The use of iodinated or gadolinium-based contrast media in pregnant or lactating women often causes concerns in the radiology department because of the principle of not exposing a fetus or neonate to any drugs. Because of the uncertainty about the use of contrast media during pregnancy and lactation, the Contrast Media Safety Committee of the European Society of Urogenital Radiology decided to review the literature and draw up guidelines. An extensive literature search was carried out and summarized in a report. Based on the limited information available, simple guidelines have been drawn up. The report and guidelines were discussed at the 11th European Symposium on Urogenital Radiology in Santiago de Compostela, Spain. Mutagenic and teratogenic effects have not been described after administration of gadolinium or iodinated contrast media. Free iodide in radiographic contrast medium given to the mother has the potential to depress fetal/neonatal thyroid function. Neonatal thyroid function should be checked during the 1st week if iodinated contrast media have been given during pregnancy. No effect on the fetus has been seen after gadolinium contrast media. Only tiny amounts of iodinated or gadolinium-based contrast medium given to a lactating mother reach the milk, and only a minute proportion entering the baby's gut is absorbed. The very small potential risk associated with absorption of contrast medium may be considered insufficient to warrant stopping breast-feeding for 24 h following either iodinated or gadolinium contrast agents.

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The use of iodinated and gadolinium contrast media during pregnancy and lactation.

It has been known since the last century that maternal milk sometimes may contain chemical contaminants which could have adverse effects on nursing infants. Such experiences came mainly from cases of exposure to occupational chemicals or drugs. Since 1950, it has further been known that human milk may contain potentially hazardous persistent environmental chemicals in concentrations higher than in cow’s milk.

Chemical Contaminants in Human Milk

Breast-feeding is the best method of feeding neonates and young infants.1 Its popularity has increased in recent years,2 although in 1995 only about 60 percent of new mothers in the United States were breast-feeding their infants at the time of hospital discharge.3 Current recommendations suggest that in the absence of contraindications, women should breast-feed their infants for at least the first 12 months of life. However, many mothers are likely to need to take medications at some point during this time.4,5 The possible effects of these medications on breast-fed infants are therefore of great concern. Benefits of Breast-Feeding Breast-feeding . . .

Drug Therapy for Breast-Feeding Women

OBJECTIVE: The authors reviewed the risks and benefits regarding the use of psychiatric medications during breast-feeding as they relate to the health and well-being of mothers and their infants. Strategies are discussed to limit infant exposure to a medication while effectively treating the nursing mother. METHOD: A MEDLINE search of the literature since 1955 was conducted to determine the use of psychotropic medications in breast-feeding women. Search items included each of the categories of psychopharmacologic agents as well as each of the agents in association with nursing, breast-feeding, postpartum, lactation, and breast milk. RESULTS: No controlled studies on the safety of psychotropic medications in nursing mothers were found. Case reports and small case series for each of the different psychotropic medications serve as the basis for suggested treatment guidelines for the management of psychiatric illnesses in breast-feeding women. Thus, each case needs to be considered on an individual basis, wit...

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The Use of Psychotropic Medications During Breast-Feeding

Pharmacokinetics of three newer quinolones in pregnant and lactating women

The excretion of drugs in human breast milk is reviewed with regard to milk production, composition, feeding patterns and mechanisms of drug transfer into milk. Fundamental principles of breast milk excretion are used to construct a pharmacokinetic approach useful for the study of most drugs. An infant-modulated 3-compartment open model is proposed for drug distribution and elimination in the breast feeding woman. Milk/plasma drug concentration ratios are projected on the basis of pH partitioning. While some studies confirm these projections, other studies demonstrate a need to consider additional factors such as lipid solubility and protein binding characteristics of a drug in milk.

P C Jobe

Papers

Drug excretion in human breast milk: principles, pharmacokinetics and projected consequences.