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Radiological contrast media in the breastfeeding woman: a position paper of the Italian Society of Radiology (SIRM), the Italian Society of Paediatrics (SIP), the Italian Society of Neonatology (SIN) and the Task Force on Breastfeeding, Ministry of Health, Italy

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Abstract

Objectives

Breastfeeding is a well-recognised investment in the health of the mother-infant dyad. Nevertheless, many professionals still advise breastfeeding mothers to temporarily discontinue breastfeeding after contrast media imaging. Therefore, we performed this review to provide health professionals with basic knowledge and skills for appropriate use of contrast media.

Methods

A joint working group of the Italian Society of Radiology (SIRM), Italian Society of Paediatrics (SIP), Italian Society of Neonatology (SIN) and Task Force on Breastfeeding, Ministry of Health, Italy prepared a review of the relevant medical literature on the safety profile of contrast media for the nursing infant/child.

Results

Breastfeeding is safe for the nursing infant of any post-conceptional age after administration of the majority of radiological contrast media to the mother; only gadolinium-based agents considered at high risk of nephrogenic systemic fibrosis (gadopentetate dimeglumine, gadodiamide, gadoversetamide) should be avoided in the breastfeeding woman as a precaution; there is no need to temporarily discontinue breastfeeding or to express and discard breast milk following the administration of contrast media assessed as compatible with breastfeeding.

Conclusions

Breastfeeding women should receive unambiguous professional advice and clear encouragement to continue breastfeeding after imaging with the compatible contrast media.

Key Points:

• Breastfeeding is a well-known investment in the health of the mother-infant dyad.

• Breastfeeding is safe after administration of contrast media to the mother.

• There is no need to temporarily discontinue breastfeeding following administration of contrast media.

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Abbreviations

HOCM:

high osmolality contrast media

LOCM:

low osmolality contrast media

IOCM:

iso-osmolar contrast media

References

  1. 1.

    Crownover BK, Bepko JL (2013) Appropriate and safe use of diagnostic imaging. Am Fam Physician 87:494–501

  2. 2.

    Wang PI, Chong ST, Kielar AZ et al (2012) Imaging of pregnant and lactating patients: part 1, evidence-based review and recommendations. AJR Am J Roentgenol 198:778–784

  3. 3.

    Frohlich JM, Kubik-Huch RA (2013) Radiographic, MR or ultrasound contrast media in pregnant or breast-feeding women: what are the key issues? Röfo 185:13–25

  4. 4.

    World Health Organization (2009) Acceptable medical reasons for use of breast-milk substitutes. World Health Organization, Geneva. Available via http://www.who.int/nutrition/publications/infantfeeding/WHO_NMH_NHD_09.01/en/. Accessed 22 Sept 2013

  5. 5.

    American Academy of Pediatrics Section on Breastfeeding (2012) Breastfeeding and the use of human milk. Pediatrics 129:e827–e841

  6. 6.

    Robinson S, Fall C (2012) Infant nutrition and later health: a review of current evidence. Nutrients 4:859–874

  7. 7.

    Varalda A, Coscia A, Di Nicola P et al (2012) Medication and breastfeeding. J Biol Regul Homeost Agents 26:1–4

  8. 8.

    Berlin CM Jr, van den Anker JN (2013) Safety during breastfeeding: drugs, foods, environmental chemicals, and maternal infections. Semin Fetal Neonatal Med 18:13–18

  9. 9.

    Available via http://toxnet.nlm.nih.gov/. Accessed 2 Feb 2014

  10. 10.

    Davanzo R, Rubert L, Oretti C (2008) Meta-variability of advice on drugs in the breastfeeding mother: the example of beta-blockers. Arch Dis Child Fetal Neonatal Ed 93:F249–F250

  11. 11.

    Hale TW (2012) Medications and mothers’ milk 2012, 15th edn. Hale Publishing, Amarillo

  12. 12.

    Wilson JT, Brown RD, Cherek DR et al (1980) Drug excretion in human breast milk: principles, pharmacokinetics and projected consequences. Clin Pharmacokinet 5:1–66

  13. 13.

    European Society of Urogenital Radiology (2013) ESUR Guidelines on Contrast Media version 8.1. Available via http://www.esur.org/esur-guidelines/. Accessed 22 Sept 2013

  14. 14.

    14 SonoVue: EPAR-Product Information. Available via http://www.ema.europa.eu/docs/en_GB/document_library/EPAR_-_Product_Information/human/000303/WC500055380.pdf. Accessed 22 Sept 2013

  15. 15.

    15 Optison: EPAR-Product Information. Available via http://www.ema.europa.eu/docs/en_GB/document_library/EPAR_-_Product_Information/human/000166/WC500059461.pdf. Accessed 22 Sept 2013

  16. 16.

    16 American College of Radiology (2013) ACR manual on contrast media, version 9. Available via http://www.acr.org/quality-safety/resources/contrast-manual. Accessed 22 Sept 2013

  17. 17.

    17 The Royal Australian and New Zealand College of Radiologists (2009) RANZCR guidelines for iodinated contrast administration. Available via http://www.ranzcr.edu.au/quality-a-safety/resources/guidelines. Accessed 22 Sept 2013

  18. 18.

    18 The Royal Australian and New Zealand College of Radiologists (2007) RANZCR MRI safety guidelines. Available via http://www.ranzcr.edu.au/quality-a-safety/resources/guidelines. Accessed 22 Sept 2013

  19. 19.

    Webb JAW (2014) Pregnancy and lactation. In: Thomsen HS, Webb JAW (eds) Contrast media: safety issues and ESUR guidelines, 3rd edn. Springer, Berlin Heidelberg

  20. 20.

    Bourrinet P, Dencausse A, Havard P, Violas X, Bonnemain B (1995) Transplacental passage and milk excretion of iobitridol. Invest Radiol 30:156–158

  21. 21.

    FitzJohn TP, Williams DG, Laker MF, Owen JP (1982) Intravenous urography during lactation. Br J Radiol 55:603–605

  22. 22.

    Texier F, Roque d'Orbcastel O, Etling N (1983) Stable iodine level in human milk after pulmonary angiography. Presse Med 12:769

  23. 23.

    Nielsen ST, Matheson I, Rasmussen JN, Skinnemoen K, Andrew E, Hafsahl G (1987) Excretion of iohexol and metrizoate in human breast milk. Acta Radiol 28:523–526

  24. 24.

    Ilett KF, Hackett LP, Paterson JW, McCormick CC (1981) Excretion of metrizamide in milk. Br J Radiol 54:537–538

  25. 25.

    Holmdahl KH (1956) Cholecystography during lactation. Acta Radiol 45:305–307

  26. 26.

    Johansen JG (1978) Assessment of a non-ionic contrast medium (Amipaque) in the gastrointestinal tract. Invest Radiol 13:523–527

  27. 27.

    Okazaki O, Murayama N, Masubuchi N, Nomura H, Hakusui H (1996) Placental transfer and milk secretion of gadodiamide injection in rats. Arzneimittelforschung 46:83–86

  28. 28.

    Kubik-Huch RA, Gottstein-Aalame NM, Frenzel T et al (2000) Gadopentetate dimeglumine excretion into human breast milk during lactation. Radiology 216:555–558

  29. 29.

    Schmiedl U, Maravilla KR, Gerlach R, Dowling CA (1990) Excretion of gadopentetate dimeglumine in human breast milk. AJR Am J Roentgenol 154:1305–1306

  30. 30.

    Rofsky NM, Weinreb JC, Litt AW (1993) Quantitative analysis of gadopentetate dimeglumine excreted in breast milk. J Magn Reson Imaging 3:131–132

  31. 31.

    Kaminsky S, Laniado M, Gogoll M et al (1991) Gadopentetate dimeglumine as a bowel contrast agent: safety and efficacy. Radiology 178:503–508

  32. 32.

    Laniado M, Kornmesser W, Hamm B, Clauss W, Weinmann HJ, Felix R (1988) MR imaging of the gastrointestinal tract: value of Gd-DTPA. AJR Am J Roentgenol 150:817–821

  33. 33.

    Idee JM, Port M, Raynal I, Schaefer M, Le Greneur S, Corot C (2006) Clinical and biological consequences of transmetallation induced by contrast agents for magnetic resonance imaging: a review. Fundam Clin Pharmacol 20:563–576

  34. 34.

    Tweedle MF, Wedeking P, Kumar K (1995) Biodistribution of radiolabeled, formulated gadopentetate, gadoteridol, gadoterate, and gadodiamide in mice and rats. Invest Radiol 30:372–380

  35. 35.

    White GW, Gibby WA, Tweedle MF (2006) Comparison of Gd(DTPA-BMA) (Omniscan) versus Gd(HP-DO3A) (ProHance) relative to gadolinium retention in human bone tissue by inductively coupled plasma mass spectroscopy. Invest Radiol 41:272–278

  36. 36.

    Abraham JL, Thakral C (2008) Tissue distribution and kinetics of gadolinium and nephrogenic systemic fibrosis. Eur J Radiol 66:200–207

  37. 37.

    Webb JAW, Thomsen HS (2013) Gadolinium contrast media during pregnancy and lactation. Acta Radiol 54:599–600

  38. 38.

    Claudon M, Dietrich CF, Choi BI et al (2013) Guidelines and good clinical practice recommendations for Contrast Enhanced Ultrasound (CEUS) in the liver—update 2012: A WFUMB-EFSUMB initiative in cooperation with representatives of AFSUMB, AIUM, ASUM, FLAUS and ICUS. Ultrasound Med Biol 39:187–210

  39. 39.

    Senthilnathan S, Gauvreau K, Marshall AC, Lock JE, Bergersen L (2009) Contrast administration in pediatric cardiac catheterization: dose and adverse events. Catheter Cardiovasc Interv 73:814–820

  40. 40.

    Frush DP, Herlong JR (2005) Pediatric thoracic CT angiography. Pediatr Radiol 35:11–25

  41. 41.

    Callahan MJ, Poznauskis L, Zurakowski D, Taylor GA (2009) Nonionic iodinated intravenous contrast material-related reactions: incidence in large urban children's hospital—retrospective analysis of data in 12,494 patients. Radiology 250:674–681

  42. 42.

    European Medicines Agency makes recommendations to minimise risk of nephrogenic systemic fibrosis with gadolinium-containing contrast agents. EMEA/CHMP/739818/2009. Available via http://www.ema.europa.eu/ema/index.jsp?curl=pages/includes/document/document_detail.jsp?webContentId=WC500015569&mid=WC0b01ac058009a3dc

  43. 43.

    Thomsen HS, Morcos SK, Almen T et al (2013) Nephrogenic systemic fibrosis and gadolinium-based contrast media: updated ESUR Contrast Medium Safety Committee guidelines. Eur Radiol 23:307–318

  44. 44.

    Bernstein EJ, Schmidt-Lauber C, Kay J (2012) Nephrogenic systemic fibrosis: a systemic fibrosing disease resulting from gadolinium exposure. Best Pract Res Clin Rheumatol 26:489–503

  45. 45.

    Nardone B, Saddleton E, Laumann AE et al (2014) Pediatric nephrogenic systemic fibrosis is rarely reported: a RADAR report. Pediatr Radiol 44:173–180

  46. 46.

    Schneider G, Schurholz H, Kirchin MA, Bucker A, Fries P (2013) Safety and adverse effects during 24 hours after contrast-enhanced MRI with gadobenate dimeglumine (MultiHance) in children. Pediatr Radiol 43:202–211

  47. 47.

    Dillman JR, Ellis JH, Cohan RH, Strouse PJ, Jan SC (2007) Frequency and severity of acute allergic-like reactions to gadolinium-containing i.v. contrast media in children and adults. AJR Am J Roentgenol 189:1533–1538

  48. 48.

    Singh N, McLean K (2012) Five things to know about…: intravascular contrast media for imaging in breastfeeding women. CMAJ 184:E775

  49. 49.

    Hylton NM (2000) Suspension of breast-feeding following gadopentetate dimeglumine administration. Radiology 216:325–326

  50. 50.

    Chen MM, Coakley FV, Kaimal A, Laros RK Jr (2008) Guidelines for computed tomography and magnetic resonance imaging use during pregnancy and lactation. Obstet Gynecol 112:333–340

  51. 51.

    Webb JA, Thomsen HS, Morcos SK (2005) The use of iodinated and gadolinium contrast media during pregnancy and lactation. Eur Radiol 15:1234–1240

  52. 52.

    Tremblay E, Therasse E, Thomassin-Naggara I, Trop I (2012) Quality initiatives: guidelines for use of medical imaging during pregnancy and lactation. Radiographics 32:897–911

  53. 53.

    Sachs HC (2013) The transfer of drugs and therapeutics into human breast milk: an update on selected topics. Pediatrics 132:e796–e809

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Acknowledgments

The scientific guarantor of this publication is Prof. Maria Assunta Cova, Head of Department of Radiology, Cattinara Hospital, University of Trieste, Azienda Ospedaliero—Universitaria “Ospedali Riuniti” Trieste. The authors of this manuscript declare relationships with the following companies: F. Stacul is an Advisory Board member of GE Healthcare and has been invited by GE Healthcare, Bracco to give lectures. All other authors declare that they have no conflict of interest related to the content of this paper. No complex statistical methods were necessary for this paper. Institutional Review Board approval was not required because the manuscript is a review of the relevant medical literature on the safety profile of contrast media for the nursing infant/child. Methodology: performed at one institution.

R. Davanzo conceived this study as Chair of the Task Force on Breastfeeding, Ministry of Health, Rome, Italy. R. Davanzo and M. Cova coordinated this study.

R. Quaranta, R. Davanzo and F. Stacul collected and analysed data.

R. Quaranta, A.A. Zuppa, R. Davanzo, M. Gregori, P. Guastalla, F. Stacul prepared the draft of the paper. F. Stacul, R. Davanzo, M. Cova, G. Salvatori, C. Fonda, and V. David critically revised the article for important intellectual content.

Between September and November 2013, the Task Force on Breastfeeding, Ministry of Health, Italy and the Executive Committees of the Italian Society of Radiology (SIRM), the Italian Society of Pediatrics (SIP) and the Italian Society of Neonatology (SIN) approved the position paper.

Author information

Correspondence to Roberto Quaranta.

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Cova, M.A., Stacul, F., Quaranta, R. et al. Radiological contrast media in the breastfeeding woman: a position paper of the Italian Society of Radiology (SIRM), the Italian Society of Paediatrics (SIP), the Italian Society of Neonatology (SIN) and the Task Force on Breastfeeding, Ministry of Health, Italy. Eur Radiol 24, 2012–2022 (2014). https://doi.org/10.1007/s00330-014-3198-6

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Keywords

  • Contrast media
  • Diagnostic imaging
  • Breastfeeding
  • Lactation
  • Breast milk