title: Excretion of radionuclides in human breast milk after nuclear medicine examinations. Biokinetic and dosimetric data and recommendations on breastfeeding interruption.
abstract: OBJECTIVE
  To review early recommendations and propose guidelines for breastfeeding interruption after administration of radiopharmaceuticals, based on additional biokinetic and dosimetric data.
  
  
  METHODS
  Activity concentrations in breast milk from 53 breastfeeding patients were determined. The milk was collected at various times after administration of 16 different radiopharmaceuticals. The fraction of the activity administered to the mother excreted in the breast milk, the absorbed doses to various organs and tissues and the effective dose to the infant were estimated.
  
  
  RESULTS
  The fraction of the administered activity excreted per millilitre of milk varied widely from 10(-10) to 10(-3) MBq/MBq administered. For (99m)Tc-labelled radiopharmaceuticals, the total fraction of the administered activity excreted in the milk varied from 0.0057 % for (99m)Tc-labelled red blood cells (RBC) to 19 % for (99m)Tc-pertechnetate. The effective dose to an infant per unit activity administered to the mother ranged from 6.7 × 10(-6) mSv/MBq for (99m)Tc-labelled RBC to 3.6 × 10(-2) mSv/MBq for (99m)Tc-pertechnetate. For the other radiopharmaceuticals, the total fraction of administered activity excreted in the milk varied from 0.018 % ((51)Cr-EDTA) to 48 % ((131)I-NaI). The effective dose ranged from 5.6 × 10(-5) mSvinfant/MBqmother ((51)Cr-EDTA) to 106 mSvinfant/MBqmother ((131)I-NaI).
  
  
  CONCLUSIONS
  Based on an effective dose limit of 1 mSv to the infant and a typical administered activity, we recommend cessation of breastfeeding for (131)I-NaI and interruption of feeding for 12 h for (125)I-iodohippurate, (131)I-iodohippurate, (99m)Tc-pertechnetate and (99m)Tc-MAA. During this 12-h period all breast milk should be expressed at least three times and discarded. For the other radiopharmaceuticals included in this study, no interruption of breastfeeding is necessary.
authors.affiliation: Department of Medical Radiation Physics, Skåne University Hospital, Lund University, SE-205 02, Malmö, Sweden. sigrid.leide_svegborn@med.lu.se.
authors.forename: Sigrid
authors.initials: S
authors.lastname: Leide-Svegborn
authors.affiliation: Department of Medical Radiation Physics, Skåne University Hospital, Lund University, SE-205 02, Malmö, Sweden.
authors.forename: Lars
authors.initials: L
authors.lastname: Ahlgren
authors.affiliation: Department of Radiation Sciences, Umeå University, Umeå, Sweden.
authors.forename: Lennart
authors.initials: L
authors.lastname: Johansson
authors.affiliation: Department of Medical Radiation Physics, Skåne University Hospital, Lund University, SE-205 02, Malmö, Sweden.
authors.forename: Sören
authors.initials: S
authors.lastname: Mattsson
mesh_terms: D000328:Adult; D001942:Breast Feeding / Q000009:adverse effects / Q000379:methods*; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D008895:Milk, Human / Q000528:radiation effects*; D017410:Practice Guidelines as Topic; D011829:Radiation Dosage; D019275:Radiopharmaceuticals / Q000008:administration & dosage / Q000009:adverse effects / Q000493:pharmacokinetics*; D014018:Tissue Distribution; D014055:Tomography, Emission-Computed / Q000009:adverse effects
chemical_list: D019275:Radiopharmaceuticals
keywords: Absorbed dose; Breast milk; Breastfeeding; Nuclear medicine; Radiopharmaceutical