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Contrast Media pp 113-120 | Cite as

Pregnancy and Lactation: Intravascular Use of Contrast Media

  • Judith A. W. Webb
Part of the Medical Radiology book series (MEDRAD)

Abstract

Iodine-based contrast media can be given during pregnancy. Neonatal thyroid function should be checked during the first week because of the potential for depressed thyroid function. Lactating women who receive iodine-based contrast media can breastfeed normally. The most stable macrocyclic agents should be used if gadolinium-based contrast media are given to pregnant women. 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.

Keywords

Amniotic Fluid Thyroid Stimulate Hormone Nephrogenic Systemic Fibrosis Gadopentetate Dimeglumine Gadobenate Dimeglumine 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

References

  1. Abraham JL, Thakral C, Skov L et al (2008) Dermal inorganic gadolinium concentrations: evidence for in vivo transmetallation and long-term persistence in nephrogenic systemic fibrosis. Br J Dermatol 158:273–280PubMedCrossRefGoogle Scholar
  2. Ahmet A, Lawson ML, Babyn P, Tricco AC (2009) Hypothyroidism in neonates post-iodinated contrast media: A systematic review. Acta Paediatr 98:1568–1574PubMedCrossRefGoogle Scholar
  3. Atwell TD, Lteif AN, Brown DL et al (2008) Neonatal thyroid function after administration of iv iodinated contrast agent to 21 pregnant patients. Am J Roentgenol 191:268–271CrossRefGoogle Scholar
  4. Barkhof E, Heijboer RJJ, Algra PR (1992) Inadvertent iv administration of gadopentetate dimeglumine during early pregnancy. Am J Roentgenol 158:1171CrossRefGoogle Scholar
  5. Beall MH, Ross MG (2009). Amniotic Fluid Dynamics. In Creasy RK, Resnik R, Iams JD, Lockwood CJ, Moore TR (eds) Maternal-Foetal medicine: principles and practice. 6th edn. Saunders Elsevier. pp 48–49Google Scholar
  6. Birchard KR, Brown MA, Hyslop WB et al (2005) MRI of acute abdominal and pelvic pain in pregnant patients. Am J Roentgenol 184:452–458CrossRefGoogle Scholar
  7. Bloomfield TH, Hawkins DF (1991) The effects of drugs on the human fetus. In: Philipp E, Setchell M (eds) Scientific foundations of obstetrics and gynaecology, 4th edn.Butterworth- Heinemann, Oxford, p 320Google Scholar
  8. Blumberg ML, Wohl GT, Wiltchik S et al (1967) Placental localisation by amniography. Am J Roentgenol 100:688–697CrossRefGoogle Scholar
  9. Bona G, Zaffaroni M, Defilippe C et al (1992) Effects of iopamidol on neonatal thyroid function. Eur J Radiol 14:22–25PubMedCrossRefGoogle Scholar
  10. Bourjeily G, Chalhoub M, Phomphutkul C et al (2010) Neonatal thyroid function: effect of a single exposure to iodinated contrast medium in utero. Radiology 256:744–750PubMedCrossRefGoogle Scholar
  11. Bourrinet P, Dencausse A, Havard P et al (1995) Transplacental passage and milk excretion of iobitridol. Invest Radiol 30:156–158PubMedCrossRefGoogle Scholar
  12. Bourrinet P, Dencausse A, Cochet P et al (1997) Secretion in milk and transplacental transfer of two iodised oils, Lipiodol UF and Oriodol, in rabbits. Biol Neonate 71:395–402PubMedCrossRefGoogle Scholar
  13. Boyd AS, Zic JA, Abraham JL (2007) Gadolinium depositon in nephrogenic fibrosing dermopathy. J Am Acad Dermatol 56:27–30PubMedCrossRefGoogle Scholar
  14. Broughton-Pipkin F, Hull D, Stephenson T (1994) Foetal physiology. In: Lamming GE (ed) Marshall’s physiology of reproduction, 4th edn. Chapman and Hall, London, p 777Google Scholar
  15. Brown RS (2003). Thyroid disease in infancy, childhood and adolescence. In Braverman LE (ed) Diseases of the thyroid, 2nd edn. Humana, p 65Google Scholar
  16. Bury RF (2002) Radiation hazards in urological practice. BJU Int 89:505–509PubMedCrossRefGoogle Scholar
  17. Cacheris WP, Quay SC, Rocklage SM (1990) The relationship between thermodynamics and the toxicity of gadolinium complexes. Magn Reson Imaging 8:467–481PubMedCrossRefGoogle Scholar
  18. Cochran ST, Norman A (1994) Induction of micronuclei in lymphocytes of patients undergoing excretory urography with ioversol. Invest Radiol 29:210–212PubMedCrossRefGoogle Scholar
  19. Cochran ST, Khodadoust A, Norman A (1980) Cytogenetic effects of contrast material in patients undergoing excretory urography. Radiology 136:43–46PubMedGoogle Scholar
  20. Commission Decision of 1.7.2010 concerning, in the framework of Article 31 of Directive 2001/83/EC of the European Parliament and of Council, the marketing authorizations for Gadolinium-containing contrast agents for human use which contain one or more of the active substances ‘gadodiamide, gadopentetic acid, gadobenic acid, gadoxetic acid, gadoteridol, and gadoteric acid ’. http://ec.europa.eu/health/documents/community-register/html/refh_others.htm Accessed Dec 6 2012
  21. Delange F, de Benoist B, Pretell B, Dunn JT (2001) Iodine deficiency in the world: where do we stand at the turn of the century? Thyroid 11:437–447PubMedCrossRefGoogle Scholar
  22. De Santis M, Straface G, Cavaliere AF et al (2007) Gadolinium periconceptional exposure: pregnancy and neonatal outcome. Acta Obstet et Gynecol 86:99–101CrossRefGoogle Scholar
  23. Donandieu AM, Idee JM, Doncet D et al (1996) Toxicologic profile of iobitridol, a new nonionic low osmolality contrast medium. Acta Radiol (Suppl) 400:17–24Google Scholar
  24. Etling N, Gehin-Fouque F, Vielh JP, Gautray JP (1979) The iodine content of amniotic fluid and placental transfer of iodinated drugs. Obstet Gynecol 53:376–380PubMedGoogle Scholar
  25. Felder E (1984) Iopamidol toxicology. Invest Radiol 19(Suppl):S168–S170CrossRefGoogle Scholar
  26. Fitzjohn TP, Williams DG, Laker MF, Owen JP (1982) Intravenous urography during lactation. Br J Radiol 55:603–605PubMedCrossRefGoogle Scholar
  27. Fujikawa K, Sakaguchi Y, Harada S et al (1995) Reproductive toxicity of iodixanol, a new non–ionic, isotonic contrast medium in rats and rabbits (in Japanese). J Toxicol Sci 20(Suppl 1):107–115PubMedCrossRefGoogle Scholar
  28. Grobner T (2006) Gadolinium - a specific trigger for the development of nephrogenic firosing dermopathy and nephrogenic systemic fibrosis? Nephrol Dial Transplant 21:1104–108PubMedCrossRefGoogle Scholar
  29. Heglund IF, Michelet AA, Blazak WF et al (1995) Preclinical pharmacokinetics and general toxicity of iodixanol. Acta Radiol (Suppl) 399:69–82Google Scholar
  30. High WA, Avers RA, Chandler J et al (2007) Gadolinium is detectable within the tissue of patients with nephrogenic systemic fibrosis. J Am Acad Dermatol 56:21–26PubMedCrossRefGoogle Scholar
  31. Hill BJ, Saigal G, Patel S, Abdenour GE (2007) Transplacental passage of non-ionic contrast agents resulting in fetal bowelopacification: a mimic of pneumoperitoneum in the newborn. Pediatr Radiol 37:396–398PubMedCrossRefGoogle Scholar
  32. Holmdahl KH (1956) Cholecystography during lactation. Acta Radiol 45:305–307PubMedCrossRefGoogle Scholar
  33. Ilett KF, Hackett LP, Paterson JW, McCormick CC (1981) Excretion of metrizamide in milk. Br J Radiol 54:537–538PubMedCrossRefGoogle Scholar
  34. Johansen JG (1978) Assessment of a non-ionic contrast medium (Amipaque) in the gastrointestinal tract. Invest Radiol 13:523–527PubMedCrossRefGoogle Scholar
  35. Jorulf H (1983) Iohexol compared with diatrizoate in pediatric urography. Acta Radiol (Suppl) 366:42–45Google Scholar
  36. Kaminsky S, Laniado M, Gogoll M et al (1991) Gadopentetate dimeglumine as a bowel contrast agent: Safety and efficacy. Radiology 178:503–508Google Scholar
  37. Kanal E, Barkovitch AJ, Bell C et al (2007) AR Guidance Document for Safe MR Practices. AM J Roentgenol 188:1447–1474Google Scholar
  38. K/DOQI Clinical Practice Guidelines (2002) Part 4. Definitions and classification of stages of chronic kidney disease. Am J Kidney Dis 39(Suppl 1):S46–S75Google Scholar
  39. Kelleher J, Feczko PJ, Radkowski MA, Griscom NT (1979) Neonatal intestinal opacification secondary to transpla- cental passage of urographic contrast medium. Am J Roentgenol 132:63–65CrossRefGoogle Scholar
  40. Klein RZ, Mitchell ML (2000) Hypothyroidism in infants and children. In: Braverman LE, Utiger RD (eds) The thyroid: a fundamental and clinical text, 8th edn. Lippincott, Philadelphia, pp 973–974Google Scholar
  41. Kochi MH, Kaloudis EV, Ahmed W, Moore WH (2012) Effect of in utero exposure of iodinated intravenous contrast on neonatal thyroid function. J Comput Assist Tomogr 36:165–169PubMedCrossRefGoogle Scholar
  42. Krause W, Schobel C, Press WR (1994) Preclinical testing of iopromide. 2nd communication: toxicological evaluation. Arzneimittelforschung 44:1275–1279PubMedGoogle Scholar
  43. Kubik-Huch RA, Gottstein-Aalame NM, Frenzel T et al (2000) Gadopentetate dimeglumine excretion into human breast milk during lactation. Radiology 216:555–558PubMedCrossRefGoogle Scholar
  44. Laniado M, Kornmesser W, Hamm B et al (1988) MR imaging of the gastrointestinal tract: value of Gd-DTPA. Am J Roentgenol 150:817–821CrossRefGoogle Scholar
  45. Leverge R, Bergmann JF, Simoneau G et al (2003) Bioavailability of oral vs intramuscular iodinated oil (Lipiodol UF) in healthy subjects. J Endocrinol Invest 26(Suppl 2):2–6Google Scholar
  46. Marckmann P, Skov L, Rossen K et al (2006) Nephrogenic systemic fibrosis: suspected causative role of gadodiamide used for contrast-enhanced magnetic resonance imaging. J Am Soc Nephrol 17:2359–2362PubMedCrossRefGoogle Scholar
  47. Marcos HB, Semelka RC, Worowattanakul S (1997) Normal placenta: gadolinium-enhanced dynamic MR imaging. Radiology 205:493–496PubMedGoogle Scholar
  48. Marti-Bonmati L, Vega T, Benito C et al (2000) Safety and efficacy of Omniscan (gadodiamide injection) at 0.1 mmol/kg for MRI in infants younger than 6 months of age: phase III open multicenter study. Invest Radiol 35:141–147PubMedCrossRefGoogle Scholar
  49. Moon AJ, Katzberg RW, Sherman MP (2000) Transplacental passage of iohexol. J Pediatr 136:548–549PubMedCrossRefGoogle Scholar
  50. Morcos SK (2007) Nephrogenic systemic fibrosis following the administration of extracellular gadolinium based contrast agents: is the stability of the contrast agent molecule an important factor in the pathogenesis of this condition? Br J Radiol 80:73–76PubMedCrossRefGoogle Scholar
  51. Morisetti A, Tirone P, Luzzani F, de Haen C (1994) Toxicological safety assessment of iomeprol, a new x-ray contrast agent. Eur J Radiol 18(Suppl 1):S21–S31PubMedCrossRefGoogle Scholar
  52. Morisetti A, Bussi S, Tirone P, de Haen C (1999) Toxicological safety evaluation of gadobenate dimeglumine 0.5 M solution for injection (Multihance), a new magnetic resonance imaging contrast medium. J Comput Assist Tomogr 23(Suppl 1):S207–S217PubMedCrossRefGoogle Scholar
  53. Morrison JC, Boyd M, Friedman BI et al (1973) The effects of Renografin-60 on the fetal thyroid. Obstet Gynecol 42:99–103PubMedGoogle Scholar
  54. Muhler MR, Clement O, Salomon LJ et al (2011) Maternofoetal pharmacokinetics of a gadolinium chelate contrast agent in mice. Radiology 258:455–460PubMedCrossRefGoogle Scholar
  55. Nader S (2009). Thyroid disease and pregnancy. In Creasy RK, Resnik R, Iams JD, Lockwood CJ, Moore TR (eds). Maternal-foetal medicine. principles and practice, 6th edn. Saunders Elsevier, pp 997–998Google Scholar
  56. Nelson JA, Livingstone GK, Moon RG (1982) Mutagenic evaluation of radiographic contrast media. Invest Radiol 17:183–185PubMedCrossRefGoogle Scholar
  57. Nielsen ST, Matheson I, Rasmussen JN et al (1987) Excretion of iohexol and metrizoate in human breast milk. Acta Radiol 28:523–526PubMedCrossRefGoogle Scholar
  58. Norman A, Adams FH, Riley RF (1978) Cytogenetic effects of contrast media and tri-iodobenzoic acid derivatives in human lymphocytes. Radiology 129:199–203PubMedGoogle Scholar
  59. Norman A, Cochran ST, Sayre JW (2001) Meta-analysis of increases in micronuclei in peripheral blood lymphocytes after angiography or excretory urography. Radiat Res 15:740–743CrossRefGoogle Scholar
  60. Novak Z, Thurmond A, Ross PL et al (1993) Gadolinium-DTPA transplacental transfer and distribution in fetal tissue in rabbits. Invest Radiol 28:828–830PubMedGoogle Scholar
  61. Pietsch H, Lengsfeld P, Jost G et al (2009) Long-term retention of gadolinium in the skin following the administration of gadolinium-based contrast agents. Eur Radiol 19:1417–1423PubMedCrossRefGoogle Scholar
  62. Okazaki O, Murayama N, Masubuchi N et al (1996) Placental transfer and milk secretion of gadodiamide injection in rats. Arzneimittelforschung/Drug Res 46:83–86Google Scholar
  63. Rajaram S, Exley CE, Fairlie F, Matthews S (2012) Effect of antenatal iodinated contrast agent on neonatal thyroid function. Brit J Radiol 85:238–242CrossRefGoogle Scholar
  64. Ralston WH, Robbins MS, James P (1989) Reproductive, developmental and genetic toxicity of ioversol. Invest Radiol 24(Suppl 1):S16–S22PubMedCrossRefGoogle Scholar
  65. Raphael MJ, Gordon H, Schiff D (1967) Radiological aspects of intra-uterine blood transfusion. Br J Radiol 40:520–527PubMedCrossRefGoogle Scholar
  66. Rodesch F, Camus M, Ermans AM et al (1976) Adverse effect of amniofetography on fetal thyroid function. Am J Obstet Gynecol 126:723–726PubMedGoogle Scholar
  67. Rofsky NM, Weinreb JC, Litt AW (1993) Quantitative analysis of gadopentetate dimeglumine excreted in breast milk. J Magn Reson Imaging 3:131–132PubMedCrossRefGoogle Scholar
  68. Rofsky NM, Pizzarello DJ, Weinreb JC et al (1994) Effect on fetal mouse development of exposure to MR imaging and gadopentetate dimeglumine. J Magn Reson Imaging 4:805–807PubMedCrossRefGoogle Scholar
  69. Rofsky NM, Pizzarello DJ, Duhaney MO et al (1995) Effect of magnetic resonance exposure combined with gadopentetate dimeglumine on chromosomes in animal specimens. Acad Radiol 2:492–496PubMedCrossRefGoogle Scholar
  70. Saigal G, Abdenour GE (2007) Another case of transplacental passage of the non-ionic contrast agent ioversol. Pediatr Radiol 37:726–727PubMedCrossRefGoogle Scholar
  71. Schmiedl U, Maravilla KR, Gerlach R, Dowling CA (1990) Excretion of gadopentetate dimeglumine in human breast milk. Am J Roentgenol 154:1305–1306CrossRefGoogle Scholar
  72. Semba RD, Delange F (2001) Iodine in human milk: perspectives for infant health. Nutr Rev 59:269–278PubMedCrossRefGoogle Scholar
  73. Shaw DD, Potts DG (1985) Toxicology of iohexol. Invest Radiol [Suppl 1]:S10–S13Google Scholar
  74. Shoenut JP, Semelka RC, Silverman R et al (1993) MRI in the diagnosis of Crohn’s disease in two pregnant women. J Clin Gastroenterol 17:244–247PubMedCrossRefGoogle Scholar
  75. Sieber MA, Lengsfeld P, Frenzel T et al (2008) Preclinical investigation to compare different gadolinium-based contrast agents regarding their propensity to release gadolinium in vivo and to trigger nephrogenic systemic fibrosis. Eur Radiol 18:2164–2173PubMedCrossRefGoogle Scholar
  76. Soltys RA (1992) Summary of preclinical safety evaluation of gadoteridol injection. Invest Radiol 27(Suppl 1):S7–S11PubMedGoogle Scholar
  77. Spencer JA, Tomlinson AJ, Weston MJ, Lloyd SN (2000) Early report: comparison of breath-hold MR excretory urography. Doppler ultrasound and isotope renography in evaluation of symptomatic hydronephrosis in pregnancy. Clin Radiol 55:446–453PubMedCrossRefGoogle Scholar
  78. Stubbe P, Heidermann P, Schumbraad P, Ulbrich R (1980) Transient congenital hypothyroidism after amniofetography. Eur J Pediatr 135:97–99PubMedCrossRefGoogle Scholar
  79. Thomas CR, Lang EK, Lloyd FP (1963) Fetal pyelography - a method for detecting fetal life. Obstet Gynecol 22:335–340PubMedGoogle Scholar
  80. 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 23:307–318PubMedCrossRefGoogle Scholar
  81. Tsai-Goodman B, Geva T, Odegard KC et al (2004) Clinical role, accuracy and technical aspects of cardiovascular magnetic resonance imaging in infants. Am J Cardiol 94:69–74PubMedCrossRefGoogle Scholar
  82. Tweedle MF, Wedeking P, Kumar K (1995) Biodistribution of radiolabelled, formulated gadopentate, gadoteridol, gadoterate and gadodiamide in mice and rats. Invest Radiol 30:372–380PubMedCrossRefGoogle Scholar
  83. Vanhaesebrouck P, Verstraete AG, De Praeter C et al (2005) Transplacental passage of a non-ionic contrast agent. Eur J Pediatr 164:408–410PubMedCrossRefGoogle Scholar
  84. Van der Molen AJ, Thomsen HS, Morcos SK, Members of Contrast Media Safety Committee of European Society of Urogenital Radiology (2004) Effect of iodinated contrast media on thyroid function in adults. Eur Radiol 14:902–907Google Scholar
  85. Webb JAW, Thomsen HS, Morcos SK et al (2005) The use of iodinated and gadolinium contrast media during pregnancy and lactation. Eur Radiol 15:1234–1240PubMedCrossRefGoogle Scholar
  86. White GW, Gibby WA, Tweedle MF (2006) Comparison of Gd(DTPA-BMA) (Omniscan) versus GD (HP-D03A) (Prohance) relative to gadolinium retention in human bone tissue by inductively coupled plasma mass spectroscopy. Invest Radiol 41:272–278PubMedCrossRefGoogle Scholar
  87. Wholey MH (1967) Evaluation of arteriography in obstetrics. Radiol Clin North Am 5:121–131PubMedGoogle Scholar
  88. Wible JH Jr, Troup CM, Hynes MR et al (2001) Toxicological assessment of gadoversetamide injection (OPTIMARK), a new contrast-enhancement agent for use in magnetic resonance imaging. Invest Radiol 36:401–412PubMedCrossRefGoogle Scholar
  89. Wilson JT, Brown RR, Cherek DR et al (1980) Drug excretion in human breast milk: principles, pharmacokinetics and projected consequences. Clin Pharmacokinet 5:1–66PubMedCrossRefGoogle Scholar

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© Springer-Verlag Berlin Heidelberg 2014

Authors and Affiliations

  1. 1.Consultant Emeritus, Department of Diagnostic RadiologySt. Bartholomew’s Hospital, University of LondonLondonUK

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