Resident Weill Cornell Medicine Brooklyn, New York, United States
Background: Gadolinium based contrast agent based (GBCA) is used in magnetic resonance imaging (MRI). There is no consensus from the WHO on the teratogenic effects of GBCA. GBCA has been shown to accumulate in maternal and placental tissue, as well as cord blood. Sensitivity analysis from previous research determined no significant difference between those with and without the exposure as regards to the fetal and neonate mortality and NICU admission. However, there is a lack of evidence on GBCA exposure and its impact on subacute adverse outcomes in infants and fetuses. Recent findings point to association between prenatal GBCA exposure and fetal growth restriction. Objective: To evaluate effects of prenatal exposure of gadolinium based contrast agents on placental weight, placental histopathology and growth measurements in prenatally exposed infants from birth to two years. Design/Methods: A single-center retrospective study which consisted of a cohort with universally mandated placental examination, included 1849 full term singleton newborns with gadolinium measured in placental tissue, placenta pathology, prenatal maternal outcomes, gestational age at birth, growth measures from birth to two years. Results: Out of the evaluated 1849 patients, 392 (21.2%) patients were exposed to GBCA during pregnancy. 1518 had undetectable levels of placental gadolinium. Five children had levels >50ppb, 82 1-10 ppb, and the remainder < 1 ppb (but still detectable). Mean maternal age in both groups was 29-30. The mean gestational age was 274 days and mean birth percentile was 48% in both groups. We found no significant association between prenatal gadolinium exposure and subacute or chronic prenatal maternal outcomes, such as gestational diabetes and preeclampsia. There was also no significant change in placental weight in exposed vs non-exposed mothers. There was no significant difference in outcomes in infants prenatally exposed to GBCA compared to those not exposed.
Conclusion(s): This study found no significant association between prenatal gadolinium exposure and adverse maternal outcomes, placental weight, or infant growth measurements. Exposure to gadolinium-based contrast agents during pregnancy continues to raise interest in maternal and fetal outcomes.
