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Is it considered safe to breastfeed after an MRI of the brain with IV contrast? I have a 5 week old exclusively breastfeed baby. I would like to avoid needing to pump and dump for an extended amount of time after if possible. Is there a certain contrast that is safer than others or is it all the same?
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Seigin14:
Basically the radiologist association suggests it is safe to breastfeed following use of Gadolinium-containing contrast (MRI). But we also know that the gadolinium metal ion does get trapped in the brain of such patients. Small amounts probably transfer into milk, but they are minimal.
If I were you, I'd pump and discard for about 4 hours. This would largely eliminate any risk at all.
Tom Hale Ph.D.
FROM MMM 2019
Gadopentetate is a radiopaque agent used in magnetic resonance imaging of the kidney. It is non-ionic, non-iodinated, has low osmolarity and contains a gadolinium ion as the radiopaque entity. Following a dose of 7 mmol (6.5 g), the amount of gadopentetate secreted in breastmilk was 3.09, 2.8, 1.08, and 0.5 µmol/L at 2, 11, 17, and 24 hours respectively.[1] The cumulative amount excreted from both breasts in 24 hours was only 0.023% of the administered dose. Oral absorption is minimal, only 0.8% of gadopentetate is absorbed. These authors suggest that only 0.013 micromole of a gadolinium-containing compound would be absorbed by the infant in 24 hours, which is incredibly low. They further suggest that 24 hours of pumping would eliminate risk, although this seems rather extreme in view of the short (1.6 hours) half-life, poor oral bioavailability, and limited milk levels.
In another study of 19 lactating women who received 0.1 mmol/kg and one additional woman who received 0.2 mmol/kg, the cumulative amount of gadolinium excreted in breastmilk during 24 hours was 0.57 µmol/L.[2] This resulted in an excreted dose of <0.04% of the IV administered maternal dose. A similar amount was noted in the patient receiving a double dose (0.2 mmol/kg). As a result, for any neonate weighing more than 1000 gm, the maximal orally ingested dose would be less than 1% of the permitted intravenous dose of 0.2 mmol/kg. According to the authors, the very small amount of gadopentetate dimeglumine transferred to a nursing infant does not warrant a potentially traumatic 24-hour suspension of breastfeeding for lactating women. The American College of Radiology concludes that it is safe for a mother-infant dyad to continue breastfeeding after the administration of a gadolinium-containing contrast medium. In another review, only minuscule amounts of gadolinium contrast agents reach the milk compartment and virtually none of this is absorbed orally by the infant.[3]
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