The use of iodinated and gadolinium contrast media during pregnancy and lactation

Abstract

The use of iodinated or gadolinium-based contrast media in pregnant or lactating women often causes concerns in the radiology department because of the principle of not exposing a fetus or neonate to any drugs. Because of the uncertainty about the use of contrast media during pregnancy and lactation, the Contrast Media Safety Committee of the European Society of Urogenital Radiology decided to review the literature and draw up guidelines. An extensive literature search was carried out and summarized in a report. Based on the limited information available, simple guidelines have been drawn up. The report and guidelines were discussed at the 11th European Symposium on Urogenital Radiology in Santiago de Compostela, Spain. Mutagenic and teratogenic effects have not been described after administration of gadolinium or iodinated contrast media. Free iodide in radiographic contrast medium given to the mother has the potential to depress fetal/neonatal thyroid function. Neonatal thyroid function should be checked during the 1st week if iodinated contrast media have been given during pregnancy. No effect on the fetus has been seen after gadolinium contrast media. Only tiny amounts of iodinated or gadolinium-based contrast medium given to a lactating mother reach the milk, and only a minute proportion entering the baby's gut is absorbed. The very small potential risk associated with absorption of contrast medium may be considered insufficient to warrant stopping breast-feeding for 24 h following either iodinated or gadolinium contrast agents.

Problematiche internistiche in corso di gravidanza

“…30 Un diametro aortico inferiore a 4 cm presenta un rischio lieve di dissezione (1%). 55 Anche se non c'è sufficiente letteratura sull'argomento, la gravidanza dovrebbe essere evitata in pazienti con diametro aortico superiore a 45 mm. 15 Se un paziente presenta un diametro dell'aorta di 40-45 mm, il clinico dovrà valutare altri fattori di rischio per dissezione (una storia familiare di dissezione, una crescita rapida del diametro aortico) prima di fornir suggerimenti riguardo una possibile gravidanza.…”

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“…54 A differenza delle altre vecchie sulfaniluree, la glibenclamide non sembra attraversare la placenta in misura significativa, non sembra aumentare le complicanze fetali, ma, come la metformina, non è attualmente raccomandata per l'uso diffuso in gravidanza a causa di una mancanza di follow-up a lungo termine dei bambini esposti a glibenclamide durante la vita fetale. 55 Le linee-guida ADA 41 2016 sottolineano comunque come la glibenclamide risulti inferiore alla insulina e alla metformina in quanto dotata di scarsa flessibilità e per l'aumentato rischio di ipoglicemia neonatale e di macrosomia.…”

Diagnosis of pregnancy-associated venous thromboembolism - position paper of the Working Group in Women’s Health of the Society of Thrombosis and Haemostasis (GTH)

“…Animal studies have revealed teratogenic eff ects, but only at markedly increased and repeated doses. However, no harmful eff ects have been reported in human foetuses to date [65,66]. Because the half-life of gadolinium in the foetus is not known, gadolinium should be used with extreme caution during pregnancy and only if the potential maternal benefi ts clearly outweigh the risks to the foetus [63,64].…”

“…Small amounts of iodinated contrast agents can cross the placenta and enter the foetal circulation and the amniotic fl uid, exposing the foetus to additional risks [66]. No eff ect on foetal thyroid function has ever been reported, but a theoretical risk of iodine-induced neonatal hypothyroidism remains [49,89,96,97].…”