate dose adjustment in response to changes in a patient's weight during pregnancy, particularly if low-molecular weight heparin is administered at therapeutic doses.
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