ABM Clinical Protocol #31: Radiology and Nuclear Medicine Studies in Lactating Women

Mitchell, Katrina B.; Fleming, Margaret M.; Anderson, Philip O.; Giesbrandt, Jamie G.; Young, Michal; Noble, Larry; Reece-Stremtan, Sarah; Bartick, Melissa; Calhoun, Sarah; Dodd, Sarah E; Elliott-Rudder, Megan; Kair, Laura; Lappin, Susan; Lawrence, Ruth A.; LeFort, Yvonne; Marinelli, Kathleen A.; Marshall, Nicole; Murak, Catherine; Myers, Eliza; Okogbule-Wonodi, Adora C.; Roberts, Audrey N.; Rosen-Carole, Casey; Rothenberg, Susan; Schmidt, Tricia; Seo, Tomoko; Sriraman, Natasha K.; Stehel, Elizabeth K.; Fleur, Rose St.; Wight, Nancy E.; Winter, Lori

doi:10.1089/bfm.2019.29128.kbm

Cited by 20 publications

(13 citation statements)

References 25 publications

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“…In addition to clinical examination, many patients will undergo radiologic staging studies. Computed tomography with intravenous contrast or MRI with gadolinium contrast does not require an interruption in breastfeeding 36 (Level 4). Positron emission tomography and bone scintigraphy may require brief separation of the dyadfor 12 hours or up to 4 hours, respectively-during which time breast milk can be expressed and safely fed to infants 36 (Level 4).…”

Section: (Level 4)mentioning

confidence: 99%

“…Computed tomography with intravenous contrast or MRI with gadolinium contrast does not require an interruption in breastfeeding 36 (Level 4). Positron emission tomography and bone scintigraphy may require brief separation of the dyadfor 12 hours or up to 4 hours, respectively-during which time breast milk can be expressed and safely fed to infants 36 (Level 4). These guidelines reflect the fact that radiotracers used in these studies are excreted in limited quantities into breast milk, but organs themselves will remain radioactive for a short period of time.…”

Section: (Level 4)mentioning

confidence: 99%

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ABM Clinical Protocol #34: Breast Cancer and Breastfeeding

Johnson

Mitchell

2020

Breastfeeding Medicine

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A central goal of The Academy of Breastfeeding Medicine is the development of clinical protocols for managing common medical problems that may impact breastfeeding success. These protocols serve only as guidelines for the care of breastfeeding mothers and infants and do not delineate an exclusive course of treatment or serve as standards of medical care. Variations in treatment may be appropriate according to the needs of an individual patient. Background B reast cancer is the most common malignancy in women worldwide, with 1 in 20 women developing the disease during her lifetime. 1 It represents the leading cause of cancer deaths and disability-adjusted life-years among women. 1 In addition, breast cancer imparts significant morbidity to women and children through its impacts on breastfeeding. Breast cancer treatments may affect breastfeeding in multiple ways. Breastfeeding women diagnosed with breast cancer may require medications or therapies that decrease milk production or are contraindicated during lactation. Women treated for breast cancer before or during pregnancy may have reduced lactational capacity due to surgical removal of breast tissue and/or irreversible effects of prior therapies. Given these unique challenges and the multitude of health risks associated with not breastfeeding, 2 women with a new or remote breast cancer diagnosis require unique support of lactation. The aim of this protocol is to guide clinicians in the delivery of optimal care of breastfeeding women as it relates to breast cancer, from screening to diagnosis, treatment, and survivorship. Throughout this protocol, the quality of evidence, based on the Oxford Centre for Evidence-Based Medicine 2011 Levels of Evidence 3 (Levels 1-5), is noted in parentheses. Recommendations Screening breastfeeding women for breast cancer Breastfeeding management in women with a history of breast cancer As breast cancer treatments may reduce lactational capacity, women with a history of breast cancer who would like

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Section: (Level 4)mentioning

confidence: 99%

Section: (Level 4)mentioning

confidence: 99%

ABM Clinical Protocol #34: Breast Cancer and Breastfeeding

Johnson

Mitchell

2020

Breastfeeding Medicine

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“…There is generally no need to stop breast feeding with other radiopharmaceuticals mentioned earlier. 28 Consultation with the nuclear physician is recommended when radionuclides are used in lactating women.…”

Section: Good Maternal Hydration and Frequent Voiding Can Resultsmentioning

confidence: 99%

Emergency Imaging in Pregnancy and Lactation

et al. 2020

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The use of diagnostic imaging studies in the emergency setting has increased dramatically over the past couple of decades. The emergency imaging of pregnant and lactating patients poses unique challenges and calls upon the crucial role of radiologists as consultants to the referring physician to guide appropriate use of imaging tests, minimize risk, ensure timely management, and occasionally alleviate unwarranted trepidation. A clear understanding of the risks and benefits involved with various imaging tests in this patient population is vital to achieve this. This review discusses the different safety and appropriateness issues that could arise with the use of ionizing radiation, iodinated-, and gadolinium-based contrast media and radiopharmaceuticals in pregnant and lactating patients. Special considerations such as trauma imaging, safety concerns with magnetic resonance imaging and ultrasound, management of claustrophobia, contrast extravasation, and allergic reactions are also reviewed. The consent process for these examinations has also been described.

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“…It is critical that breastfeeding recommendations after radiology studies are evidence based and up to date to prevent any unnecessary interruption of breastfeeding. The current recommendations about the continuation of breastfeeding after radiologic imaging studies are summarized in the Academy of Breastfeeding Clinical Protocol #31 [5]. Radiation is used to obtain images in X-ray, mammography and CT studies.…”

Section: Introductionmentioning

confidence: 99%

“…Radiation is used to obtain images in X-ray, mammography and CT studies. Radiation usage in these studies was shown to have no effect on breast milk, and the continuation of breastfeeding was recommended after these studies [5]. In iodinated contrast-enhanced CT, the systemic dose of contrast to the child is less than 0.01% of the maternal dose [5].…”

Section: Introductionmentioning

confidence: 99%

Should Breastfeeding Be Interrupted after Radiological Imaging Examinations? Evidence and Clinical Applications

Karatekin,

Şenol,

Karabayır

2024

Children

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Purpose: Breastfeeding provides optimal growth and development for infants. Lactating mothers may have challenges maintaining breastfeeding, and one of those challenges is being falsely advised to interrupt breastfeeding following radiologic studies. The aim of this study was to evaluate the knowledge, attitudes and experiences of healthcare professionals regarding breastfeeding after radiological imaging studies on lactating mothers. Method: In this cross-sectional study, an online survey consisting of 29 semi-structured questions was delivered to radiology technicians and physicians in radiology and pediatrics via social media. Mixed methods were used to analyze responses descriptively. Results: Of the 404 participants, 39% (n = 158) were radiology technicians, 31% (n = 125) were pediatricians, 11% (n = 46) were radiologists, 10% (n = 41) were pediatric residents and 8% (n = 34) were radiology residents. Of all healthcare professionals, 91% reported that breastfeeding does not need to be interrupted after ultrasound, 75% X-ray, 56% mammography, 62% non-contrast CT, 18% contrast-enhanced CT, 93% non-contrast MRI and 23% contrast-enhanced MRI. Interruption of breastfeeding was recommended more frequently after contrast-enhanced imaging studies (p < 0.01). After contrast-enhanced CT, 54% of participants recommended pumping and dumping for <24 h and 25% for 24–48 h; after contrast-enhanced MRI, these rates were found to be 57% and 20%, respectively. Of the healthcare professionals, 63% reported that their knowledge about management of breastfeeding after radiological studies was not sufficient. Conclusions: Situations requiring the interruption of breastfeeding after radiological studies are rare. However, recommendations in clinical practice vary in our country. Increasing the awareness and knowledge of healthcare professionals will prevent breastfeeding from being negatively affected.

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ABM Clinical Protocol #31: Radiology and Nuclear Medicine Studies in Lactating Women

Cited by 20 publications

References 25 publications

ABM Clinical Protocol #34: Breast Cancer and Breastfeeding

ABM Clinical Protocol #34: Breast Cancer and Breastfeeding

Emergency Imaging in Pregnancy and Lactation

Should Breastfeeding Be Interrupted after Radiological Imaging Examinations? Evidence and Clinical Applications

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