With permission, a recent post from Dr. Jack Newman (via Barbara Latterner)
If you have already received this, please accept my apologies. I am trying
to get this out because I am sick of hearing that mothers are being told to
stop breastfeeding for completely unacceptable reasons.
Dear all,
In the past week, I have heard from three mothers in the same city who were
told in three different teaching hospitals to stop breastfeeding for 48 after
CT or MRI scans. Who knows how many believed they did have to stop and didn't
check? If it were necessary, this is one thing. But, it is completely
unnecessary to stop even for a second, and on top of that, stopping breastfeeding,
aside from exposing the baby to foreign proteins and an inferior food, can
result in serious breastfeeding problems once the mother tries to go back to
breastfeeding. If anyone is interested in the list of articles on the risks of not
breastfeeding (mentioned below), I would be pleased to send it on.
Jack Newman, MD, FRCPC
Magnetic Resonance Imaging: Gadopentetate (Gadolinium) is the contrast
material, and this is the reason mothers are being told they must not
breastfeeding.
With regard to this:
1. the American Academy of Pediatrics considers this drug compatible with
continued breastfeeding.
2. in one study (1), the cumulative amount excreted from both breasts in 24
hours was only 0.023% of the administered dose. Oral absorption of
gadopentetate is only 0.8% of that ingested. Thus the amount the baby would get from a
single dose is insignificant (0.018 mmole of a gadolinium containing compound
would be absorbed by the baby in 24 hours).
3. the half life of gadopentetate is 1.6 hours. Thus 98% would be excreted
from the mother in 5 half lives or 8 hours. So why 24 hours? Why 48 hours?
Even if it were necessary, but it's not!
4. we use gadopentetate in tiny babies, some premature.
5. in another study (2) of 19 lactating women who received 0.1 mmol/kg and
one additional woman who received 0.2 mmol/kg, the cumulative dose of gadolinium
excreted in breastmilk during 24 hours was 0.57 micromole. A similar amount
was observed in the patient receiving the double dose. According to the
authors “the very small amount of gadopentetate transferred to the nursing infant
does not warrant a potentially traumatic 24 hour suspension of breastfeeding...
Of course, then they come up with the bizarre conclusion that 12 hours is
enough!!!CT scan (and other studies using radioopaque contrast media containing
iodine):
1. we do contrast studies in infants, using the same radioopaque substances
(CT scan, IVP etc)
2. iodine compounds are felt by some to be a contraindicated during
breastfeeding (I do not agree except for long term exposure), but in these contrast
media, the iodine is covalently bound to the organic molecule and is
metabolically stable and essentially not bioavailable. For the most part, these organic
radiocontrast agents are rapidly excreted without significant metabolism and
the amount of elemental iodine released is minimal. Virtually all these agents
have very short plasma half lives (<1 hour) and milk concentrations are
extremely low. Of the minimal amount in the milk, virtually none is bioavailable
to the infant and not absorbed.
Given the above, it is both irrational and harmful to the baby and the mother
to insist on interruption of breastfeeding. One can only conclude that the
interruption of breastfeeding is more harmful to the baby and the mother, than
encouraging her to continue breastfeeding as soon after the procedure as is
practical. I include a list of the risks of not breastfeeding.
With regard to radioactive contrast material, this is a different situation.
However, since many of these radioactive studies are done in the first few
days after birth when the baby is getting only small amounts of breastmilk, and
interruption of breastfeeding at this point could seriously compromise
breastfeeding, it is probably not necessary to stop breastfeeding at all. Later on,
this type of study is only occasionally an emergency, and the mother can be
advised to express her milk in advance in the amount estimated to cover the baby’
s needs for the time necessary.
1.Rofsky NM, et al. Quantitative analysis of gadopentetate dimeglumine
secreted into breastmilk. J Magnetic Resonance Imaging 1993;3:131 2.Kubik-Huch RA,
et al. Gadopentetate dimeglumine excretion into human breastmilk during
lactation. Radiology 2000;216(2);555-8
2.Kubik-Huch RA, et al. Gadopentetate dimeglumine excretion into human
breastmilk during lactation. Radiology 2000;216(2);555-8
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