Radioisotopes in Lactation

When assessing the use of a radioisotope in lactation, it is important to know that the International Commission on Radiological Protection (ICRP) recommends to limit the infants exposure to less than 1 millisievert (mSv) of radiation.[1] To put this exposure in context, the average American adult is exposed to 6.2 mSv of radiation per year from their environ- ment. Please be advised that these recommendations still permit a minimal amount of radiation transfer to the infant; to avoid any radiation to the infant it is best to wait for all of the radiopharmaceutical to decay (5-10 radioactive half-lives). The physician may use discretion in their recommendation based on maternal and infant health and increase or decrease the duration of interruption. In addition, please follow any further instructions regarding limitations of close contact (proximity to the infant) and duration of contact as per your healthcare provider (procedure/radioisotope dependent).

References

1. Mattsson S, Johansson L, Svegborn S et al. Radiation dose to patients from radiopharmaceuticals: a compendium of current information related to frequently used substances. Annex D. Recommenda- tions on breast-feeding interruptions. Ann ICRP 2015;44(2Suppl):319-21.
2. Rubow S, Klopper J, Wasserman H et al. The excretion of radiopharmaceuticals in human breast milk: additional data and dosimetry. European Journal of Nuclear Medicine 1994;21:144-53.
3. Moses-Kolko EL, Meltzer CC, Helsel JC et al. No interruption of lactation in needed after (11)C-WAY 100635 or (11)C-raclopride PET. J Nucl Med 2003 Oct;46(10):1765.
4. Pullar M, Hartkamp A. Excretion of radioactivity in breast milk following administration of an 113-Indium labeled chelate complex. Br J Radial 1977; 50:846.
5. Leide-Svegborn S, Ahlgren L, Johansson L et al. Excretion of radiopharmaceuticals in human breast milk after nuclear medicine examinations. Biokinetic and dosimetric data and recommendations on breastfeeding interruption. Eur J Nucl Med Mol Imaging 2015: DOI 10.1007/s00259-016-3326-4.
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7. Howe DB, Beardsley M, Bakhsh S. Appendix U. Model Procedure for Release of Patients or Human Research Subjects Administered Radioactive Materials. NUREG1556. Consolidated guidance about materials licenses. Program-specific guidance about medical use licenses. Final report. U.S. Nuclear Regulatory Commission Office of Nuclear Material Safety and Safeguards. 2008;9, Rev. 2. https://www.nrc.gov/docs/ML0734/ML073400289.pdf
8. Dilsizian V, Metter D, Palestro C, et al. Advisory Committee on Medical Uses of Isotopes (ACMUI) Sub-Committee on Nursing Mother Guidelines for the Medical Administration of Radioactive Material. Final report submitted: January 31, 2019. https://www.nrc.gov/docs/ML1903/ML19038A498.pdf.
9. American Academy of Pediatrics (AAP), Committee on Drugs. Transfer of drugs and other chemicals into human milk. Pediatrics 2001; 108(3):776-89.
10. American Academy of Pediatrics Committee on Drugs. The transfer of drugs and therapeutics into human breast milk: an update on selected topics. Pediatrics 2013;132(3):796-809.
11. International Atomic Energy Agency (IAEA). Radiation Protection and Safety in Medical uses of Ionizing Radiation, Specific Safety Guides. Appendix III, Cessation of Breastfeeding. 2018.
12. Bartick M, Hernández-Aguilar MT, Wight N, et al. ABM Clinical Protocol #35: Supporting Breastfeeding During Maternal or Child Hospitalization Breastfeed Med. 2021;16(9):664-674.