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Use of Radioisotopes (and other imaging agents) during Lactation
By Kelly Bonyata, IBCLC
Radiocontrast dyes (contrast media used
with diagnostic testing)
X-rays, MRIs, CAT scans, Intravenous Pyelogram (IVP), ultrasound,
mammograms, etc. do not affect breastfeeding. Barium is sometimes
used as a contrast agent; it is not absorbed orally and thus does
not affect breastfeeding.
Sometimes radiocontrast dyes are used to aid the imaging - these
dyes do not require that mom interrupt breastfeeding.
"Although most package inserts for these products suggest
that nursing mothers postpone breastfeeding their babies for 24
hours after use, research indicates that this is not necessary
(Kubik-Huch 2000; Rofsky 1993; Nielson 1987; Fitz-John 1982).
In Medications and Mothers' Milk (2002), Dr. Thomas Hale
explains that 'Although under usual circumstances iodine products
are contraindicated in nursing mothers (due to ion trapping in
milk), these products are unique in that they are extremely inert
and do not release free iodine... They are virtually unabsorbed
after oral administration' (Hale, p. 480). In mothers who have
used these agents while breastfeeding, no effects have been reported
in their nursing babies (Kubik-Huch 2000; Nielson 1987). These
preparations are also used in children for diagnostic purposes."
From: Mohrbacher N, Stock J.
The
Breastfeeding Answer Book. 3rd Revised Edition. Schaumburg,
Illinois: La Leche League International; 2003:508.
"Because of the very small percentage of iodinated contrast
medium that is excreted into the breast milk and absorbed by the
infant’s gut, we believe that the available data suggest
that it is safe for the mother and infant to continue breastfeeding
after receiving such an agent... Review of the literature shows
no evidence to suggest that oral ingestion by an infant of the
tiny amount of gadolinium contrast agent excreted into breast
milk would cause toxic effects. We believe, therefore, that the
available data suggest that it is safe for the mother and infant
to continue breastfeeding after receiving such an agent."
From: American College of Radiology
Committee on Drugs and Contrast Media. Administration
of Contrast Medium to Breastfeeding Mothers. ACR Bulletin. October
2001;57(10):12-13.
"Contrast medium is not appreciably deionated. In addition,
the absorption of hydrophilic contrast medium is minimal when
it is given orally for imaging studies of the gastrointestinal
tract. Since no toxicity is known in full-term infants even after
the direct administration of contrast medium, the use of these
compounds by breastfeeding women appear to pose no risk to their
infants."
From: Ito S. Drug
therapy for breast-feeding women. N Engl J Med. Jul 13, 2000;343(2):118-26.
See particularly "Iodine-Containing Contrast Medium and Antiseptic
Agents" on p. 123-124.
Contrast
dyes & radiopaque agents
approved by the AAP for use in breastfeeding mothers * |
| Generic name |
Trade Name |
Pregnancy
Risk Category** |
Lactation
Risk Category** |
| Diatrizoate |
- |
- |
NR |
| Fluorescein |
- |
C |
L3 |
| Gadopentetic (Gadolinium) |
- |
C |
L2 |
| Iohexol |
Omnipaque |
B |
L2 |
| Iopanoic acid |
Telepaque |
D |
L2 |
| Metrizamide |
Amipaque |
B |
L2 |
| Metrizoate |
Isopaque |
B |
L2 |
|
* American Academy of Pediatrics Committee on Drugs.
Transfer
of drugs and other chemicals into human milk. Pediatrics.
Sep 2001;108(3):776-89.
** Hale TW. Medications
and Mothers Milk. 11th Edition. Amarillo, Texas: Pharmasoft
Publishing; 2004.
| Lactation
Risk Categories |
Pregnancy
Risk Categories |
- L1
(safest)
- L2
(safer)
- L3
(moderately safe)
- L4
(possibly hazardous)
- L5
(contraindicated)
|
- A
(controlled studies show no risk)
- B
(no evidence of risk in humans)
- C
(risk cannot be ruled out)
- D
(positive evidence of risk)
- X
(contraindicated in pregnancy)
|
| NR: Not Reviewed. This
drug has not yet been reviewed by Hale. |
|
More information
References (most recent listed first)
- JAW Webb, HS Thomsen, SK Morcos and members of the Contrast
Media Safety Committee of the European Society of Urogenital Radiology
(ESUR). The
use of iodinated and gadolinium contrast media during pregnancy
and lactation. Eur Radiol. 2005 Jun;15(6):1234-40. See also:
The
use of iodinated and gadolinium contrast media during pregnancy
and lactation on the ESUR website.
- Riordan J. Breastfeeding
and Human Lactation. 3rd ed. Boston and London: Jones and
Bartlett; 2004:159-161.
- Hale TW. Medications
and Mothers Milk. 11th Edition. Amarillo, Texas: Pharmasoft
Publishing; 2004.
- Mohrbacher N, Stock J. The
Breastfeeding Answer Book. 3rd Revised Edition. Schaumburg,
Illinois: La Leche League International; 2003:508, 609-612.
American College of Radiology Committee on Drugs and Contrast
Media. Administration
of Contrast Medium to Breastfeeding Mothers. ACR Bulletin.
October 2001;57(10):12-13.- American Academy of Pediatrics Committee on Drugs. Transfer
of drugs and other chemicals into human milk. Pediatrics.
Sep 2001;108(3):776-89.
- Ito S. Drug
therapy for breast-feeding women. N Engl J Med. Jul 13, 2000;343(2):118-26.
- Kubik-Huch RA, et al. Gadopentetate
Dimeglumine Excretion into Human Breast Milk during Lactation.
Radiology. 2000;216:555-558.
- Hylton NM. Suspension
of Breast-feeding following Gadopentetate Dimeglumine Administration
(Editorial). Radiology. 2000;216:325-326.
- Rofsky NM, Weinreb JC, Litt AW. Quantitative
analysis of gadopentetate dimeglumine excreted in breast milk.
J Magn Reson Imaging. Jan-Feb 1993;3(1):131-2.
- Nielsen ST et al. Excretion
of iohexol and metrizoate in human breast milk.
Acta Radiol. Sep-Oct 1987;28(5):523-6.
- FitzJohn TP, Williams DG, Laker MF, Owen JP. Intravenous
urography during lactation. Br J Radiol. Aug 1982;55(656):603-5.
Radioisotopes
Use of radioisotopes sometimes requires temporary weaning. The
length of time will depend upon the type of radioactive material
used, the dose, the age of the baby, whether baby is getting anything
other than breastmilk, and how often mom expresses milk. If use
of a particular radioisotope requires that you wean temporarily
(some don't), you'll want to pump regularly while the radiation
is working out of your system to reduce radiation exposure to breast
tissue. At least 97% of the radioactivity is gone from your body
in 5 half-lives - after this point it is generally considered safe
to breastfeed (but other factors may also need to be considered).
The more often you pump, the more quickly the radioactivity will
be eliminated from your body. It may be possible to have your milk
tested for radioactivity, perhaps by the radiology department at
the hospital, to help determine when it is safe to return to breastfeeding.
Important note: If you do suspend breastfeeding due to use
of radioactive isotopes, it is important to pump regularly during
this time. See also Maintaining
milk supply when baby is not nursing. You do not need to dump
this milk. It can be dated, frozen and used after 5+ half-lives
of the radioisotope have passed (after 5 half-lives, 96.9% of the
radiation is gone; after 10 half-lives, 99.9% of the radiation is
gone). You may also get your milk checked for radiation by your
radiology/nuclear medicine department.
Specifics on certain tests
Always check with your nuclear medicine department to find out
exactly which radioisotope will be used. Once you have this information,
you can look it up in the US Nuclear Regulatory Commission table
and other references.
HIDA/Hepatobiliary scan (for
gall bladder problems) - This test usually uses Tc-99m DISIDA, which
should not require an interruption of breastfeeding (see the links
below for detailed information).
Bone Scan - This test usually
uses Tc99m MDP, which should not require an interruption of breastfeeding
(see the links below for detailed information).
Thyroid Scan or Treatment
- see Breastfeeding
and Thyroid Problems: Diagnostic Testing & Treatments
More information & references
Radioactive
scans and breastfeeding by Jack Newman, MD, FRCPC
U.S.
Nuclear Regulatory Commission information on Radiopharmaceuticals
for Breastfeeding Patients (1/27/03) from Dr. Thomas Hale's
Breastfeeding Pharmacology website
Belgian
Guidelines for the Reference Administered Activities: Breastfeeding
from the Belgian Society for Nuclear Medicine
Breastfeeding
suspension periods and other information for various radiopharmaceuticals
from Flinders Medical Centre in South Australia
Radionuclides
and Breastfeeding from "Pregnancy and Medical Radiation
Part II" (p. 3 of PDF file) by Julie Timins, MD, FACR, from
Journal of Women's Imaging 2002;4(1):33-34.
Table
3: Summary of Recommendations for Radiopharmaceuticals Excreted
in the Breast Milk, In: Stabin MG, Breitz HB. Breast
milk excretion of radiopharmaceuticals: mechanisms, findings, and
radiation dosimetry. Journal of Nuclear Medicine 2000;
41(5):863-873.
Nuclear
Medicine Guidelines for Breastfeeding Mothers (revised 9/3/96)
from the Radiation
Internal Dose Information Center (RIDIC) at the Oak Ridge Institute
for Science and Education.
Nuclear
Medicine Mediabook has general information, including nuclear
medicine protocols for various procedures
Hale TW. Medications
and Mothers Milk, 11th Edition. Amarillo, Texas: Pharmasoft
Publishing, 2004.
Lawrence R and Lawrence R. Breastfeeding:
A Guide for the Medical Profession, 5th ed. St. Louis: Mosby,
1999, p. 387-8,510,521-523, 810-815.
Mohrbacher N, Stock J. The
Breastfeeding Answer Book, Third Revised Edition. Schaumburg,
Illinois: La Leche League International, 2003, p. 609-612.
Riordan J. Breastfeeding
and Human Lactation, 3rd ed. Boston and London: Jones and Bartlett,
2004, p. 159-161, 481.
Page last modified:
11/14/2006
Written: 03/04/2003
