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

@article{Webb2004TheUO,
  title={The use of iodinated and gadolinium contrast media during pregnancy and lactation},
  author={Judith A. W. Webb and Henrik S. Thomsen and Sameh K. Morcos and Members of Contrast Media Safety Committee of European Soc Radiology},
  journal={European Radiology},
  year={2004},
  volume={15},
  pages={1234-1240}
}
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… 
The use of MR contrast media in pregnant women and small children
TLDR
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Gadolinium contrast media during pregnancy and lactation
TLDR
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Neonatal thyroid function: effect of a single exposure to iodinated contrast medium in utero.
TLDR
A single, high-dose in utero exposure to water-soluble, low-osmolar, iodinated intravenous products, such as iohexol, is unlikely to have a clinically important effect on thyroid function at birth.
Effect of In Utero Exposure of Iodinated Intravenous Contrast on Neonatal Thyroid Function
TLDR
There is no significant adverse clinical risk of thyroid function abnormalities to the fetus after IV iodinated contrast material to their mothers after computed tomographic scans of pregnant women during the years 2004 through 2009.
Contrast Considerations in Pregnancy
TLDR
Radiological investigations using iodinated contrast media are not often carried out in pregnant patients in order to avoid exposing the foetus to ionising radiation, and the administration of contrast media is off-label, but not contraindicated, in this group of patients.
Neonatal thyroid function after administration of IV iodinated contrast agent to 21 pregnant patients.
TLDR
Based on neonatal TSH measurements in a small number of patients, it is found that there is no ill effect of iodinated contrast agents on Neonatal thyroid function after in utero exposure.
Effect of antenatal iodinated contrast agent on neonatal thyroid function.
TLDR
No adverse effect on thyroid function was demonstrated in neonates exposed to in utero iodinated contrast media in babies whose mothers were investigated for suspected pulmonary embolism during pregnancy.
Imaging Pregnant and Lactating Patients.
TLDR
Appropriateness and safety issues, estimated doses for imaging examinations that use iodizing radiation, radiation risks to the mother and conceptus during various stages of pregnancy, and use of iodinated or gadolinium-based contrast agents and radiotracers in pregnant and lactating women are described.
Is administration of gadolinium‐based contrast media to pregnant women and small children justified?
TLDR
The current literature and present guidelines regarding the use of gadolinium‐based contrast media have been reviewed to validate the justification for their administration to pregnant or lactating women and small children.
Pregnancy and Lactation: Intravascular Use of Contrast Media
TLDR
Although only small amounts of gadolinium-based contrast media reach the milk, if a lactating woman receives one of the lower stability agents, breastfeeding should be discontinued for 24 h.
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References

SHOWING 1-10 OF 77 REFERENCES
Effect of iodinated contrast media on thyroid function in adults
TLDR
Patients at high- risk of developing thyrotoxicosis after contrast medium injection are patients with Graves’ disease and patients with multinodular goiter with thyroid autonomy, especially elderly patients and patients living in areas of iodine deficiency, although it may offer some protection in selected high-risk individuals.
The Iodine Content of Amniotic Fluid and Placental Transfer of Iodinated Drugs
TLDR
This study demonstrated that such elevated levels can be produced by urography with an iodinated medium, by thyroid extract therapy, and by vaginal therapy with an iodineinated agent.
Gadolinium‐DTPA Transplacental Transfer and Distribution in Fetal Tissue in Rabbits
TLDR
The results indicate that gadolinium does cross the rabbit Placenta, and that concentrations in the placenta and the fetal urinary tract are sufficient for imaging as well as possible fetal toxicity.
Placental transfer and milk secretion of gadodiamide injection in rats.
TLDR
Exposure of the developing rat fetus to gadodiamide after maternal drug administration is quantitatively small, and radioactivity levels in the milk increased with time, reaching a maximum 1 h after dosing, and gradually decreased to levels below detection limits over 8 h.
Excretion of gadopentetate dimeglumine in human breast milk.
TLDR
Serial measurements of gadolinium excretion in the patient’s breast milk and urine form the basis of this report and are important for treating lactating patients.
Early report: comparison of breath-hold MR excretory urography, Doppler ultrasound and isotope renography in evaluation of symptomatic hydronephrosis in pregnancy.
TLDR
MR excretory urography is a promising technique which affords equivalent functional and additional anatomical information to isotope renography and is more accurate than Doppler ultrasound in the assessment of ureteric obstruction in pregnancy.
Normal placenta: gadolinium-enhanced dynamic MR imaging.
TLDR
The placenta rapidly and intensely enhanced on images acquired immediately after contrast material administration and preceded substantial enhancement of the myometrium, indicating normal placental enhancement is intense on immediately postcontrast images and precedes substantial myometrial enhancement.
Excretion of Iohexol and Metrizoate in Human Breast Milk
TLDR
The authors consider breast feeding to be acceptable for mothers receiving iohexol or metrizoate, and it is not likely, that such a low dose of poorly absorbed drug would cause any adverse effects in the infant, unless it is hypersensitive to the drug already.
Intravenous urography during lactation.
Two patients recently referred for intravenous urography whilst lactating spontaneously requested information concerning possible excretion of contrast medium in their breast milk, and if this would
Biodistribution of Radiolabeled, Formulated Gadopentetate, Gadoteridol, Gadoterate, and Gadodiamide in Mice and Rats
TLDR
The molecular feature found to be most important in differentiating the four chelates evaluated is the presence or absence of a macrocyclic structure and the Gd chelate containing this structure, gadoteridol and gadoterate, have the lowest residual Gd at long residence times in both mice and rats.
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