### instruction:
If you are a doctor, please answer the medical questions based on the patient's description.

### input:
hello doctor, i m palvinder kaur bakshi from new delhi. i operated in 2007 AV+MV replacement. i m now 7 week pregnent. it is my first baby. but unfortunately i was taking acitrom of 5mg till today. is it harmful for my baby? i m afraid. my USG today shows that my baby is normal and heart beat is normal. is everything ok withmy baby. thanx. palvinder YYYY@YYYY

### output:

Hello Harvinder, thanks for the query. While it is very important to be on citron for you to prevent thrombotic complications in pregnancy, it is equally important to prevent significant malformations in the baby due to citron. Please consider the following facts.1. The fact that you were on citron says you must have had mechanical prosthetic valve replacement rather bio prosthetic valve where anticoagulation may not be required at all.2. The use of any anticoagulants in pregnancy is a risk for bleeding at the placental site and subsequent miscarriage, preterm birth and low birth weight in the baby. In such a circumstance, using citron (warfarin) in the first trimester poses further risk of malformations in the baby. And hence once pregnancy is detected, citron is usually replaced with either low molecular weight heparin or fractionated heparin till 12 to 13 weeks to avoid teratogenicity. As citron is the best anticoagulant used to prevent thrombotic complications (the risk for blood clotting in pregnancy is magnified 6-fold), it can be restarted following 12 weeks or continued with heparin depending on physician judgement. However, one must know that the risk for valvular thrombosis increases about 7% if only heparin is used during this period.3. Although it is very hard to determine the effects of citron on baby so early, as you have discontinued it in the very early stage and the dose is less 5 mg) there may not be any harm on the baby. But I must warn you that you need to see your doctor for a detailed discussion and for anticoagulant replacement with heparin which is of utmost importance till 12 weeks following which you can be on warfarin again. Continued therapy during breastfeeding is safe and encouraged. Hope this helped. Take care.