Effect of antenatal iodinated contrast agent on neonatal thyroid function

Rajaram, Shalini; Exley, Catherine; Fairlie, Fiona; Matthews, S.

doi:10.1259/bjr/29806327

Cited by 42 publications

(20 citation statements)

References 31 publications

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“…Iodinated contrast crosses the placenta into the fetal circulation and is excreted through the kidneys into the amniotic fluid. 44,51,52 Studies of LOCM have demonstrated negligible risk of inducing neonatal hypothyroidism, 44,[53][54][55] and animal testing of LOCM has revealed no evidence of mutagenic or teratogenic effects, but no well-controlled studies in pregnant women have been performed. 44 For ethical reasons, such studies are unlikely.…”

Section: Administration Of Iodinated Contrast To Pregnant Womenmentioning

confidence: 99%

Neuroimaging in Pregnant Women

Chansakul

Young

2017

Semin Neurol

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Choosing the most appropriate diagnostic neuroimaging study for a pregnant woman involves assessing the pretest likelihood of serious treatable neurologic disease, the diagnostic utility of various available computed tomography (CT) and magnetic resonance (MR) modalities, and the risks of each. Of these three elements-pretest differential diagnosis, utility of MRI and CT, and risks of MR and CT-the risk component is perhaps the least well understood by most physicians. We provide a basic review of the intrinsic risks of MRI and CT, particularly radiation biology and radiation safety, as well as the risks pertaining to the use of contrast agents, to reduce provider confusion and anxiety and improve quality, safety, and efficiency of neuroimaging diagnosis in pregnant patients. We believe that a better understanding of the associated very low risks with mother and fetus will reassure the reader that CT remains the most appropriate tool for initial rapid diagnosis of acute neurological conditions in pregnancy and that in urgent situations CT should not be withheld or delayed due to exaggerated concern about radiation. Noncontrast MRI, while not without risk, is generally considered safe in pregnancy, as no evidence of fetal adverse effects has been demonstrated to date. Iodinated CT contrast agents are likely safer than gadolinium-based MRI contrast agents because of gadolinium accumulation in the amniotic fluid and fetal tissue, although no harmful effects of tissue gadolinium accumulation are known. In most but not all pregnant patients presenting with a new or worsening neurological abnormality, the risks intrinsic to the disease will outweigh the risks of imaging. In an individual patient, the pretest probability of serious treatable disease and acuity of presentation will usually suggest an optimal imaging strategy and choice of test. This optimal strategy will also depend on the immediate availability and level of sophistication of the scanners, software, technologists, and radiologists. As such, the standard of care for imaging in pregnancy requires direct consultation between the referring clinician and radiologist to determine the most appropriate strategy and brief documentation of the resulting consensus risk-benefit assessment.

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Section: Administration Of Iodinated Contrast To Pregnant Womenmentioning

confidence: 99%

Neuroimaging in Pregnant Women

Chansakul

Young

2017

Semin Neurol

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“…No eff ect on foetal thyroid function has ever been reported, but a theoretical risk of iodine-induced neonatal hypothyroidism remains [49,89,96,97]. Although it is standard practice to screen all neonates for hypothyroidism, this test is particularly important in neonates born to women who re- Table IV.…”

Section: Iodinated Contrast Agentsmentioning

confidence: 99%

Diagnosis of pregnancy-associated venous thromboembolism - position paper of the Working Group in Women’s Health of the Society of Thrombosis and Haemostasis (GTH)

Linnemann¹,

Scholz

Rott

et al. 2016

Vasa

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EpidemiologyVTE is a leading cause of maternal morbidity in the developed world and, in the case of PE, of mortality as well [1]. While the relative risk of VTE is greatly increased during pregnancy compared with that in non-pregnant women, the absolute risk remains low: estimates of the incidence of pregnancy-associated VTE have varied from 1:500 to 1:1500 pregnancies [2 -7]. The risk of VTE is approximately 5-fold greater in pregnant women than in non-pregnant women.Approximately 80 % of pregnancy-associated VTEs are isolated DVTs, and approximately 20 % are PEs or both DVTs and PEs [5]. Although a systematic review reported weighted event rates for DVT of 21.9 %, 33.7 % and 47.6 % for the fi rst, second and third trimesters, respectively [6], a recent study suggested that the risk might in fact increase exponentially over the duration of the pregnancy [7], with 12.4 % of VTEs diagnosed in the fi rst trimester, 15.3 % in the second trimester and 72.3 % in the third trimester. This detailed risk assessment for each gestational week demonstrated a 21-fold increased risk for the last two weeks before delivery [7]. Summary: Pregnancy and the postpartum period are associated with an increased risk of venous thromboembolism (VTE). Over the past decade, new diagnostic algorithms have been established, combining clinical probability, laboratory testing and imaging studies for the diagnosis of deep vein thrombosis (DVT) and pulmonary embolism (PE) in the non-pregnant population. However, there is no such generally accepted algorithm for the diagnosis of pregnancy-associated VTE. Studies establishing clinical prediction rules have excluded pregnant women, and prediction scores currently in use have not been prospectively validated in pregnancy or during the postpartum period. D-dimers physiologically increase throughout pregnancy and peak at delivery, so a negative D-dimer test result, based on the reference values of non-pregnant subjects, becomes unlikely in the second and third trimesters. Imaging studies therefore play a major role in confi rming suspected DVT or PE in pregnant women. Major concerns have been raised against radiologic imaging because of foetal radiation exposure, and doubts about the diagnostic value of ultrasound techniques in attempting to exclude isolated iliac vein thrombosis grow stronger as pregnancy progresses. As members of the Working Group in Women's Health of the Society of Thrombosis and Haemostasis (GTH), we summarise evidence from the available literature and aim to establish a more uniform strategy for diagnosing pregnancy-associated VTE. Review Diagnosis of pregnancy-associated

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“…If this screening is performed, no extra attention is felt to be necessary for cases of intravenous administration of iodinated, water-soluble contrast agents at routine clinical doses during pregnancy. 24 28 29 In countries without routine screening for hypothyroidism, an extra test should be performed during the first week of life if an iodinated contrast agent was administered to the mother during pregnancy. A general rule for the imaging strategy in a pregnant patient is to intravenously administer the iodinated contrast agent for an examination that would also be performed with contrast agent if the patient was not pregnant.…”

Section: Imaging Modalitiesmentioning

confidence: 99%