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Tembelis M, Blumberg G, Colon-Flores L, Hong J, Hoffmann JC, Katz DS. Potpourri of Contrast Controversies and Myths: Where Is the Actual Evidence? Radiol Clin North Am 2024; 62:971-978. [PMID: 39393855 DOI: 10.1016/j.rcl.2024.04.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/13/2024]
Abstract
There are many misconceptions related to the usage of intravenous contrast agents for medical imaging. These misconceptions can affect patient care, as they can lead to nonoptimal examination usage. Knowledge of the current contrast-related misconceptions can help radiologists provide higher quality care to their patients.
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Affiliation(s)
- Miltiadis Tembelis
- Department of Radiology, NYU Grossman Long Island School of Medicine, NYU Langone Hospital - Long Island, 259 First Street, Mineola, NY 11501, USA.
| | - Gregg Blumberg
- Department of Radiology, NYU Grossman Long Island School of Medicine, NYU Langone Hospital - Long Island, 259 First Street, Mineola, NY 11501, USA
| | - Luis Colon-Flores
- Department of Radiology, NYU Grossman Long Island School of Medicine, NYU Langone Hospital - Long Island, 259 First Street, Mineola, NY 11501, USA
| | - Julie Hong
- Department of Surgery, New York-Presbyterian Queens Hospital, Flushing, NY, USA
| | - Jason C Hoffmann
- Department of Radiology, NYU Grossman Long Island School of Medicine, NYU Langone Hospital - Long Island, 259 First Street, Mineola, NY 11501, USA
| | - Douglas S Katz
- Department of Radiology, NYU Grossman Long Island School of Medicine, NYU Langone Hospital - Long Island, 259 First Street, Mineola, NY 11501, USA
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2
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Lyons JG, Shinde MU, Maro JC, Petrone A, Cosgrove A, Kempner ME, Andrade SE, Mwidau J, Stojanovic D, Hernández-Muñoz JJ, Toh S. Use of the Sentinel System to Examine Medical Product Use and Outcomes During Pregnancy. Drug Saf 2024; 47:931-940. [PMID: 38940904 DOI: 10.1007/s40264-024-01447-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/15/2024] [Indexed: 06/29/2024]
Abstract
While many pregnant individuals use prescription medications, evidence supporting product safety during pregnancy is often inadequate. Existing electronic healthcare data sources provide large, diverse samples of health plan members to allow for the study of medical product utilization during pregnancy, as well as pregnancy, maternal, and infant outcomes. The Sentinel System is a national medical product surveillance system that includes administrative claims and electronic health record databases from large national and regional health insurers. In addition to these data sources, Sentinel develops and maintains a sizeable selection of analytic tools to facilitate epidemiologic analyses in a way that protects patient privacy and health system autonomy. In this article, we provide an overview of Sentinel System infrastructure, including the Mother-Infant Linkage Table, parameterizable analytic tools, and algorithms to estimate gestational age and identify pregnancy outcomes. We also describe past and future Sentinel work that contributes to our understanding of the way medical products are used and the safety of these products during pregnancy.
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Affiliation(s)
- Jennifer G Lyons
- Division of Therapeutics Research and Infectious Disease Epidemiology, Department of Population Medicine, Harvard Medical School, Harvard Pilgrim Health Care Institute, 401 Park Drive, Suite 401 East, Boston, MA, 02215, USA.
| | - Mayura U Shinde
- Division of Therapeutics Research and Infectious Disease Epidemiology, Department of Population Medicine, Harvard Medical School, Harvard Pilgrim Health Care Institute, 401 Park Drive, Suite 401 East, Boston, MA, 02215, USA
| | - Judith C Maro
- Division of Therapeutics Research and Infectious Disease Epidemiology, Department of Population Medicine, Harvard Medical School, Harvard Pilgrim Health Care Institute, 401 Park Drive, Suite 401 East, Boston, MA, 02215, USA
| | - Andrew Petrone
- Division of Therapeutics Research and Infectious Disease Epidemiology, Department of Population Medicine, Harvard Medical School, Harvard Pilgrim Health Care Institute, 401 Park Drive, Suite 401 East, Boston, MA, 02215, USA
| | - Austin Cosgrove
- Division of Therapeutics Research and Infectious Disease Epidemiology, Department of Population Medicine, Harvard Medical School, Harvard Pilgrim Health Care Institute, 401 Park Drive, Suite 401 East, Boston, MA, 02215, USA
| | - Maria E Kempner
- Division of Therapeutics Research and Infectious Disease Epidemiology, Department of Population Medicine, Harvard Medical School, Harvard Pilgrim Health Care Institute, 401 Park Drive, Suite 401 East, Boston, MA, 02215, USA
| | - Susan E Andrade
- Division of Therapeutics Research and Infectious Disease Epidemiology, Department of Population Medicine, Harvard Medical School, Harvard Pilgrim Health Care Institute, 401 Park Drive, Suite 401 East, Boston, MA, 02215, USA
| | - Jamila Mwidau
- Office of Surveillance and Epidemiology, Center for Drug Evaluation and Research, US Food and Drug Administration, Silver Spring, MD, USA
| | - Danijela Stojanovic
- Office of Surveillance and Epidemiology, Center for Drug Evaluation and Research, US Food and Drug Administration, Silver Spring, MD, USA
| | - José J Hernández-Muñoz
- Office of Surveillance and Epidemiology, Center for Drug Evaluation and Research, US Food and Drug Administration, Silver Spring, MD, USA
| | - Sengwee Toh
- Division of Therapeutics Research and Infectious Disease Epidemiology, Department of Population Medicine, Harvard Medical School, Harvard Pilgrim Health Care Institute, 401 Park Drive, Suite 401 East, Boston, MA, 02215, USA
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Varotto L, Spigolon L, Dotto A, Leonardi D, Bragantini G, Cerrito LF, Deluca C, Hoxha A. Myocardial Involvement in Catastrophic Antiphospholipid Syndrome during Pregnancy or Puerperium: A Case of a Young Breastfeeding Woman and Literature Review. J Clin Med 2024; 13:4732. [PMID: 39200874 PMCID: PMC11355751 DOI: 10.3390/jcm13164732] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2024] [Revised: 07/27/2024] [Accepted: 07/27/2024] [Indexed: 09/02/2024] Open
Abstract
Catastrophic Antiphospholipid Syndrome (CAPS) is a rare complication that can occur in patients with Antiphospholipid Syndrome (APS). CAPS occurs even more rarely during pregnancy/puerperium and pregnant patients, even less likely to show cardiac involvement without signs of damage on ultrasound and angiography with non-obstructive coronary arteries. We present a case of a 26-year-old breastfeeding woman, the youngest described with CAPS and acute myocardial infarction, whose diagnosis was made with cardiac magnetic resonance imaging (CMRI). A literature review of pregnant patients with similar problems was performed. There are diagnostic and therapeutic difficulties in treating these patients. CMRI demonstrated a transmural late enhancement area. A combination of therapies led to rapid clinical improvement. CMRI is an underused tool that reaffirms the pathophysiology of CAPS and leads clinicians to the possibility of a diffuse thrombotic process. CAPS involves more organs with high mortality rates. CMRI could be optimized in order to reach an early diagnosis and the most effective treatment. This study provides real-world evidence of the feasibility of MRI in a primary care setting during pregnancy/puerperium. Evidence from this study may influence future APS screening and inform policymakers regarding the use of leading MRI technology in the detection of the thrombotic process in a primary care setting.
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Affiliation(s)
- Leonardo Varotto
- Department of Cardiology, San Bortolo Hospital, viale Rodolfi 37, 36100 Vicenza, Italy; (G.B.); (L.F.C.)
| | - Luca Spigolon
- Department of Radiology, San Bortolo Hospital, Viale Rodolfi 37, 36100 Vicenza, Italy;
| | - Alberto Dotto
- Department of Medicine—Division of Cardiology, University of Verona, Piazzale A. Stefani 1, 37126 Verona, Italy; (A.D.); (D.L.)
| | - Denis Leonardi
- Department of Medicine—Division of Cardiology, University of Verona, Piazzale A. Stefani 1, 37126 Verona, Italy; (A.D.); (D.L.)
| | - Giulia Bragantini
- Department of Cardiology, San Bortolo Hospital, viale Rodolfi 37, 36100 Vicenza, Italy; (G.B.); (L.F.C.)
| | - Luca Felice Cerrito
- Department of Cardiology, San Bortolo Hospital, viale Rodolfi 37, 36100 Vicenza, Italy; (G.B.); (L.F.C.)
| | - Cristina Deluca
- Department of Neurology, San Bortolo Hospital, Viale Rodolfi 37, 36100 Vicenza, Italy;
| | - Ariela Hoxha
- Internal Medicine Unit, Thrombotic and Hemorrhagic Diseases Unit, Department of Medicine, University of Padua, via Giustiniani 2, 35128 Padova, Italy;
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George E, Jaimes C, Xu D, Kasprian G, Glenn OA. How to Perform Fetal MR Imaging. Magn Reson Imaging Clin N Am 2024; 32:443-457. [PMID: 38944433 DOI: 10.1016/j.mric.2024.02.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/01/2024]
Abstract
This article provides the readers with practical guidance on how to perform fetal MR imaging, including technical considerations such as scanner field strength and use of appropriate radiofrequency receive coils, and summarizes the role, strengths, and limitations of the various MR imaging sequences. The authors review the various factors to consider in scan preparation, including study indication, timing, maternal preparation, and the creation of an institutional fetal imaging protocol. Additional factors that go into scan optimization during acquisition including prioritizing maternal comfort and ways to troubleshoot various artifacts that maybe encountered in fetal imaging are discussed.
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Affiliation(s)
- Elizabeth George
- Department of Radiology and Biomedical Imaging, University of California, 505 Parnassus Avenue, San Francisco, CA 94143, USA.
| | - Camilo Jaimes
- Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA
| | - Duan Xu
- Department of Radiology and Biomedical Imaging, University of California, 1700 4th Street BH303B, San Francisco, CA 94143, USA
| | - Gregor Kasprian
- Division of Neuroradiology, Department of Radiology and Biomedical Imaging, Medical University of Vienna, Währinger Gürtel 18-21, Vienna 1090, Austria
| | - Orit A Glenn
- Department of Radiology and Biomedical Imaging, University of California, 505 Parnassus Avenue, San Francisco, CA 94143, USA
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Saliba T, Preziosi M, Simoni P, De Leucio A. Fibromatosis Colli: A Thorough Description of Its MRI Characteristics and a Review of the Literature. J Belg Soc Radiol 2024; 108:51. [PMID: 38737379 PMCID: PMC11086591 DOI: 10.5334/jbsr.3270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Accepted: 04/26/2024] [Indexed: 05/14/2024] Open
Abstract
Introduction Fibromatosis colli (FC) is a rare pseudotumor of the sternocleidomastoid muscle with an incidence of 0.4%, generally diagnosed using ultrasound between 2 and 4 weeks of age. This is an important entity considering the clinical concerns it causes due to its appearance as a cervical mass with torticollis. Few magnetic resonance imaging (MRI) descriptions of its appearance have been made, with the existing reported cases being sporadic. We aim to provide a thorough description of this paediatric entity. Materials and Methods We conducted a retrospective study by searching our hospital's database for previous cases of FC where an MRI had been performed. We found six cases of FC where an MRI had been performed. Of these cases, five out of six were contrast-enhanced. We examined the MRIs to be able to discern and describe the MRI characteristics of FC. Results We found that FC presents a T1 signal isointense to the muscle, a T2 signal hyperintense to the muscle, a variable diffusion signal and a thick enhancing peripheral ring after contrast administration. Discussion Our results match what has been reported in the literature to date regarding the MRI signal of FC, confirming previous reports. However, we provide new data regarding the characteristic appearance post-enhancement, which was previously unreported. Conclusion The MRI characteristics of FC have rarely been described, with only a few isolated case reports in the medical literature. We review the current literature, describe the key MRI characteristics of the pathology, and provide the most thorough description to date.
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Affiliation(s)
- Thomas Saliba
- Queen Fabiola Children’s University Hospital, Av. Jean Joseph Crocq 15, 1020 Brussels, Belgium
| | - Marco Preziosi
- Queen Fabiola Children’s University Hospital, Av. Jean Joseph Crocq 15, 1020 Brussels, Belgium
| | - Paolo Simoni
- Queen Fabiola Children’s University Hospital, Av. Jean Joseph Crocq 15, 1020 Brussels, Belgium
| | - Alessandro De Leucio
- Queen Fabiola Children’s University Hospital, Av. Jean Joseph Crocq 15, 1020 Brussels, Belgium
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Rovira À, Doniselli FM, Auger C, Haider L, Hodel J, Severino M, Wattjes MP, van der Molen AJ, Jasperse B, Mallio CA, Yousry T, Quattrocchi CC. Use of gadolinium-based contrast agents in multiple sclerosis: a review by the ESMRMB-GREC and ESNR Multiple Sclerosis Working Group. Eur Radiol 2024; 34:1726-1735. [PMID: 37658891 DOI: 10.1007/s00330-023-10151-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Revised: 07/06/2023] [Accepted: 07/12/2023] [Indexed: 09/05/2023]
Abstract
Magnetic resonance imaging (MRI) is the most sensitive technique for detecting inflammatory demyelinating lesions in multiple sclerosis (MS) and plays a crucial role in diagnosis and monitoring treatment effectiveness, and for predicting the disease course. In clinical practice, detection of MS lesions is mainly based on T2-weighted and contrast-enhanced T1-weighted sequences. Contrast-enhancing lesions (CEL) on T1-weighted sequences are related to (sub)acute inflammation, while new or enlarging T2 lesions reflect the permanent footprint from a previous acute inflammatory demyelinating event. These two types of MRI features provide redundant information, at least in regular monitoring of the disease. Due to the concern of gadolinium deposition after repetitive injections of gadolinium-based contrast agents (GBCAs), scientific organizations and regulatory agencies in Europe and North America have proposed that these contrast agents should be administered only if clinically necessary. In this article, we provide data on the mode of action of GBCAs in MS, the indications of the use of these agents in clinical practice, their value in MS for diagnostic, prognostic, and monitoring purposes, and their use in specific populations (children, pregnant women, and breast-feeders). We discuss imaging strategies that achieve the highest sensitivity for detecting CELs in compliance with the safety regulations established by different regulatory agencies. Finally, we will briefly discuss some alternatives to the use of GBCA for detecting blood-brain barrier disruption in MS lesions. CLINICAL RELEVANCE STATEMENT: Although use of GBCA at diagnostic workup of suspected MS is highly valuable for diagnostic and prognostic purposes, their use in routine monitoring is not mandatory and must be reduced, as detection of disease activity can be based on the identification of new or enlarging lesions on T2-weighted images. KEY POINTS: • Both the EMA and the FDA state that the use of GBCA in medicine should be restricted to clinical scenarios in which the additional information offered by the contrast agent is required. • The use of GBCA is generally recommended in the diagnostic workup in subjects with suspected MS and is generally not necessary for routine monitoring in clinical practice. • Alternative MRI-based approaches for detecting acute focal inflammatory MS lesions are not yet ready to be used in clinical practice.
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Affiliation(s)
- Àlex Rovira
- Section of Neuroradiology, Department of Radiology, University Hospital Vall d'Hebron, Autonomous University of Barcelona, Barcelona, Spain.
| | - Fabio M Doniselli
- Neuroradiology Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Cristina Auger
- Section of Neuroradiology, Department of Radiology, University Hospital Vall d'Hebron, Autonomous University of Barcelona, Barcelona, Spain
| | - Lukas Haider
- Department of Biomedical Imaging and Image Guided Therapy, Medical University of Vienna, Vienna, Austria
- Queen Square Multiple Sclerosis Centre, Department of Neuroinflammation, UCL Queen Square Institute of Neurology, University College London, London, UK
| | - Jerome Hodel
- Department of Radiology, Groupe Hospitalier Paris-Saint Joseph, Paris, France
| | | | - Mike P Wattjes
- Department of Diagnostic and Interventional Neuroradiology, Hannover Medical School, Hannover, Germany
| | | | - Bas Jasperse
- Department of Radiology and Nuclear Medicine, MS Center Amsterdam, Amsterdam University Medical Center, Amsterdam, Netherlands
| | - Carlo A Mallio
- Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy
- Research Unit of Radiology, Department of Medicine and Surgery, Università Campus Bio-Medico Di Roma, Rome, Italy
| | - Tarek Yousry
- Lysholm Department of Neuroradiology, UCLH National Hospital for Neurology and Neurosurgery, Neuroradiological Academic Unit, UCL Institute of Neurology, London, UK
| | - Carlo C Quattrocchi
- Centre for Medical Sciences CISMed, University of Trento, Trento, Italy
- Radiology, Multizonal Unit of Rovereto and Arco, APSS Provincia Autonoma Di Trento, Trento, Italy
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Winterstein AG, Wang Y, Smolinski NE, Thai TN, Ewig C, Rasmussen SA. Prenatal Care Initiation and Exposure to Teratogenic Medications. JAMA Netw Open 2024; 7:e2354298. [PMID: 38300617 PMCID: PMC10835507 DOI: 10.1001/jamanetworkopen.2023.54298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2023] [Accepted: 12/11/2023] [Indexed: 02/02/2024] Open
Abstract
Importance With new legal abortion restrictions, timing of prenatal care initiation is critical to allow for discussion of reproductive options among pregnancies exposed to teratogenic medications. Objective To investigate the prevalence of prenatal exposure to teratogenic medications and prenatal care initiation across gestational weeks. Design, Setting, and Participants This descriptive, population-based cross-sectional study used health encounter data from a national sample of individuals with employer-sponsored health insurance. A validated algorithm identified pregnancies among persons identifying as female that ended with a live or nonlive outcome between January 2017 and December 2019. Data were analyzed from December 2022 to December 2023. Exposures Prenatal exposure to any of 137 teratogenic medications, measured via pharmacy and medical claims. Measurement of prenatal care initiation was adapted from the Children's Health Care Quality Measures. Main Outcomes and Measures Prevalence of prenatal exposure to teratogens and prenatal care initiation by gestational week. Timing of prenatal teratogenic exposure was compared with timing of prenatal care initiation and legal abortion cutoffs. Results Among 639 994 pregnancies, 472 472 (73.8%; 95% CI, 73.7%-73.9%) had a live delivery (mean [SD] age, 30.9 [5.4] years) and 167 522 (26.2%; 95% CI, 26.1%-26.3%) had a nonlive outcome (mean [SD] age, 31.6 [6.4] years). Of pregnancies with live deliveries, 5.8% (95% CI, 5.7%-5.8%) were exposed to teratogenic medications compared with 3.1% (95% CI, 3.0%-3.2%) with nonlive outcomes. Median time to prenatal care was 56 days (IQR, 44-70 days). By 6 weeks' gestation, 8186 pregnancies had been exposed to teratogenic medications (25.2% [95% CI, 24.7%-25.7%] of pregnancies exposed at any time during gestation; 1.3% [95% CI, 1.3%-1.3%] of all pregnancies); in 6877 (84.0%; 95% CI, 83.2%-84.8%), prenatal care was initiated after 6 weeks or not at all. By 15 weeks, teratogenic exposures had occurred for 48.9% (95% CI, 48.4%-49.5%) of all teratogen-exposed pregnancies (2.5% [2.4-2.5] of all pregnancies); prenatal care initiation occurred after 15 weeks for 1810 (16.8%; 95% CI, 16.1%-17.5%) with live deliveries and 2975 (58.3%; 95% CI, 56.9%-59.6%) with nonlive outcomes. Teratogenic medications most used within the first 15 gestational weeks among live deliveries included antiinfectives (eg, fluconazole), anticonvulsants (eg, valproate), antihypertensives (eg, lisinopril), and immunomodulators (eg, mycophenolate). For nonlive deliveries, most antihypertensives were replaced by vitamin A derivatives. Conclusions and Relevance In this cross-sectional study, most exposures to teratogenic medications occurred in early pregnancy and before prenatal care initiation, precluding prenatal risk-benefit assessments. Prenatal care commonly occurred after strict legal abortion cutoffs, prohibiting consideration of pregnancy termination if concerns about teratogenic effects arose.
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Affiliation(s)
- Almut G. Winterstein
- Pharmaceutical Outcomes & Policy, College of Pharmacy, University of Florida, Gainesville
- Center for Drug Evaluation and Safety, University of Florida, Gainesville
- Epidemiology, University of Florida, Gainesville
| | - Yanning Wang
- Pharmaceutical Outcomes & Policy, College of Pharmacy, University of Florida, Gainesville
- Health Outcomes & Biomedical Informatics, University of Florida, Gainesville
| | - Nicole E. Smolinski
- Pharmaceutical Outcomes & Policy, College of Pharmacy, University of Florida, Gainesville
- Center for Drug Evaluation and Safety, University of Florida, Gainesville
| | - Thuy N. Thai
- Pharmaceutical Outcomes & Policy, College of Pharmacy, University of Florida, Gainesville
- Center for Drug Evaluation and Safety, University of Florida, Gainesville
- Faculty of Pharmacy, HUTECH University, Ho Chi Minh City, Vietnam
| | - Celeste Ewig
- Pharmaceutical Outcomes & Policy, College of Pharmacy, University of Florida, Gainesville
- Center for Drug Evaluation and Safety, University of Florida, Gainesville
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Wang Y, Smolinski NE, Thai TN, Sarayani A, Ewig C, Rasmussen SA, Winterstein AG. Common teratogenic medication exposures-a population-based study of pregnancies in the United States. Am J Obstet Gynecol MFM 2024; 6:101245. [PMID: 38061552 DOI: 10.1016/j.ajogmf.2023.101245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Revised: 11/21/2023] [Accepted: 11/27/2023] [Indexed: 12/25/2023]
Abstract
BACKGROUND Risk mitigation for most teratogenic medications relies on risk communication via drug label, and prenatal exposures remain common. Information on the types of and risk factors for prenatal exposures to medications with teratogenic risk can guide strategies to reduce exposure. OBJECTIVE This study aimed to identify medications with known or potential teratogenic risk commonly used during pregnancy among privately insured persons. STUDY DESIGN We used the Merative™ MarketScan® Commercial Database to identify pregnancies with live or nonlive (ectopic pregnancies, spontaneous and elective abortions, stillbirths) outcomes among persons aged 12 to 55 years from 2011 to 2018. Start/end dates of medication exposure and pregnancy outcomes were identified via an adapted algorithm based on validation studies. We required continuous health plan enrollment from 90 days before conception until 30 days after the pregnancy end date. Medications with known or potential teratogenic risk were selected from TERIS (Teratogen Information System) and drug monographs based on the level of risk and quality of evidence (138 with known and 60 with potential risk). We defined prenatal exposure on the basis of ≥1 outpatient pharmacy claim or medical encounter for medication administration during target pregnancy periods considering medication risk profiles (eg, risk only in the first trimester or at a certain dose threshold). Sex hormones and hormone analogs, and abortion and postpartum/abortion hemorrhage treatments were not considered as teratogenic medications because of challenges in separating pregnancy-related indications, nor were opioids (because of complex risk-benefit considerations) or antiobesity medications if their only teratogenic mechanism was weight loss. RESULTS Among all pregnancies, the 10 medications with known teratogenic risk and the highest prenatal exposures were sulfamethoxazole/trimethoprim (1988 per 100,000 pregnancy-years), high-dose fluconazole (1248), topiramate (351), lisinopril (144), warfarin (57), losartan (56), carbamazepine (50), valproate (49), vedolizumab (28 since 2015), and valsartan (25). Prevalence of exposure to sulfamethoxazole/trimethoprim decreased from 2346 to 1453 per 100,000 pregnancy-years from 2011 to 2018, but prevalence of exposure to vedolizumab increased 6-fold since its approval in 2015. Prenatal exposures in the first trimester were higher among nonlive pregnancies than among live-birth pregnancies, with the largest difference observed for warfarin (nonlive 370 vs live birth 78), followed by valproate (258 vs 86) and topiramate (1728 vs 674). Prenatal exposures to medications with potential teratogenic risk were most prevalent for low-dose fluconazole (6495), metoprolol (1325), and atenolol (448). The largest first-trimester exposure differences between nonlive and live-birth pregnancies were observed for lithium (242 vs 89), gabapentin (1639 vs 653), and duloxetine (1914 vs 860). Steady increases in hydralazine and gabapentin exposures were observed during the study years, whereas atenolol exposure decreased (561 to 280). CONCLUSION Several medications with teratogenic risk for which there are potentially safer alternatives continue to be used during pregnancy. The fluctuating rates of prenatal exposure observed for select teratogenic medications suggest that regular reevaluation of risk mitigation strategies is needed. Future research focusing on understanding the clinical context of medication use is necessary to develop effective strategies for reducing exposures to medications with teratogenic risk during pregnancy.
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Affiliation(s)
- Yanning Wang
- Department of Pharmaceutical Outcomes and Policy, College of Pharmacy, University of Florida, Gainesville, FL (Ms Wang and Drs Smolinski, Thai, Sarayani, Ewig, and Winterstein); Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida, Gainesville, FL (Ms Wang)
| | - Nicole E Smolinski
- Department of Pharmaceutical Outcomes and Policy, College of Pharmacy, University of Florida, Gainesville, FL (Ms Wang and Drs Smolinski, Thai, Sarayani, Ewig, and Winterstein)
| | - Thuy Nhu Thai
- Department of Pharmaceutical Outcomes and Policy, College of Pharmacy, University of Florida, Gainesville, FL (Ms Wang and Drs Smolinski, Thai, Sarayani, Ewig, and Winterstein); Faculty of Pharmacy, Ho Chi Minh City University of Technology, Ho Chi Minh City, Vietnam (Dr Thai)
| | - Amir Sarayani
- Department of Pharmaceutical Outcomes and Policy, College of Pharmacy, University of Florida, Gainesville, FL (Ms Wang and Drs Smolinski, Thai, Sarayani, Ewig, and Winterstein)
| | - Celeste Ewig
- Department of Pharmaceutical Outcomes and Policy, College of Pharmacy, University of Florida, Gainesville, FL (Ms Wang and Drs Smolinski, Thai, Sarayani, Ewig, and Winterstein)
| | - Sonja A Rasmussen
- Department of Genetic Medicine, Johns Hopkins University School of Medicine, Baltimore, MD (Dr Rasmussen)
| | - Almut G Winterstein
- Department of Pharmaceutical Outcomes and Policy, College of Pharmacy, University of Florida, Gainesville, FL (Ms Wang and Drs Smolinski, Thai, Sarayani, Ewig, and Winterstein); Department of Epidemiology, College of Medicine and College of Public Health and Health Professions, University of Florida, Gainesville, FL (Dr Winterstein); Center for Drug Evaluation and Safety (CoDES), University of Florida, Gainesville, FL (Dr Winterstein).
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9
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Jiang W, Chen W. Safety concerns related to prenatal exposure to gadolinium magnetic resonance imaging. Am J Obstet Gynecol 2023; 229:699. [PMID: 37544350 DOI: 10.1016/j.ajog.2023.08.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Accepted: 08/01/2023] [Indexed: 08/08/2023]
Affiliation(s)
- Wen Jiang
- Department of Obstetrics and Gynecology, West China Second University Hospital, Sichuan University, Chengdu, China; Key Laboratory of Birth Defects and Related Diseases of Women and Children of the Ministry of Education, West China Second University Hospital, Sichuan University, Chengdu, China
| | - Wei Chen
- West China Biomedical Big Data Center, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, China.
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10
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Winterstein AG, Rasmussen SA. Trade-offs in safety study design decisions on teratogenic gadolinium effects. Am J Obstet Gynecol 2023; 229:699-700. [PMID: 37544348 DOI: 10.1016/j.ajog.2023.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Accepted: 08/01/2023] [Indexed: 08/08/2023]
Affiliation(s)
- Almut G Winterstein
- Department of Pharmaceutical Outcomes and Policy, College of Pharmacy, University of Florida, 1225 Center Dr., HPNP Building, Gainesville, FL 32610; Department of Epidemiology, College of Medicine and College of Public Health and Health Professions, University of Florida, Gainesville, FL; Center for Drug Evaluation and Safety (CoDES), University of Florida, Gainesville, FL.
| | - Sonja A Rasmussen
- Department of Genetic Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
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Maralani PJ, Pai V, Ertl-Wagner BB. Safety of Magnetic Resonance Imaging in Pregnancy. RADIOLOGIE (HEIDELBERG, GERMANY) 2023; 63:34-40. [PMID: 37747489 DOI: 10.1007/s00117-023-01207-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 08/24/2023] [Indexed: 09/26/2023]
Abstract
Magnetic resonance imaging is being increasingly used to diagnose and follow up a variety of medical conditions in pregnancy, both for maternal and fetal indications. However, limited data regarding its safe use in pregnancy may be a source of anxiety and avoidance for both patients and their healthcare providers. In this review, we critically discuss the main safety concerns of Magnetic Resonance Imaging (MRI) in pregnancy including energy deposition, acoustic noise, and use of contrast agents, supported by data from animal and human studies. Use of maternal sedatives and concerns related to occupational exposure in pregnant personnel are also addressed. Exposure to gadolinium-based contrast agents and sedation for MRI during pregnancy should be avoided whenever feasible.
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Affiliation(s)
- Pejman Jabehdar Maralani
- Department of Medical Imaging, Sunnybrook Health Sciences Centre, Bayview Avenue, Room AG270C, 2075, Toronto, Ontario, Canada.
| | - Vivek Pai
- Department of Medical Imaging, University of Toronto, The Hospital for Sick Children, 555 University Ave, M5G 1X8, Toronto, ON, Canada
| | - Birgit B Ertl-Wagner
- Department of Medical Imaging, University of Toronto, The Hospital for Sick Children, 555 University Ave, M5G 1X8, Toronto, ON, Canada
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Coyte RM, Darrah T, Olesik J, Barrett E, O'Connor TG, Brunner J, Love T, Perez-D'Gregorio R, Wang HZ, Aleksunes LM, Buckley B, Doherty C, Miller RK. Gadolinium during human pregnancy following administration of gadolinium chelate before pregnancy. Birth Defects Res 2023; 115:1264-1273. [PMID: 37334869 DOI: 10.1002/bdr2.2209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Revised: 05/18/2023] [Accepted: 05/31/2023] [Indexed: 06/21/2023]
Abstract
Gadolinium (Gd), a toxic rare earth element, has been shown to dissociate from chelating agents and bioaccumulate within tissues, raising concerns about the possibility of their remobilization during pregnancy with subsequent free Gd exposures to developing fetuses. Gd chelates are among the most commonly used magnetic resonance imaging (MRI) contrast agents. This investigation was undertaken after the detection of elevated Gd (800-1000× higher than the usual rare earth element levels) in preliminary unpublished studies from the placentae of subjects in the NIH ECHO/UPSIDE Rochester Cohort Study and unpublished studies from placentae analyzed in formalin-fixed placental specimens from Surgical Pathology at the University of Rochester. Fifteen pregnancies with elevated Gd were studied (12 first pregnancies and 3 second pregnancies). Maternal bloods were collected from all three trimesters, maternal, and cord (fetal) bloods at delivery as well as placental tissue. Breastmilk was also collected from selected mothers. It was determined that Gd was present in maternal bloods from all three trimesters, and in cord bloods and breastmilk in both first and second pregnancies. These results emphasize the need to fully appreciate the implications of pre-pregnancy exposure to Gd chelates and its potential effects on maternal and fetal health.
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Affiliation(s)
- Rachel M Coyte
- School of Earth Sciences, The Ohio State University, Columbus, Ohio, USA
| | - Thomas Darrah
- School of Earth Sciences, The Ohio State University, Columbus, Ohio, USA
- Global Water Institute, The Ohio State University, Columbus, Ohio, USA
| | - John Olesik
- School of Earth Sciences, The Ohio State University, Columbus, Ohio, USA
| | - Emily Barrett
- Department of Obstetrics and Gynecology, University of Rochester School of Medicine and Dentistry, Rochester, New York, USA
- Department of Biostatistics and Epidemiology, Rutgers School of Public Health; Environmental and Occupational Health Sciences Institute, Piscataway, New Jersey, USA
| | - Thomas G O'Connor
- Department of Obstetrics and Gynecology, University of Rochester School of Medicine and Dentistry, Rochester, New York, USA
- Department of Psychiatry, University of Rochester, School of Medicine and Dentistry, Rochester, New York, USA
- Department of Neuroscience, University of Rochester, School of Medicine and Dentistry, Rochester, New York, USA
| | - Jessica Brunner
- Department of Obstetrics and Gynecology, University of Rochester School of Medicine and Dentistry, Rochester, New York, USA
| | - Tanzy Love
- Department of Biostatistics and Computational Biology, University of Rochester, Rochester, New York, USA
| | - Rogelio Perez-D'Gregorio
- Department of Obstetrics and Gynecology, University of Rochester School of Medicine and Dentistry, Rochester, New York, USA
| | - Henry Z Wang
- Department of Imaging Science, University of Rochester School of Medicine and Dentistry, Rochester, New York, USA
| | - Lauren M Aleksunes
- Department of Pharmacology and Toxicology, Rutgers University, Piscataway, New Jersey, USA
| | - Brian Buckley
- Environmental and Occupational Health Sciences Institute, Piscataway, New Jersey, USA
| | - Cathleen Doherty
- Environmental and Occupational Health Sciences Institute, Piscataway, New Jersey, USA
| | - Richard K Miller
- Department of Obstetrics and Gynecology, University of Rochester School of Medicine and Dentistry, Rochester, New York, USA
- Department of Pediatrics, University of Rochester School of Medicine and Dentistry, Rochester, New York, USA
- Department of Pathology, University of Rochester School of Medicine and Dentistry, Rochester, New York, USA
- Department of Environmental Medicine, University of Rochester School of Medicine and Dentistry, Rochester, New York, USA
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Mervak BM, Sakala MD. Beyond the AJR: In Utero Exposure to Gadolinium-Based Contrast Agents May Not Increase Rates of Stillbirth or Neonatal Death or ICU Admission. AJR Am J Roentgenol 2023; 221:280. [PMID: 36598097 DOI: 10.2214/ajr.22.28891] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Affiliation(s)
- Benjamin M Mervak
- Department of Radiology, Michigan Medicine, 1500 E Medical Center Dr, Ann Arbor, MI 48109
| | - Michelle D Sakala
- Department of Radiology, Michigan Medicine, 1500 E Medical Center Dr, Ann Arbor, MI 48109
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Nduaguba SO, Smolinski NE, Thai TN, Bird ST, Rasmussen SA, Winterstein AG. Validation of an ICD-9-Based Algorithm to Identify Stillbirth Episodes from Medicaid Claims Data. Drug Saf 2023; 46:457-465. [PMID: 37043168 DOI: 10.1007/s40264-023-01287-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/01/2023] [Indexed: 04/13/2023]
Abstract
INTRODUCTION In administrative data, accurate timing of exposure relative to gestation is critical for determining the effect of potential teratogen exposure on pregnancy outcomes. OBJECTIVE To develop an algorithm for identifying stillbirth episodes in the ICD-9-CM era using national Medicaid claims data (1999-2014). METHODS Unique stillbirth episodes were identified from clusters of medical claims using a hierarchy that identified the encounter with the highest potential of including the actual stillbirth delivery and that delineated subsequent pregnancy episodes. Each episode was validated using clinical detail on retrieved medical records as the gold standard. RESULTS Among 220 retrieved records, 197 were usable for validation of 1417 stillbirth episodes identified by the algorithm. The positive predictive value (PPV) was 64.0% (57.3-70.7%) overall, 80.4% (73.8-87.1%) for inpatient episodes, 28.2% (14.1-42.3%) for outpatient-only episodes, and 20.0% (2.5-37.5%) for outpatient episodes with overlapping hospitalizations. The absolute difference between the dates of the algorithm-specified stillbirth delivery and the medical record-based event was 4.2 ± 24.3 days overall, 1.7 ± 7.7 days for inpatient episodes, 14.3 ± 51.4 days for outpatient-only episodes, and 1.0 ± 2.0 days for outpatient episodes that overlapped with a hospitalization. Excluding all outpatient episodes, as well as pregnancies involving multiple births, the PPV increased to 82.7% (76.8-89.8%). CONCLUSIONS Our algorithm to identify stillbirths from administrative claims data had a moderately high PPV. Positive predictive value was substantially increased by restricting the setting to inpatient episodes and using only input diagnostic codes for singleton stillbirths.
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Affiliation(s)
- Sabina O Nduaguba
- Department of Pharmaceutical Systems and Policy, College of Pharmacy, West Virginia University, Morgantown, WV, USA
- West Virginia University Cancer Institute, Morgantown, WV, USA
- Department of Pharmaceutical Outcomes and Policy, College of Pharmacy, University of Florida, 1225 Center Drive, PO Box 100496, Gainesville, FL, 32611, USA
| | - Nicole E Smolinski
- Department of Pharmaceutical Outcomes and Policy, College of Pharmacy, University of Florida, 1225 Center Drive, PO Box 100496, Gainesville, FL, 32611, USA
| | - Thuy N Thai
- Department of Pharmaceutical Outcomes and Policy, College of Pharmacy, University of Florida, 1225 Center Drive, PO Box 100496, Gainesville, FL, 32611, USA
- Faculty of Pharmacy, Ho Chi Minh City University of Technology (HUTECH), Ho Chi Minh City, Vietnam
| | - Steven T Bird
- Division of Epidemiology, Office of Surveillance and Epidemiology, Center for Drug Evaluation and Research, Food and Drug Administration, Silver Spring, MD, USA
| | - Sonja A Rasmussen
- Center for Drug Evaluation and Safety (CoDES), University of Florida, Gainesville, FL, USA
- Department of Epidemiology, College of Public Health and Health Professionals and College of Medicine, University of Florida, Gainesville, FL, USA
- Department of Pediatrics and Obstetrics and Gynecology, College of Medicine, University of Florida, Gainesville, FL, USA
| | - Almut G Winterstein
- Department of Pharmaceutical Outcomes and Policy, College of Pharmacy, University of Florida, 1225 Center Drive, PO Box 100496, Gainesville, FL, 32611, USA.
- Center for Drug Evaluation and Safety (CoDES), University of Florida, Gainesville, FL, USA.
- Department of Epidemiology, College of Public Health and Health Professionals and College of Medicine, University of Florida, Gainesville, FL, USA.
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Alghamdi SA. Gadolinium-Based Contrast Agents in Pregnant Women: A Literature Review of MRI Safety. Cureus 2023; 15:e38493. [PMID: 37273372 PMCID: PMC10237509 DOI: 10.7759/cureus.38493] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/03/2023] [Indexed: 06/06/2023] Open
Abstract
Gadolinium-based contrast agents (GBCAs) are commonly used in magnetic resonance imaging (MRI) to enhance the visualisation and characterisation of the region of interest/lesion. Internal structures are well seen with MRI with good spatial resolution. Although MRI is generally considered safe during pregnancy, concerns have been raised regarding the safety of GBCAs, particularly during the first trimester. Limited studies have been conducted to assess the safety of GBCAs in pregnant women, with conflicting results. A comprehensive literature search was conducted using PubMed, SpringerLink, Medscape, ResearchGate and Wiley Online Library. The search terms included various combinations of MRI, pregnancy, first trimester, gadolinium contrast agents, foetus, risk, and toxicity. The search criteria were articles published in English in the last 20 years and indexed in the MEDLINE or Embase databases. The majority of studies found no definitive evidence that GBCAs are harmful during pregnancy, particularly during the first trimester. Some studies reported no increased risk of adverse outcomes in infants exposed to GBCAs during the first trimester. However, other studies showed inconsistent results. Retrospective cohort studies provided some reassurance regarding the safety of GBCAs when indicated in pregnant women but did not address potential long-term adverse outcomes in infants exposed to GBCAs during gestation. The literature review also highlights the importance of further evaluating the subacute and chronic effects of GBCA exposure in infants. The safety of GBCAs during pregnancy, particularly during the first trimester, remains uncertain. More large-scale, long-term studies are needed to clarify the safety of GBCAs in pregnant women and their potential effects on foetal and neonatal outcomes. Until conclusive evidence is available, healthcare providers should carefully weigh the benefits and risks of using GBCAs during pregnancy and consider alternative imaging modalities, such as non-contrast MRI or ultrasound, when necessary.
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Affiliation(s)
- Sami A Alghamdi
- Department of Radiological Sciences, College of Applied Medical Sciences, King Saud University, Riyadh, SAU
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Staub E. Current and potential methods to assess kidney structure and morphology in term and preterm neonates. Anat Rec (Hoboken) 2023. [PMID: 36883787 DOI: 10.1002/ar.25195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2022] [Revised: 01/25/2023] [Accepted: 02/21/2023] [Indexed: 03/09/2023]
Abstract
After birth, the kidney structure in neonates adapt to the functional demands of extrauterine life. Nephrogenesis is complete in the third trimester, but glomeruli, tubuli, and vasculature mature with the rapidly increasing renal blood flow and glomerular filtration. In preterm infants, nephrogenesis remains incomplete and maturation is slower and may be aberrant. This structural and functional deficit has life-long consequences: preterm born individuals are at higher risk for chronic kidney disease and arterial hypertension later in life. This review assembles the literature on existing and potential methods to visualize neonatal kidney structure and morphology and explore their potential to longitudinally document the developmental deviation after preterm birth. X-rays with and without contrast, fluoroscopy and computed tomography (CT) involve relevant ionizing radiation exposure and, apart from CT, do not provide sufficient structural details. Ultrasound has evolved into a safe and noninvasive high-resolution imaging method which is excellent for longitudinal observations. Doppler ultrasound modes can characterize and quantify blood flow to and through the kidneys. Microvascular flow imaging has opened new possibilities of visualizing previously unseen vascular structures. Recent advances in magnetic resonance imaging display renal structure and function in unprecedented detail, but are offset by the logistical challenges of the imaging procedure and limited experience with the new techniques in neonates. Kidney biopsies visualize structure histologically, but are too invasive and remain anecdotal in newborns. All the explored methods have predominantly been examined in term newborns and require further research on longitudinal structural observation in the kidneys of preterm infants.
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Affiliation(s)
- Eveline Staub
- Department of Neonatology, Royal North Shore Hospital, St Leonards, New South Wales, Australia
- University of Sydney Northern Clinical School, Royal North Shore Hospital, St Leonards, New South Wales, Australia
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Sundaram KM, Morgan MA, Depetris J, Arif-Tiwari H. Imaging of benign gallbladder and biliary pathologies in pregnancy. Abdom Radiol (NY) 2023; 48:1921-1932. [PMID: 36790454 DOI: 10.1007/s00261-023-03832-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2022] [Revised: 01/23/2023] [Accepted: 01/23/2023] [Indexed: 02/16/2023]
Abstract
The rising incidence combined with pregnancy-related physiological changes make gallbladder and biliary pathology high on the differential for pregnant patients presenting with right upper abdominal pain. Imaging plays a crucial role in determining surgical versus non-surgical management in pregnant patients with biliary or gallbladder pathology. Ultrasound (first-line) and magnetic resonance with magnetic resonance cholangiopancreatography (second-line) are the imaging techniques of choice in pregnant patients with suspected biliary pathology due to their lack of ionizing radiation. MRI/MRCP offers an excellent non-invasive imaging option, providing detailed anatomical detail without known harmful fetal side effects. This article reviews physiological changes in pregnancy that lead to gallstone and biliary pathology, key imaging findings on US and MRI/MRCP, and management pathways.
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Affiliation(s)
- Karthik M Sundaram
- Department of Radiology, University of Pennsylvania Health System, 1 Silverstein, 3400 Spruce Street, Philadelphia, PA, USA.
| | - Matthew A Morgan
- Department of Radiology, University of Pennsylvania Health System, 1 Silverstein, 3400 Spruce Street, Philadelphia, PA, USA
| | - Jena Depetris
- Department of Radiology, University of California Los Angeles, 757 Westwood Plaza, Los Angeles, CA, USA
| | - Hina Arif-Tiwari
- Department of Radiology, University of Arizona-Tuscon, 1501 N. Campbell Avenue, Tuscon, AZ, USA
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The radiologist's role in a multidisciplinary approach to cancer in pregnancy. Abdom Radiol (NY) 2023; 48:1605-1611. [PMID: 36705722 PMCID: PMC10149443 DOI: 10.1007/s00261-023-03809-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Revised: 01/05/2023] [Accepted: 01/10/2023] [Indexed: 01/28/2023]
Abstract
Pregnancy-associated cancer (PAC) occurs in approximately 1 in 1000 pregnancies, and the incidence is expected to rise due to delayed childbearing (Silverstein et al. in JCO Oncol Pract 16:545-557, 2020; Woitek et al. in ESMO Open 1:e000017, 2016). Diagnosis and management of PACs are challenging and diagnosis is often delayed as symptoms may overlap with physiologic changes of pregnancy (Jha et al. in RadioGraphics 42:220005, 2022). These patients are best cared for by a multidisciplinary healthcare team composed of experts (Silverstein et al. in JCO Oncol Pract 16:545-557, 2020). Management of these patients must balance optimal maternal care with potentially harmful fetal effects. This involves honest, forthright, and sometimes difficult discussions between the care team and the patient throughout the entirety of care. Radiologists play a significant role in timely cancer diagnosis, staging and follow-up during and after pregnancy, accurate determination of gestational age, and in assessing fetal growth and well-being throughout pregnancy.
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Perelli F, Turrini I, Giorgi MG, Renda I, Vidiri A, Straface G, Scatena E, D’Indinosante M, Marchi L, Giusti M, Oliva A, Grassi S, De Luca C, Catania F, Vizzielli G, Restaino S, Gullo G, Eleftheriou G, Mattei A, Signore F, Lanzone A, Scambia G, Cavaliere AF. Contrast Agents during Pregnancy: Pros and Cons When Really Needed. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:16699. [PMID: 36554582 PMCID: PMC9779218 DOI: 10.3390/ijerph192416699] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Revised: 12/06/2022] [Accepted: 12/10/2022] [Indexed: 05/13/2023]
Abstract
Many clinical conditions require radiological diagnostic exams based on the emission of different kinds of energy and the use of contrast agents, such as computerized tomography (CT), positron emission tomography (PET), magnetic resonance (MR), ultrasound (US), and X-ray imaging. Pregnant patients who should be submitted for diagnostic examinations with contrast agents represent a group of patients with whom it is necessary to consider both maternal and fetal effects. Radiological examinations use different types of contrast media, the most used and studied are represented by iodinate contrast agents, gadolinium, fluorodeoxyglucose, gastrographin, bariumsulfate, and nanobubbles used in contrast-enhanced ultrasound (CEUS). The present paper reports the available data about each contrast agent and its effect related to the mother and fetus. This review aims to clarify the clinical practices to follow in cases where a radiodiagnostic examination with a contrast medium is indicated to be performed on a pregnant patient.
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Affiliation(s)
- Federica Perelli
- Azienda USL Toscana Centro, Gynecology and Obstetric Department, Santa Maria Annunziata Hospital, 50012 Florence, Italy
| | - Irene Turrini
- Azienda USL Toscana Centro, Gynecology and Obstetric Department, Santo Stefano Hospital, 59100 Prato, Italy
| | - Maria Gabriella Giorgi
- Azienda USL Toscana Centro, Gynecology and Obstetric Department, Santo Stefano Hospital, 59100 Prato, Italy
| | - Irene Renda
- Division of Obstetrics and Gynecology, Department of Biomedical, Experimental and Clinical Sciences, University of Florence, 50134 Florence, Italy
| | - Annalisa Vidiri
- School of Medicine, Catholic University of the Sacred Hearth, 00168 Rome, Italy
| | - Gianluca Straface
- Obstetrics and Gynecology Unit, Policlinico Abano Terme, 35031 Abano Terme, Italy
| | - Elisa Scatena
- Azienda USL Toscana Centro, Gynecology and Obstetric Department, Santo Stefano Hospital, 59100 Prato, Italy
| | - Marco D’Indinosante
- Azienda USL Toscana Centro, Gynecology and Obstetric Department, Santo Stefano Hospital, 59100 Prato, Italy
| | - Laura Marchi
- Azienda USL Toscana Centro, Gynecology and Obstetric Department, Santo Stefano Hospital, 59100 Prato, Italy
| | - Marco Giusti
- Azienda USL Toscana Centro, Gynecology and Obstetric Department, Santa Maria Annunziata Hospital, 50012 Florence, Italy
| | - Antonio Oliva
- Department of Health Surveillance and Bioethics, Section of Legal Medicine, Fondazione Policlinico A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Simone Grassi
- Department of Health Surveillance and Bioethics, Section of Legal Medicine, Fondazione Policlinico A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Carmen De Luca
- Teratology Information Service, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy
| | - Francesco Catania
- Department of Obstetrics and Gynecology, Ospedale “Santa Maria Alla Gruccia”, 52025 Montevarchi, Italy
| | - Giuseppe Vizzielli
- Department of Medicinal Area (DAME) Clinic of Obstetrics and Gynecology, Santa Maria della Misericordia Hospital, Azienda Sanitaria Universitaria Friuli Centrale, 33100 Udine, Italy
| | - Stefano Restaino
- Department of Medicinal Area (DAME) Clinic of Obstetrics and Gynecology, Santa Maria della Misericordia Hospital, Azienda Sanitaria Universitaria Friuli Centrale, 33100 Udine, Italy
| | - Giuseppe Gullo
- IVF Public Center, Azienda Ospedaliera Ospedali Riuniti (AOOR) Villa Sofia Cervello, University of Palermo, 90146 Palermo, Italy
| | - Georgios Eleftheriou
- Poison Control Center and Teratology Information Service, Hospital Papa Giovanni XIII, 24127 Bergamo, Italy
| | - Alberto Mattei
- Azienda USL Toscana Centro, Gynecology and Obstetric Department, Santa Maria Annunziata Hospital, 50012 Florence, Italy
| | - Fabrizio Signore
- Obstetrics and Gynecology Unit, Santo Eugenio Hospital, 00144 Rome, Italy
- School of Medicine, Unicamillus University Rome, 00131 Rome, Italy
| | - Antonio Lanzone
- School of Medicine, Catholic University of the Sacred Hearth, 00168 Rome, Italy
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy
| | - Giovanni Scambia
- School of Medicine, Catholic University of the Sacred Hearth, 00168 Rome, Italy
- Division of Gynecologic Oncology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy
| | - Anna Franca Cavaliere
- School of Medicine, Catholic University of the Sacred Hearth, 00168 Rome, Italy
- Division of Gynecology and Obstetrics Fatebenefratelli Isola Tiberina, 00186 Rome, Italy
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