Administration Of Contrast Media To Women Who Are Breast-Feeding
Imaging studies requiring either iodinated or gadolinium-based contrast media are occasionally required
in patients who are breast feeding. Both the patient and the patient’s physician may have concerns regarding
potential toxicity to the infant from contrast media that is excreted into the breast milk.
The literature on the excretion into breast milk of iodinated and gadolinium-based contrast media and
the gastrointestinal absorption of these agents from breast milk is very limited; however, several studies
have shown that the expected dose of contrast medium absorbed by an infant from ingested breast milk is
extremely low.
Iodinated X-ray Contrast Media (Ionic and Nonionic)
Background
The plasma half-life of intravenously administered iodinated contrast medium is approximately 2 hours,
with nearly 100% of the media cleared from the bloodstream in patients with normal renal function within
24 hours. Because of its low lipid solubility, less than 1% of the administered maternal dose of iodinated
contrast medium is excreted into the breast milk in the first 24 hours [1,2]. In addition, less than 1% of the
contrast medium ingested by the infant is absorbed from its gastrointestinal tract [3]. Therefore, the expected
systemic dose absorbed by the infant from the breast milk is less than 0.01% of the intravascular dose given
to the mother. This amount represents less than 1% of the recommended dose for an infant being prescribed
iodinated contrast material related to an imaging study (usually 1.5 to 2 mL/kg). The potential risks to the
infant include direct toxicity and allergic sensitization or reaction, which are theoretical concerns but have
not been reported.
The likelihood of either direct toxic or allergic-like manifestations resulting from ingested iodinated
contrast material in the infant is extremely low. As with other medications in milk, the taste of the milk may
be altered if it contains contrast medium [1-4].
Recommendation
Because of the very small percentage of iodinated contrast medium that is excreted into the breast milk
and absorbed by the infant’s gut, we believe that the available data suggest that it is safe for the mother and
infant to continue breast-feeding after receiving such an agent.
Ultimately, an informed decision to temporarily stop breast-feeding should be left up to the mother after
these facts are communicated. If the mother remains concerned about any potential ill effects to the infant,
she may abstain from breast-feeding from the time of contrast administration for a period of 12 to 24 hours.
There is no value to stop breast feeding beyond 24 hours. The mother should be told to express and discard
breast milk from both breasts during that period. In anticipation of this, she may wish to use a breast pump
to obtain milk before the contrast-enhanced study to feed the infant during the 24-hour period following
the examination