Diagnostic Radiation in Pregnancy: Perception Versus True Risks

Knowledge and attitude of pregnant women in Urmia, Iran, about oral health care during pregnancy

OBJECTIVES

Physiological changes during pregnancy make mothers susceptible to periodontal diseases, in particular gingivitis, which could be prevented by good oral hygiene. Therefore, their knowledge and attitude could affect their oral hygiene and general health. This study therefore aimed to investigate the knowledge, attitude, and practice regarding oral hygiene, of pregnant women living in a city in Iran.

MATERIAL AND METHODS

It was a cross-sectional study that was performed in Urmia City in 2019. After completing an informed consent form, pregnant women completed a specially designed questionnaire, which included questions on demographic characteristics and assessed participants' knowledge and attitude about oral health care during pregnancy. A clinical examination of each participant's oral cavity was performed and dental plaque index (PI), gingival index (GI), and number of decayed, missed, filled teeth (DMFT) index were recorded. Any correlations between participants' knowledge and attitude and oral health indices were evaluated. A paired t test and Pearson's correlation coefficient were employed for statistical analysis.

RESULTS

A total of 96 pregnant women (mean age of 29.11 ± 6.80 years) participated in this study. Among them, 67 had a moderate level of knowledge. There was no significant correlation between participants' knowledge, and attitude levels and educational level (p = .88 and p = .43, respectively). Also, there was no correlation between knowledge and attitude levels and GI, PI, and DMFT (p > .05).

CONCLUSIONS

This study showed that the knowledge and attitude of the pregnant women who participated were not favorable and their oral hygiene needed to be improved.

Radiation exposure in pregnancy: outcomes, perceptions and teratological counseling in Turkish women

BACKGROUND

Fetal effects of radiation are associated with the gestational week of exposure, dose, and duration of exposure, but the perception of risk of radiation in expecting mothers is greater than the actual risk of physical effects.

OBJECTIVES

Evaluate the overestimation of the teratogenic risk in women exposed to radiation and the role of teratological counseling in minimizing preconceptions.

DESIGN

Analytical, cross-sectional.

SETTING

Tertiary care center, genetic diseases diagnosis center.

PATIENTS AND METHODS

Out of 10 784 people who applied for teratological consultation between 2009 and 2018, pregnant women meeting inclusion criteria and exposed to radiation were selected as the study group; pregnant women without radiation exposure were selected as the control group. Two subgroups of the study group based on the week and dose of exposure were also analyzed.

MAIN OUTCOME MEASURES

Abortion rate, termination recommendation rates before and after teratological counseling.

SAMPLE SIZE

461 pregnant exposed to radiation; 213 pregnant women without radiation exposure.

RESULTS

Preterm birth and termination rates differed significantly between cases and controls (P=.038, P=.019, respectively). Termination recommendation at the first examination was more frequent for both the week of exposure overall and dose subgroups comparing cases and controls (P<.001). In the comparison of subgroups by week of exposure, only the miscarriage rate was statistically significant (P=.007). After teratological counseling termination decision rates were significantly decreased (P<.001).

CONCLUSION

Subjective perceptions about the risks of radiation may lead to the termination of an otherwise wanted pregnancy. Teratological counseling is crucial for the prevention of termination of pregnancy, clarifying misinformation, and minimizing anxiety.

LIMITATIONS

With the exception of measurable values as calculated doses of radiation, the conclusions are mostly derived from medical records and subjective responses of pregnant women. The termination rates in our study probably do not reflect the whole population.

CONFLICT OF INTEREST

None.

Protocol of a prospective and multicentre China Teratology Birth Cohort (CTBC): association of maternal drug exposure during pregnancy with adverse pregnancy outcomes

BACKGROUND

As reported, 27-93 % of pregnant women take at least one drug during pregnancy. However, drug exposure during pregnancy still lacks sufficient foetal safety evidence of human origin. It is urgent to fill the knowledge gap about medication safety during pregnancy for optimization of maternal disease treatment and pregnancy drug consultation.

METHODS AND ANALYSIS

The China Teratology Birth Cohort (CTBC) was established in 2019 and is a hospital-based open-ended prospective cohort study with the aim of assessing drug safety during pregnancy. Pregnant women who set up the pregnancy health records in the first trimester or who seek drug consultation regardless of gestational age in the member hospitals are recruited. Enrolled pregnant women need to be investigated four times, namely, 6-14 and 24-28 weeks of gestational age, before discharge after hospital delivery, and 28-42 days after birth. Maternal medication exposure during pregnancy is the focus of the CTBC. For drugs, information on the type, name, and route of medication; start and end time of medication; single dose; frequency of medication; dosage form; manufacturer; and reason for medication is collected. The adverse pregnancy outcomes collected in the study include birth defects, stillbirth, spontaneous abortion, preterm birth, post-term birth, low birth weight, macrosomia, small for gestational age, large for gestational age and low Apgar score. CTBC uses an electronic questionnaire for data collection and a cloud system for data management. Biological samples are collected if informed consents are obtained. Multi-level logistic regression, mixed-effect negative binomial distribution regression and spline function regression are used to explore the effect of drugs on the occurrence of birth defects.

DISCUSSION

The findings of the study will assist in further understanding the risk of birth defects and other adverse pregnancy outcomes associated with maternal drug exposure and developing the optimal treatment plans and drug counselling for pregnant women.

TRIAL REGISTRATION

This study was approved by the Research Ethics Committee of the West China Second Hospital of Sichuan University and registered at the Chinese Clinical Trial Registry ( http://www.chictr.org.cn/index.aspx , registration number ChiCTR1900022569 ).

Radiation safety of women of the reproductive age: evaluation of the role of referring physicians

Background:

Women between 12 and 50 years are in the reproductive age. The likelihood of or actual presence of pregnancy should be ruled out before they are exposed to medical ionizing radiation. Fetal exposure to ionizing radiation can either induce malformation (teratogenic) or cancer. They should be exposed only when it is safe for the fetus or when the benefit far outweighs the risk in urgent medical conditions. The radiation dose in medical imaging is generally below the threshold to induce malformation (100 mGy) in the fetus, but there is indeed no safe level as the risk of cancer induction later in life can occur at any dose. The referring physician must obtain the last menstrual period (LMP) and sometimes carry out pregnancy test before sending their patients for examinations using ionizing radiation. However, there are circumstances in which these rules are waived.

Objective:

The purpose of the study is to evaluate the role of the referring physician in the radiation protection of the fetus using the LMP. Subjects and Methods: This is a prospective study over a 2-month period. All the request forms of menstruating women aged 12-50 years sent for conventional radiography are included in the study.

Results:

One percent provided the LMP in the request forms. 0.6% (one) of our subjects was sure she is pregnant, but 13.7% (25) had an overdue menstruation.

Conclusion:

The level of compliance of the physicians with the referral guidelines for women of reproductive age is poor.

Management of pelvic injuries in pregnancy

Pelvic fractures in pregnant women are usually high-energy injuries associated with risk of mortality to both mother and fetus. The mother's life always takes priority in the acute setting as it offers the best chance of survival to both the mother and the fetus. Indications for operative intervention of acute pubic symphysis rupture depend on presence of an open disruption, amount of displacement, and degree of disability. Chronic symphyseal instability related to pregnancy is a challenging problem and the first line of treatment is nonoperative care. A previous pelvic fracture is not a contraindication by itself to vaginal delivery.

Hodgkin's disease and pregnancy: case series and proposal for treatment protocol

The peak frequency of Hodgkin's disease convergesmatches with women of reproductive fertility age. Currently, this disease is the fourth more diagnosed neoplasia during pregnancy. In addition, there is no consensus in the literature on how to treat pregnant women because of the risks of chemotherapy for mothers and for fetuses. We report three cases of pregnant women with Hodgkin's disease. A review of the literature was made aiming to suggest a protocol to treat these patients.

Perception of risk regarding the use of medications and other exposures during pregnancy

BACKGROUND

Perception of risk may impact a woman's decision to take a needed drug during pregnancy. There is a paucity of research on this topic in the literature.

OBJECTIVES

(1) To evaluate the perception of risk of 17 commonly used drugs and other substances by pregnant women. (2) To investigate which sources of information regarding exposures during pregnancy were most commonly used by women.

METHODS

A questionnaire was developed through the University of Oslo's website for Internet surveys and posted on four Web pages used by pregnant women and mothers, from mid-September 2008 through October 2008. The inclusion criteria included women who were (1) pregnant or 2) a mother of a child less than 5 years old.

RESULTS

A total of 1,793 eligible women completed the questionnaire. Most women overestimated the teratogenic risk associated with all the drugs during pregnancy. Characteristics of the women that were associated with a high perception of risk were primiparity, higher age, higher education, and choosing not to use a drug during pregnancy. More than 80% of the women had used drugs during pregnancy, mostly paracetamol, penicillins and reflux medications. The physician, the product information leaflet and the pharmacist were the three most frequently used sources of information.

CONCLUSION

Women overestimate the risk of drug use and other exposures during pregnancy. Therefore, it is important for health care providers to use evidence-based information, to reduce unnecessary anxiety, and to ensure safe and appropriate treatment during pregnancy.

"Doctor, will that x-ray harm my unborn child?"

Exposure to ionizing radiation can be a source of anxiety for many pregnant women and their health care providers. An awareness of the radiation doses delivered by different techniques and the acceptable exposure thresholds can help both patients and practitioners. We describe exposure to radiodiagnostic procedures during pregnancy and suggest an approach to assess the potential risk.

Saving lives and changing family histories: appropriate counseling of pregnant women and men and women of reproductive age, concerning the risk of diagnostic radiation exposures during and before pregnancy

Over the past 50 years, our laboratory has provided consultations dealing with the risks of various environmental toxicant exposures during pregnancy. These contacts were primarily by telephone or written communications. Since the year 2000, the primary source of consultations has been via the internet. In 2007, the pregnancy website of the Health Physics Society received 1,299,672 visits. The contacts who downloaded information totaled 620,035. After reading the website information, 1442 individuals who were still concerned contacted me directly. Unfortunately, we have learned that many physicians and other counselors are not prepared to counsel patients concerning radiation risks. Approximately, 8% of the website contacts, who had consulted a professional, were provided inaccurate information that could have resulted in an unnecessary interruption of a wanted pregnancy. Research from our and other investigators' laboratories has provided radiation risk data that are the basis for properly counseling contacts with radiation exposures. Mammalian animal research has been an important source of information that improves the quality and accuracy of estimating the reproductive and developmental risks of ionizing radiation in humans. What are the reproductive and developmental risks of in utero ionizing radiation exposure? 1. Birth defects, mental retardation, and other neurobehavioral effects, growth retardation, and embryonic death are deterministic effects (threshold effects). This indicates that these effects have a no adverse effect level (NOAEL). Almost all diagnostic radiological procedures provide exposures that are below the NOAEL for these developmental effects. 2. For the embryo to be deleteriously affected by ionizing radiation when the mother is exposed to a diagnostic study, the embryo has to be exposed above the NOAEL to increase the risk of deterministic effects. This rarely happens when the pregnant women have x-ray studies of the head, neck, chest or extremities. 3. During the preimplantation and preorganogenesis stages of embryonic development, the embryo is least likely to be malformed by the effects of ionizing radiation because the cells of the very young embryo are omnipotential and can replace adjacent cells that have been deleteriously affected. This early period of development has been designated as "the all-or-none period." 4. Protraction and fractionation of exposures of ionizing radiation to the embryo decrease the magnitude of the deleterious effects of deterministic effects. 5. The increased risk of cancer following high exposures to ionizing radiation exposure to adult populations has been demonstrated in the atomic bomb survivor population. Radiation-induced carcinogenesis is assumed to be a stochastic effect (nonthreshold effect) so that there is theoretically a risk at low exposures. Whereas there is no question that high exposures of ionizing radiation can increase the risk of cancer, the magnitude of the risk of cancer from embryonic exposures following diagnostic radiological procedures is very controversial. Recent publications and analyses indicate that the risk is lower for the irradiated embryo than the irradiated child, which surprised many scientists interested in this subject, and that there may be no increased carcinogenic risk from diagnostic radiological studies. Examples of appropriate and inappropriate counseling will be presented to demonstrate how counseling can save lives and change family histories. The reader is referred to the Health Physics Society website to obtain many examples of the answers to questions posed by women and men who have been exposed to radiation (www.hps.org). Then click on ATE (ask the expert).