Prenatal X-Ray Exposure and Teratogenic Risks: A Literature Review

Authors

Department of Obstetrics and Gynaecology, Telefono Rosso Teratology Information Service, Catholic University of the Sacred Heart, Rome, Italy

Abstract

Context: Many women of reproductive age and pregnant women require diagnostic tests involving ionizing radiation. Fetal exposure to radiation worries both the patient and the obstetricians and could lead to inappropriate termination of pregnancy.
 
Evidence Acquisition: To conduct this review of the literature Pub-med was searched. Retrospective studies, reviews of literature, multicentric epidemiological case control studies were reviewed. Official data base Reprotox and The Teratogen Information System Teris were also consulted.
 
Results: Standard diagnostic X ray tests including those of the lower abdomen imply that the dose absorbed by the uterus is in any case less than 0.05 Sv ( = 5 rad). The majority of the studies in literature estimates that 1-2 rad fetal exposure may increase the risk of leukemia of 1.5 - 2.0 over the natural incidence, meaning that 1 in 2,000 children exposed to ionizing radiation in utero will develop leukemia in childhood.
Conclusions: At present, no single diagnostic procedure is able to cause damage to the embryo or fetus. There are possible harmful effects for doses above 0.2 - 0.25 Gy (20-25 rad).

Keywords

Open Access Policy: This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited. To view a copy of this licence, visit https://creativecommons.org/licenses/by/4.0/

References

1. Tracking Radiation Exposure from Medical Diagnostic Procedures: Workshop Reports Committee on Tracking Radiation Doses from Medical Diagnostic Procedures, Nuclear and Radiation Studies Board, Division on Earth and Life Studies, National Research .Washington (DC): National Academies Press; 2011.
 
2. De Santis M, Cesari E, Ligato MS, Nobili E, Straface G, Cavaliere A, et al. Prenatal drug exposure and teratological risk: one-year experience of an Italian Teratology Information Service. Med Sci Monit. 2008;14(2):PH1-8.
 
3. Teh WT, Stern C, Chander S, Hickey M. The impact of uterine radiation on subsequent fertility and pregnancy outcomes. Biomed Res Int. 2014;2014:482968.
https://doi.org/10.1155/2014/482968
PMid:25165706 PMCid:PMC4140124
 
4. Fitzpatrick RB. REPROTOX: an information system on environmental hazards to human reproduction and development. Med Ref Serv Q. 2008;27(1):73-80.
https://doi.org/10.1300/J115v27n01_05
PMid:18689204
 
5. Friedman JM, Polifka J. TERIS: Teratogenic effects of drugs in resourcefor clinicians (TERIS) Second edition. Baltimore: The Johns Hopkins University Press; 2000. Available from: http://apps.medical.washington.edu/Teris/default.aspx. 6.
 
6. McElhatton RM, Garbis H, Schaefer C. Academic Press; 2001. Drugs during pregnancy and lactation, Chapter: 2.22.
 
7. Parker L, Pearce MS, Dickinson HO, Aitkin M, Craft AW. Stillbirths among offspring of male radiation workers at Sellafield nuclear reprocessing plant. Lancet. 1999;354(9188):1407-14.
https://doi.org/10.1016/S0140-6736(99)04138-0
PMid:10543666
 
8. Doyle P, Maconochie N, Roman E, Davies G, Smith PG, Beral V. Fetal death and congenital malformation in babies born to nuclear industry employees: report from the nuclear industry family study. Lancet. 2000;356(9238):1293-9.
https://doi.org/10.1016/S0140-6736(00)02812-9
PMid:11073016
 
9. Otake M, Schull WJ. In utero exposure to A-bomb radiation and mental retardation; a reassessment. Br J Radiol. 1984; 57(677):409-14.
https://doi.org/10.1259/0007-1285-57-677-409
PMid:6539140
 
10. Otake M, Schull WJ, Lee S. Threshold for radiation-related severe mental retardation in prenatally exposed A-bomb survivors: a reanalysis. Int J Radiat Biol. 1996;70(6):755-63.
https://doi.org/10.1080/095530096144644
PMid:8980673
 
11. Yamazaki JN, Schull WJ. Perinatal loss and neurological abnormalities among children of the atomic bomb. Nagasaki and Hi- D'Oria L et al. Razavi Int J Med. 2015;3(2):e27508 5 roshima revisited, 1949 to 1989. JAMA. 1990;264(5):605-9.
https://doi.org/10.1001/jama.1990.03450050063029
PMid:2366301
 
12. Loewe WE, Mendelsohn E. Revised dose estimates at Hiroshima and Nagasaki. Health Phys. 1981;41(4):663-6.
 
13. Brent RL. Utilization of developmental basic science principles in the evaluation of reproductive risks from pre- and postconception environmental radiation exposures. Teratology. 1999;59(4):182-204.
https://doi.org/10.1002/(SICI)1096-9926(199904)59:4<182::AID-TERA2>3.0.CO;2-H
 
14. Sternberg J. Radiation and pregnancy. Can Med Assoc J. 1973; 109(1):51-7.
https://doi.org/10.1007/978-94-011-6621-8_44
PMCid:PMC1946757
 
15. Mettler FA, Moseley RD. Medical Effects of Ionizing Radiation.New York: Grune & Stratton; 1985.
 
16. Toppenberg KS, Hill DA, Miller DP. Safety of radiographic imaging during pregnancy. Am Fam Physician. 1999;59(7):1813-8.
 
17. Kahaleh M, Hartwell GD, Arseneau KO, Pajewski TN, Mullick T, Isin G, et al. Safety and efficacy of ERCP in pregnancy. Gastrointest Endosc. 2004;60(2):287-92.
https://doi.org/10.1016/S0016-5107(04)01679-7
PMid:15278066
 
18. Mortimer AM, Bradley MD, Likeman M, Stoodley NG, Renowden SA. Cranial neuroimaging in pregnancy and the post-partum period. Clin Radiol. 2013;68(5):500-8.
https://doi.org/10.1016/j.crad.2012.08.024
PMid:23063171
 
19. Jacobsen L, Mellemgaard L. A retrospective study of the possible teratogenic effects of diagnostic pelvic X-irradiation, in Progress in Radiology.Amsterdam: Excerpta Medica; 1966.
 
20. Cheeseman EA, Walby AL. Intra-Uterine Irradiation and Iris Heterochromia. Ann Hum Genet. 1963;27:23-9.
https://doi.org/10.1111/j.1469-1809.1963.tb00777.x
PMid:14059286
 
21. De Santis M, Di Gianantonio E, Straface G, Cavaliere AF, Caruso A, Schiavon F, et al. Ionizing radiations in pregnancy and teratogenesis: a review of literature. Reprod Toxicol. 2005;20(3):323-9. 22. Dunn K, Yoshimaru H, Otake M, Annegers JF, Schull WJ. Prenatal exposure to ionizing radiation and subsequent development of seizures. Am J Epidemiol. 1990;131(1):114-23.
https://doi.org/10.1093/oxfordjournals.aje.a115464
PMid:2293744
 
22. Hamilton PM, Roney PL, Keppel KG, Placek PJ. Radiation procedures performed on U.S. women during pregnancy: findings from two 1980 surveys. Public Health Rep. 1984;99(2):146-51.
 
23. Hujoel PP, Bollen AM, Noonan CJ, del Aguila MA. Antepartum dental radiography and infant low birth weight. JAMA. 2004; 291(16):1987-93.
https://doi.org/10.1001/jama.291.16.1987
PMid:15113817
 
24. De Santis M, Straface G, Cavaliere AF, Caruso A, Cichocki F, Venga L, et al. First trimester maternal thyroid X-ray exposure and neonatal birth weight. Reprod Toxicol. 2005;20(1):3-4.
https://doi.org/10.1016/j.reprotox.2004.12.002
PMid:15808780
 
25. Brent RL. Commentary on JAMA article by Hujoel et al. Health Phys. 2005;88(4):379-81.
https://doi.org/10.1097/01.HP.0000152109.40007.35
PMid:15761300
 
26. Boice JD, Jr., Stovall M, Mulvihill JJ, Green DM. Dental x-rays and low birth weight. J Radiol Prot. 2004;24(3):321-3.
https://doi.org/10.1088/0952-4746/24/3/L01
PMid:15511024
 
27. Lockhart PB, Brennan MT, Sasser H, Ludlow J. Antepartum dental radiography and low birth weight. JAMA. 2004;292(9):1020.
https://doi.org/10.1001/jama.292.9.1020-a
PMid:15339889
 
28. Steinberg BJ, Hilton IV, Iida H, Samelson R. Oral Health Care during Pregnancy Expert Workgroup Oral health care during pregnancy: a national consensus statement - summary of an expert workgroup meeting. Dent Clin N Am. 2013;57:195-210.
https://doi.org/10.1016/j.cden.2013.01.002
PMid:23570802
 
29. Cohen-Karem R, Medina D, Koren G, Nulman I. Diagnostic radiation in pregnancy: termination of pregnancy due to risk misperception. Clin Mol Teratol. 2003;67(5):392.
 
30. National Council on Radiation Protection and Measurements.. NCRP Report No. 54 Medical Radiation exposure of pregnant and potentially pregnant women.: NCRP; 1979.
 
31. Harvey EB, Boice JD, Jr., Honeyman M, Flannery JT. Prenatal x-ray exposure and childhood cancer in twins. N Engl J Med. 1985;312(9):541-5.
https://doi.org/10.1056/NEJM198502283120903
PMid:3969117
 
32. MacMahon B. Childhood cancer and prenatal irradiation. In: Burchenal JH, Oettgen HF editors. Cancer Achievements, challenges and prospects for the 1980's.. New York: Grune & Stratton; 1980. pp. 223-8.
 
33. Stewart A, Webb J, Hewitt D. A survey of childhood malignancies. Br Med J. 1958;1(5086):1495-508.
https://doi.org/10.1136/bmj.1.5086.1495
PMid:13546604 PMCid:PMC2029590
 
34. Macmahon B. Prenatal x-ray exposure and childhood cancer. J Natl Cancer Inst. 1962;28:1173-91.
 
35. Wakeford R, Little MP. Risk coefficients for childhood cancer after intrauterine irradiation: a review. Int J Radiat Biol. 2003;79(5):293- 309.
https://doi.org/10.1080/0955300031000114729
PMid:12943238
 
36. Boice JD, Jr., Miller RW. Childhood and adult cancer after intrauterine exposure to ionizing radiation. Teratology. 1999; 59(4):227-33.
https://doi.org/10.1002/(SICI)1096-9926(199904)59:4<227::AID-TERA7>3.0.CO;2-E
 
37. Stalberg K, Haglund B, Axelsson O, Cnattingius S, Pfeifer S, Kieler H. Prenatal X-ray exposure and childhood brain tumors: a population-based case-control study on tumor subtypes. Br J Cancer. 2007;97(11):1583-7.
https://doi.org/10.1038/sj.bjc.6604046
PMid:17971773 PMCid:PMC2360258
 
38. Bunch KJ, Muirhead CR, Draper GJ, Hunter N, Kendall GM, O'Hagan JA, et al. Cancer in the offspring of female radiation workers: a record linkage study. Br J Cancer. 2009;100(1):213-8.
https://doi.org/10.1038/sj.bjc.6604841
PMid:19127273 PMCid:PMC2634667
 
39. Brent RL. Carcinogenic risks of prenatal ionizing radiation. Semin Fetal Neonatal Med. 2014;19(3):203-13.
https://doi.org/10.1016/j.siny.2013.11.009
PMid:24378676
 
40. Acog Committee on Obstetric Practice . ACOG Committee Opinion. Number 299, September 2004 (replaces No. 158, September 1995). Guidelines for diagnostic imaging during pregnancy. Obstet Gynecol. 2004;104(3):647-51.
https://doi.org/10.1097/00006250-200409000-00053
PMid:15339791
 
41. Brent RL. Saving lives and changing family histories: appropriate counseling of pregnant women and men and women of reproductive age, concerning the risk of diagnostic radiation exposures during and before pregnancy. Am J Obstet Gynecol. 2009;200(1):4-24.
https://doi.org/10.1016/j.ajog.2008.06.032
PMid:19121655
 
42. Stewart A. Low dose radiation cancers in man. Adv Cancer Res. 1971;14:359-90.
https://doi.org/10.1016/S0065-230X(08)60524-2
PMid:4941152
 
43. Carpenter DO, Bushkin-Bedient S. Exposure to chemicals and radiation during childhood and risk for cancer later in life. J Adolesc Health. 2013;52(5 Suppl):S21-9.
https://doi.org/10.1016/j.jadohealth.2013.01.027
PMid:23601608
 
44. Sharp C. Health surveillance--myth and reality. J Radiol Prot. 1998;18(3):195-201. 46. Osei EK, Faulkner K. Fetal doses from radiological examinations. Br J Radiol. 1999;72(860):773-80.
https://doi.org/10.1259/bjr.72.860.10624343
PMid:10624343
 

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