In fact, the American College of Obstetricians and Gynecologists (COG) recommends that pregnant women maintain good oral health by keeping up with such routine dental procedures as X -rays, teeth cleaning, cavity-filling, and root canals. It's a still a good idea to use a leaded apron to protect your abdomen to minimize your baby's radiation exposure when you've having other parts X-rayed.
According to the American Academy of Family Physicians, x -rays are generally safe during pregnancy, but there is quite a bit of controversy surrounding this issue. Studies have been conflicting and, therefore, x -rays should only be done when the benefits outweigh the risks.
At UVA Radiology and Medical Imaging, we are dedicated to giving our patients the best care possible. Many things are especially important during pregnancy, such as eating right, cutting out cigarettes and alcohol, and being careful about the prescription and over-the-counter drugs you take.
Diagnostic x -rays and other medical radiation procedures of the abdominal area also deserve extra attention during pregnancy. Diagnostic x -rays can give the doctor important and even life-saving information about a person's medical condition.
If radiation or other agents were to cause changes in these cells, there could be a slightly increased chance of birth defects or certain illnesses, such as leukemia, later in life. It should be pointed out, however, that the majority of birth defects and childhood diseases occur even if the mother is not exposed to any known harmful agent during pregnancy.
Scientists believe that heredity and random errors in the developmental process are responsible for most of these problems. There are, however, rare situations in which a woman who is unaware of her pregnancy may receive a very large number of abdominal x -rays over a short period.
This is important for many medical decisions, such as drug prescriptions and nuclear medicine procedures, as well as x -rays. This is to prevent damage to your genes that could be passed on and cause harmful effects in your future descendants.
Most people believe that X -rays are harmful to the unborn baby as there could be risks of deformities and other congenital conditions. In fact, countless research studies have been conducted and these offer conflicting results.
Still, the rule of thumb is for the pregnant woman to avoid undergoing unnecessary medical procedures as much as possible. Maternal illness during pregnancy is not uncommon and sometimes requires radiographic imaging for proper diagnosis and treatment.
The accepted cumulative dose of ionizing radiation during pregnancy is 5 rad, and no single diagnostic study exceeds this maximum. Rare consequences of prenatal radiation exposure include a slight increase in the incidence of childhood leukemia and, possibly, a very small change in the frequency of genetic mutations.
Many women become ill while pregnant and require acute medical care, including radiographic imaging with ionizing radiation. 1 Even physicians are at times known to approach this topic in a biased and unscientific manner, leading to poor patient care and inappropriate advice.
Because some studies will be performed before a pregnancy is recognized, even doctors not routinely providing prenatal care should understand these issues. Family physicians must be ready to counsel expectant mothers requiring radiographic imaging and women who have already been exposed.
Her flank pain progressed despite antibiotic treatment, necessitating a renal ultrasound examination, which was inconclusive. An intravenous pyelogram (MVP) was ordered, but the radiologist refused to perform the study because of concern about radiation exposure to the fetus.
3 A patient's dose of photons is measured in the gray (GY) and the rem, or in the older and more commonly recognized unit, the rad. Much of our information regarding the effects of radiation in humans has come from the study of atomic bomb survivors who were irradiated with high doses while in uteri in Nagasaki and Hiroshima, Japan.
These effects can be grouped into three classic categories: teratogenesis (fetal malformation), carcinogenic (induced malignancy) and muteness (alteration of germ-line genes). The fetal malformations most commonly caused by high-dose radiation are central nervous system (CNS) changes, especially microcephaly and mental retardation.
9 A linear, dose-related association between severe mental retardation and radiation was also found, with the important caveat that most cases followed exposure during weeks 10 to 17 of gestation. 3, 10, 11 This trend reaches 40 percent at 100 rad, although it is not statistically significant at doses generated by diagnostic radiographs.
2 While these doses do fall within the range of that supplied by some radiographic studies, the absolute increase of risk (about one in 10,000) is very small. Nevertheless, physicians should carefully weigh the risks and benefits of any radiographic study and include the mother in the decision-making process whenever possible.
3 The dosage required to double this baseline mutation rate is between 50 and 100 rad, far in excess of the radiation doses occurring in common radiographic studies. Table 2 presents various conclusions from key organizations that may help physicians better understand the overall risks from x -rays and other diagnostic imaging methods.
For example, the general population's total risk of spontaneous abortion, major malformations, mental retardation and childhood malignancy is approximately 286 per 1,000 deliveries. 2, 13 However, if numbers like these are quoted to patients, they are likely to hear only the words “risk,” “abortion,” “mental retardation” and “malignancy.” This situation emphasizes the challenge that doctors face in ensuring good communication during counseling.
Graphic comparison of common radiographic studies with the accepted 5-rad cumulative fetal exposure limit. As part of counseling, physicians should help patients understand that birth anomalies frequently occur spontaneously, with no identifiable cause.
Yet, if after any exposure an anomaly is found, a parent's natural inclination may be to blame radiation, and it will then be difficult to help them understand baseline malformation rates. For example, one author reported on a case of a woman who nearly instituted legal action because of mild syndactyly of her infant's fourth and fifth fingers after third-trimester dental radiographs (exposure 0.0001 rad or less).
Diagnostic x -rays during pregnancy are considered safe, yet physicians should use reasonable caution while remaining sensitive to patients' fears and concerns. Thus, a factual discussion of the nature of the planned examination and its potential outcomes, and documenting consent are appropriate steps before ordering a study.
Women exposed to radiation exceeding a cumulative dose of 5 rad and those with particular concerns about their infant's health may require further evaluation or referral. Concerns of medico legal liability may lead some caregivers to inappropriately withhold needed x -rays, thus jeopardizing the health of both mother and fetus.
Ensuring that radiographs are truly indicated and are ordered in accordance with applicable published guidelines will give further support to a physician's course of action at any review. 17 After the nuclear reactor accident in Chernobyl, Russia, 23 percent of pregnancies in Greece were terminated because of unfounded concerns about fetal teratogenicity.
17 While electively terminating an early pregnancy is legal in the United States, it is important that patients and physicians not confuse social issues with medical ones. Medically, the additional risk imposed by diagnostic radiation is simply too small to justify terminating a pregnancy.
A pregnant woman who is ill and requires radiographic imaging faces potential risks from her disease to her own health as well as that of her developing infant's. Physicians should not hesitate to order a study if an appropriate work-up of the mother requires a specific test to guide diagnosis and treatment.
When diagnostic imaging is acutely needed, ultrasonography may represent an alternative to ionizing radiation and is considered safe throughout pregnancy.