Contrast media and breastfeeding

Contrast media and breastfeeding is an area of imaging safety that has been investigated for both iodinated and gadolinium-based contrast agents. The current guidelines do not support the cessation of breastfeeding or any special precautions after intravenous administration of these contrast media.

Iodinated contrast media

The plasma half-life of IV iodinated contrast agents is two hours, with ~100% excreted in 24 hours. Contrast agents have poor lipid solubility and <1% of dose enters breast milk. Furthermore <1% of this ingested dose is absorbed by the infant's gastrointestinal system. Therefore the total dose to the infant is <0.01%.

There is a theoretical risk of allergic reaction to contrast from breast milk, but this has never been reported:

• current guidelines do not support the cessation of breastfeeding after contrast administration
• a conservative approach, only if the mother remains concerned about any potential effects, may wait 12-24 hours, expressing and discarding milk over that period, but there is no benefit to waiting >24 hours

Gadolinium-based contrast media

The plasma half-life of IV gadolinium-based contrast agents is two hours, with ~100% excreted in 24 hours. It is estimated that <0.0004% of the maternal dose is absorbed by the infant, and it is also thought that any gadolinium in breast milk is in a stable chelated form:

• current guidelines do not support the cessation of breastfeeding after contrast administration
• a conservative approach, only if the mother remains concerned about any potential effects, may wait 12-24 hours, expressing and discarding milk over that period, but there is no benefit to waiting >24 hours