by Anne Eglash MD, IBCLC, FABM
Do breastfeeding women need to avoid certain types of x-rays or other imaging studies? The American College of Obstetrics and Gynecology recent published their Committee Opinion 723 entitled Guidelines for Diagnostic Imaging during Pregnancy and Lactation. The authors state that pregnant and lactating women often are denied imaging studies that are needed for diagnosis, and breastfeeding is often unnecessarily interrupted after having certain radiologic studies. While most of this opinion paper discusses the use and safety of diagnostic radiologic testing for pregnant women, the committee does address recommendations for nursing mothers.
What do you think are recommendations by the American College of Obstetrics and Gynecology regarding diagnostic radiologic studies during lactation? Choose 1 or more:
- Breastfeeding women should avoid having more than 1 chest x-ray during lactation, in order to avoid the risk of too much radiation in breastmilk.
- The MRI contrast gadolinium is preferred over superparamagnetic iron oxide particles during lactation.
- A breastfeeding mother undergoing a CT scan with oral and intravenous contrast does not need to interrupt breastfeeding.
- The radioactive materials used in nuclear medicine imaging tests, such as bone scans and thyroid scans, enter into breastmilk. Mothers need counseling on the safety of breastfeeding when being given these agents.
See the Answer
Answers: B,C,D (not A)
ABSTRACT: Imaging studies are important adjuncts in the diagnostic evaluation of acute and chronic conditions. However, confusion about the safety of these modalities for pregnant and lactating women and their infants often results in unnecessary avoidance of useful diagnostic tests or the unnecessary interruption of breastfeeding. Ultrasonography and magnetic resonance imaging are not associated with risk and are the imaging techniques of choice for the pregnant patient, but they should be used prudently and only when use is expected to answer a relevant clinical question or otherwise provide medical benefit to the patient. With few exceptions, radiation exposure through radiography, computed tomography scan, or nuclear medicine imaging techniques is at a dose much lower than the exposure associated with fetal harm. If these techniques are necessary in addition to ultrasonography or magnetic resonance imaging or are more readily available for the diagnosis in question, they should not be withheld from a pregnant patient. Breastfeeding should not be interrupted after gadolinium administration.
Milk Mob Comment by Anne Eglash MD, IBCLC, FABM
The radiation from plain x-rays, such as chest x-rays, does not affect the quality of breastmilk, so there is no limit to the amount of plain x-rays that a breastfeeding woman receives.
I hope that these recommendations will finally convince radiology centers that breastfeeding women don’t need to pump and dump after having CT scans and MRIs with gadolinium contrast. Not much is known about the MRI contrast superparamagnetic iron oxide particles, so best to avoid this contrast until more is known about it.
The American College of Radiology for years has stated that MRIs and CTs are safe during nursing, and they recently updated their recommendations in 2017 on contrast media given to breastfeeding women, verifying the ACOG recommendations.
Diagnostic imaging that uses nuclear materials, such as thyroid scans and bone scans, are best avoided during breastfeeding. Often these tests can wait until the mother naturally weans, and other testing can be done in place of nuclear scanning. If nuclear scanning must be done, I suggest checking the free online National Library of Medicine Lactmed resource for detailed information on the pharmacokinetics of the specific nuclear contrast agent the mother will be receiving, so that she can be instructed on how long to pump and store her breastmilk. Unfortunately, there is a concern for the health of the breasts in this process, because of the breasts’ exposure to radiation.
She does not need to dump the milk, because if kept frozen, the radiation in the milk will dissipate over time. The milk should be kept in a freezer that is not opened often and is distant from where people hang out, in order to limit radiation exposure to anyone near to or opening the freezer. Women can contact their closest hospital nuclear medicine department to find out where the milk can be tested for radiation.