First-trimester MR exam OK, but hold the gadolinium
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First-trimester MR exam OK, but hold the gadolinium

por Thomas Dworetzky , Contributing Reporter
MR studies in the first-trimester of pregnancy do not boost risks to the fetus, Canadian researchers report.

The study, published in JAMA, reviewed the records of 1.4 million births in Ontario between 2003 and 2015. The study is the first controlled examination of first-trimester safety, according to a report from St. Michael's Hospital.

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“For first-trimester MR exposure, the risk of stillbirth or neonatal death within 28 days of birth and any congenital anomaly, neoplasm, and hearing or vision loss was evaluated from birth to age 4 years,” reported Dr. Joel Ray and colleagues.

“Having an MR at the earliest stages of pregnancy does not seem to alter the development of the fetus,” said Ray, who is a physician and researcher at St. Michael’s Hospital and an adjunct scientist at ICES.

“We already have a fair amount of data on CAT scan safety in pregnancy, but MR was lacking,” Ray told CBS New York.

Use of gadolinium-enhanced MR in pregnancy is another matter, the study found, noting that “gadolinium MR at any time during pregnancy was associated with an increased risk of a broad set of rheumatological, inflammatory, or infiltrative skin conditions and for stillbirth or neonatal death.”

The study “reinforces a to-date evidence-free notion that gadolinium might harm the fetus,” Ray told the station. “Gadolinium contrast would be best avoided in pregnancy.”

Five contrast agents use gadolinium, according to a report in Forbes. These are Magnevist, MultiHance, Omniscan, OptiMARK and ProHance.

“The 397 newborns exposed to gadolinium did have a statistically significant 1.3 times greater risk of any kind of rheumatological, inflammatory or skin condition,” noted the magazine, adding that “infants exposed to gadolinium also had triple the risk of stillbirth or newborn death, based on seven deaths, 1.8 percent of all those exposed to gadolinium. Meanwhile, 0.7 percent of those not exposed to any MR died.”

Ray and his fellow researchers used health data housed at the Institute for Clinical Evaluative Sciences. They examined and compared the data of those who had first-trimester MRs and those who had not. They also followed the children born to these women to age 4.

In addition, the researchers found that one out of every 250 pregnant Ontarians had an MR during pregnancy and that one in 1,200 did so during the first trimester.

The report did not have information as to the conditions that led to the use of MR, but specialties of the ordering physicians were gathered. The requests for first-trimester MRs came from physicians in family medicine 44 percent of the time, brain sciences 14 percent of the time, general surgery 5 percent of the time, orthopedic surgery 6.5 percent of the time, and internal medicine 5 percent of the time.

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