Department of Reproductive Medicine, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Reproduction & Development Research Institute, Amsterdam, the Netherlands.
Medical Library, VU University Amsterdam, Amsterdam, the Netherlands.
Eur J Endocrinol. 2021 Jan;184(1):189-198. doi: 10.1530/EJE-20-0627.
Thyroid dysfunction is a known side effect of iodinated contrast media. There is some evidence to suggest that iodinated contrast media administered to pregnant women may cause thyroid dysfunction not only in themselves but also in their offspring. Here, we systematically evaluated literature on the use of iodinated contrast media prior to or during pregnancy on the offspring's thyroid function.
Systematic review of published literature.
Relevant studies were identified by PubMed, EMBASE and The Cochrane Library up to June 5, 2020. All study designs, reporting on the foetal or neonatal thyroid function after exposure to iodinated contrast media prior to or during pregnancy, were included. We undertook random effects meta-analysis and pooled the estimates as proportions with 95% CIs.
We identified 402 articles, of which 26 were included. Six studies reported (n = 369) on exposure to iodinated contrast media prior to pregnancy by hysterosalpingography and 20 studies (n = 670) on exposure to these media during pregnancy by amniofetography, urography or CT. There was low to high risk of bias. The proportion of (transient) neonatal thyroid dysfunction was 0.0% (95% CI: 0.0-2.9% based on 3 studies) for hysterosalpingography, 2.25% (95% CI: 0.03-6.55% based on 2 studies) for amniofetography and 0.0% (95% CI: 0.0-0.02% based on 5 studies) for CT. There was a tendency towards an increased risk of thyroid dysfunction with higher amounts of contrast used.
Exposure to iodinated contrast media prior to or during pregnancy may increase the risk of thyroid dysfunction in offspring. We recommend keeping the amount of contrast used as low as possible.
甲状腺功能障碍是碘造影剂的已知副作用。有一些证据表明，给孕妇使用碘造影剂不仅会导致自身甲状腺功能障碍，还会导致其后代甲状腺功能障碍。在这里，我们系统地评估了关于孕妇在怀孕前或怀孕期间使用碘造影剂对后代甲状腺功能的影响的文献。
已发表文献的系统评价。
通过 PubMed、EMBASE 和 The Cochrane Library 检索截至 2020 年 6 月 5 日的相关文献。所有研究设计，报告在怀孕前或怀孕期间暴露于碘造影剂后胎儿或新生儿甲状腺功能的研究都被纳入。我们进行了随机效应荟萃分析，并将估计值作为比例与 95%置信区间（CI）合并。
我们共检索到 402 篇文章，其中 26 篇被纳入。6 项研究（n = 369）报告了在子宫输卵管造影术之前暴露于碘造影剂，20 项研究（n = 670）报告了在羊膜穿刺术、尿路造影术或 CT 期间暴露于这些造影剂。这些研究的偏倚风险高低不一。子宫输卵管造影术导致（短暂）新生儿甲状腺功能障碍的比例为 0.0%（95%CI：基于 3 项研究为 0.0-2.9%），羊膜穿刺术为 2.25%（95%CI：基于 2 项研究为 0.03-6.55%），CT 为 0.0%（95%CI：基于 5 项研究为 0.0-0.02%）。使用的造影剂量越高，甲状腺功能障碍的风险就越大。
在怀孕前或怀孕期间暴露于碘造影剂可能会增加后代甲状腺功能障碍的风险。我们建议尽量减少使用造影剂的量。
