Feature | Magnetic Resonance Imaging (MRI) | September 07, 2016

MRIs During Pregnancy Are Safe, But Gadolinium Scans May Increase Risk to Fetus

Study finds MRIs in first trimester of pregnancy were not associated with increased risk

Fetal MRI, safety of MRI in Pregnant women, Philips, Ingenia 1.5T, Cincinnati Children’s Hospital

This study found MRI is safe by itself, but the use of gadolinium contrast may be a factor involved with an array of issues that impact the fetus and young children after birth.  

Fetal MRI, safety of MRI in Pregnant women, Philips, Ingenia 1.5T

September 7, 2016 — In an analysis that included more than 1.4 million births, exposure to magnetic resonance imaging (MRI) during the first trimester of pregnancy compared with nonexposure was not associated with increased risk of harm to the fetus or in early childhood. However, data suggests gadolinium contrast enhanced MRI scans at any time during pregnancy may be associated with an increased risk of a broad set of rheumatological, inflammatory or skin conditions and, possibly, for stillbirth or neonatal death, according to a study appearing in the Sept. 6, 2016, issue of Journal of the American Medical Association (JAMA).

Concern has been expressed about the safety of MRI exposure in the first trimester of pregnancy due to the heating of sensitive tissues by radiofrequency fields and exposure to the loud acoustic environment. When indicated, MRI's diagnostic accuracy is improved with gadolinium, an intravenous contrast agent. Fetal safety of MRI during the first trimester of pregnancy or with gadolinium enhancement at any time of pregnancy is unknown. While MRI is generally thought to be safe for the fetus in the second or third trimesters of pregnancy, there were no prior controlled studies on its safety in the first trimester, when the fetus forms its major organs and body structures.

 

Watch the VIDEO "MRI Gadolinium Contrast Retention in the Brain."

 

To inform clinical guidelines for MRIs on pregnant women, Joel G. Ray, M.D., M.Sc., FRCPC, of St. Michael's Hospital and the Institute for Clinical Evaluative Sciences, Toronto, and colleagues used health data housed at the Institute for Clinical Evaluative Sciences to examine records of more than 1.4 million births in Ontario from 2003-2015. They compared women who had first-trimester MRIs with those who had not, and also followed their children up to age 4. 

In pregnancies that lasted a minimum of 21 gestational weeks, 1 in 250 had an MRI in pregnancy, including 1 in 1,200 in the first trimester and 1 in 3,000 with gadolinium contrast. Maternal MRI in the first trimester was not associated with a higher risk of stillbirth or neonatal death, congenital anomalies, neoplasm or hearing loss.

"Having an MRI at the earliest stages of pregnancy does not seem to alter the development of the fetus," Ray said.

However, exposure to gadolinium-enhanced MRI at any gestation was not associated with a greater risk of congenital anomalies. Although a nephrogenic systemic fibrosis-like outcome was extremely rare, gadolinium-enhanced MRI was associated with an increased risk for a non-specific outcome of any rheumatological, inflammatory or infiltrative skin condition up to age 4 years, and for stillbirth or neonatal death, although there were just seven events in the gadolinium MRI group.

"The current findings inform published recommendations about the safety of MRI in the first trimester of pregnancy," the authors wrote. "Until further studies are done, these findings suggest that gadolinium contrast should be avoided during pregnancy."

Read the article “Gadolinium May Remain in Brain after Contrast MRI.” 

Even though the actual number of stillbirths was low (one in 50), and the outcome of a skin or rheumatological condition was very broadly defined, Ray said the results support clinical guidelines to avoid giving pregnant women gadolinium unless strongly indicated.

The current study did not include specific information as to why the women received an MRI, or whether they knew they were pregnant at the time. But the study did track the specialty of the physician ordering the MRI: 44 percent were family physicians, suggesting the MRI may have been booked prior to a woman having conceived. The other common specialty was a neurologist or neurosurgeon, suggesting that some women were investigated for headaches or spinal disc issues.

For more information http://jama.jamanetwork.com/article.aspx?doi=10.1001/jama.2016.12126

 

Related Gadolinium Safety Concern Articles

Gadolinium May Remain in Brain after Contrast MRI

ACR Manual on Contrast Media Addresses FDA Gadolinium Safety Concerns

Study Finds No Association Between Gadolinium Contrast and Nervous System Disorder

Even High Doses of Gadolinium-Based Contrast Agents Doesn't Cause NSF

Reference: 

1. Joel G. Ray, Marian J. Vermeulen, Aditya Bharatha, et al. “Association Between MRI Exposure During Pregnancy and Fetal and Childhood Outcomes.” JAMA. 2016;316(9):952-961. doi:10.1001/jama.2016.12126.

Related Content

AAPM 2019 Features More Than 40 Presentations on ViewRay's MRIdian MRI-guided Radiotherapy
News | Image Guided Radiation Therapy (IGRT) | July 16, 2019
ViewRay Inc. announced that the company's MRIdian System is the focus of more than 40 abstracts selected by the...
FDA Approves Bayer's Gadavist Contrast for Cardiac MRI in Adult Coronary Artery Disease Patients
Technology | Contrast Media | July 15, 2019
The U.S. Food and Drug Administration (FDA) has approved Gadavist injection for use in cardiac magnetic resonance...
FDA Clears Koios DS Breast 2.0 AI-based Software
News | Ultrasound Women's Health | July 11, 2019
Koios Medical announced its second 510(k) clearance from the U.S. Food and Drug Administration (FDA).
Insightec's Exablate Neuro Approved With GE Signa Premier MRI in U.S. and Europe
News | Focused Ultrasound Therapy | July 10, 2019
GE Healthcare and Insightec announced U.S. Food and Drug Administration (FDA) approval and CE mark for Insightec’s...
Delta T1 Maps Provide Quantitative, Automated Solution to Assess Brain Tumor Burden
News | Neuro Imaging | July 05, 2019
Imaging Biometrics LLC (IB) a subsidiary of IQ-AI Ltd., is highlighting a recently published study in the American...
Medic Vision Wins Japanese PMDA Clearance for iQMR Image Reconstruction Solution
News | Magnetic Resonance Imaging (MRI) | July 05, 2019
Medic Vision Imaging Solutions announced that its 3-D iterative image reconstruction technology for shortening magnetic...
Therapixel Appoints Matthieu Leclerc-Chalvet as CEO
News | Artificial Intelligence | July 03, 2019
Artificial intelligence (AI) breast cancer screening specialist Therapixel announced the appointment of Matthieu...
GE Healthcare showcases Senographe Pristina Serena featuring its add-on-biopsy kit at the Breast Imaging Symposium. Photo by Greg Freiherr

GE Healthcare showcases Senographe Pristina Serena featuring its add-on-biopsy kit at the Breast Imaging Symposium. Photo by Greg Freiherr

Feature | Breast Imaging | July 03, 2019 | By Greg Freiherr
Productivity and its enabler — efficiency — guided the display of products at the April...
Countless possibilities can impact the future of global healthcare and AI is the first step toward breakthrough that will change the landscape of personalized medicine
Feature | Women's Health | July 03, 2019 | By Samir Parikh
Contrary to what many people believe,...

Image courtesy of GE Healthcare

Feature | Radiology Business | July 03, 2019 | By Jeffrey Hoffmeister, M.D.
Burnout in the medical profession is not uncommon, particularly as clinicians have become more overwhelmed by growing