MRI
Everyday exposureMedical tests & proceduresAlso called · 5 names▾▴
magnetic resonance imaging, MRI scan, magnetic resonance scan, MRI with contrast, gadolinium MRI
Imaging test
General information · effects depend on amount, timing, and how it is used. About these sources
Research strength: 4 / 5
MotherToBaby says MRI uses magnetic fields and radio waves, not ionizing radiation, and ACR supports noncontrast scans up to 3T in Normal Operating Mode when the test is expected to help and no practical alternative provides the needed information. Among births after 20 weeks, Ray et al. compared 1,737 first-trimester MRI exposures and found no significant rise in birth defects or hearing or vision loss; its estimate for stillbirth or newborn death included a possible increase. MotherToBaby says MRI-related miscarriage risk has not been studied, and Ray's cohort could not assess earlier losses. ACR and ACOG limit routine gadolinium; EMA's 2024 review of gadopentetic acid judged a causal link to pregnancy risks at least reasonably possible, and the MHRA's 2026 guidance says gadolinium-based contrast should generally be avoided unless potential benefits clearly outweigh fetal risks. The FDA gadoterate label says to use the agent during pregnancy only when imaging is essential and cannot be delayed; its boxed warning says gadoterate is not approved for injection into the spinal canal, where gadolinium-based contrast can cause death, coma, encephalopathy, or seizures, and warns that impaired clearance can lead to nephrogenic systemic fibrosis (NSF), a potentially fatal or disabling disease of the skin, muscle, and internal organs. Ask your provider about your situation.
Last reviewed: 2026-10-16
Sources
- MotherToBaby: Magnetic Resonance Imaging (MRI)Teratology service
- ACOG Committee Opinion No. 723: Guidelines for Diagnostic Imaging During Pregnancy and LactationProfessional society
- ACR Manual on MR Safety
- Ray et al., JAMA 2016: Association Between MRI Exposure During Pregnancy and Fetal and Childhood OutcomesUS government
- ACR Manual on Contrast Media: Pregnancy guidance
- EMA CMDh position on gadopentetic acid, PSUSA/00001504/202304EU agencyEuropean guidance
- SMFM Consult Series #76: Cancer in pregnancyProfessional society
- DailyMed: Gadoterate meglumine injection labelDrug company label
Research strength: 4 / 5
MotherToBaby says MRI can be performed in any trimester when medically needed; ACOG calls it an imaging option when it answers a clinical question, and ACR supports noncontrast scans up to 3T in Normal Operating Mode when no practical alternative provides the same information. Chartier et al.'s 2019 study compared 81 healthy newborns exposed to 3T MRI during pregnancy with 162 controls and found no significant difference in birth weight or hearing impairment; it did not assess every outcome. ACR and ACOG advise against routine gadolinium; the EMA's 2024 review of gadopentetic acid judged a causal link to pregnancy risks at least reasonably possible, and the MHRA's 2026 guidance says gadolinium-based contrast should generally be avoided unless potential benefits clearly outweigh fetal risks. The 2026 SMFM cancer consult says clinically indicated gadolinium for MRI should not be withheld during cancer care; that advice is specific to cancer. The FDA gadoterate label says to use the agent during pregnancy only when imaging is essential and cannot be delayed; its boxed warning says gadoterate is not approved for injection into the spinal canal, where gadolinium-based contrast use can cause death, coma, encephalopathy, or seizures; impaired drug clearance raises the risk of potentially fatal or disabling nephrogenic systemic fibrosis. Ask your provider about your situation.
Last reviewed: 2026-10-16
Sources
- MotherToBaby: Magnetic Resonance Imaging (MRI)Teratology service
- ACOG Committee Opinion No. 723: Guidelines for Diagnostic Imaging During Pregnancy and LactationProfessional society
- ACR Manual on MR Safety
- Chartier et al., AJR 2019: The Safety of Maternal and Fetal MRI at 3 TUS government
- ACR Manual on Contrast Media: Pregnancy guidance
- SMFM Consult Series #76: Cancer in pregnancyProfessional society
- DailyMed: Gadoterate meglumine injection labelDrug company label
Research strength: 4 / 5
MotherToBaby says medically needed MRI can be performed in any trimester, and the ACR manual supports noncontrast MRI up to 3T in Normal Operating Mode when no practical alternative can provide the needed information. Chartier et al.'s 2019 study found no significant difference in birth weight or hearing impairment among 81 exposed healthy newborns and 162 controls, though it did not assess all outcomes. The 2026 MHRA MRI guidance says gadolinium-based contrast should generally be avoided unless their potential benefits clearly outweigh fetal risks; ACR and ACOG advise against routine use, and the EMA's 2024 review of gadopentetic acid judged a causal link to pregnancy risks at least reasonably possible. SMFM's 2026 recommendation not to withhold clinically indicated gadolinium applies to cancer care, rather than routine imaging. The FDA gadoterate label says to use the agent during pregnancy only when imaging is essential and cannot be delayed; its boxed warning says gadoterate is not approved for injection into the spinal canal, where gadolinium-based contrast use can cause death, coma, encephalopathy, or seizures; impaired drug clearance raises the risk of potentially fatal or disabling nephrogenic systemic fibrosis. Ask your provider about your situation.
Last reviewed: 2026-10-16
Sources
- MotherToBaby: Magnetic Resonance Imaging (MRI)Teratology service
- ACOG Committee Opinion No. 723: Guidelines for Diagnostic Imaging During Pregnancy and LactationProfessional society
- ACR Manual on MR Safety
- Chartier et al., AJR 2019: The Safety of Maternal and Fetal MRI at 3 TUS government
- MHRA Safety Guidelines for MRI Equipment in Clinical Use, fifth editionUK government
- ACR Manual on Contrast Media: Pregnancy guidance
- SMFM Consult Series #76: Cancer in pregnancyProfessional society
- DailyMed: Gadoterate meglumine injection labelDrug company label
MRI — Breastfeeding
Research strength: 4 / 5
MotherToBaby says MRI without contrast needs no nursing break, and ACOG and the 2026 ACR criteria say breastfeeding need not be interrupted after gadolinium. Kubik-Huch et al. measured gadolinium in milk from 20 women and found less than 0.04% of the maternal dose in milk over 24 hours; the ACR manual estimates that less than 0.0004% of the maternal dose reaches an infant's circulation after gut absorption. Kubik-Huch measured milk levels, not infant outcomes, so the smaller figure is an estimate of infant absorption rather than a measured effect in babies. ACR says a parent who remains concerned may choose a 12- to 24-hour pause, but a routine 24-hour stop is not required. The FDA gadoterate label's boxed warning says gadoterate is not approved for injection into the spinal canal; gadolinium-based contrast injected into the spinal canal can cause death, coma, encephalopathy, or seizures, and impaired drug clearance raises the risk of potentially fatal or disabling nephrogenic systemic fibrosis. Ask your provider about your situation.
Last reviewed: 2026-10-16
Sources
- MotherToBaby: Magnetic Resonance Imaging (MRI)Teratology service
- ACOG Committee Opinion No. 723: Guidelines for Diagnostic Imaging During Pregnancy and LactationProfessional society
- ACR Manual on Contrast Media: Breastfeeding guidance
- Kubik-Huch et al., Radiology 2000: Gadopentetate dimeglumine excretion into human breast milk during lactationUS government
- ACR Appropriateness Criteria: Breast Imaging During Lactation, 2026US government
- DailyMed: Gadoterate meglumine injection labelDrug company label
Pregnancy
Noncontrast MRI: Ray et al. (2016) analyzed Ontario health records for 1,424,105 deliveries after 20 weeks from 2003 to 2015; 1,737 had first-trimester MRI. The study found no statistically significant increase in congenital anomalies, neoplasms, or hearing or vision loss. Stillbirth or neonatal death had an adjusted relative risk of 1.68 (95% CI, 0.97 to 2.90), which was not statistically significant. The study design could not assess miscarriages before 20 weeks. Chartier et al. (2019) studied 81 healthy neonates exposed to 3T MRI at any gestational age and 162 controls; mean birth weight was 3,398 g vs 3,510 g (p=0.06), and hearing impairment was 0/81 vs 3/162 (p=0.55). Gadolinium-enhanced MRI: Ray et al. identified 397 exposed births; a broad rheumatologic, inflammatory, or infiltrative skin outcome occurred in 123 vs 384,180 unexposed births (adjusted HR 1.36, 95% CI 1.09 to 1.69). There were 7 stillbirths or neonatal deaths in the gadolinium-exposed cohort vs 9,844 such events in the unexposed cohort (adjusted RR 3.70, 95% CI 1.55 to 8.85; adjusted risk difference 47.5 per 1,000 pregnancies, 95% CI 9.7 to 138.2). ACR notes that the comparator was no MRI rather than MRI without GBCA, the exposed group was small, and postnatal GBCA exposure was not assessed. Winterstein et al. (2023) reviewed more than 11 million Medicaid-covered pregnancies and included 5,991 qualifying pregnancies; fetal or neonatal death was 11 (1.4%) in the GBCA MRI group and 73 (1.4%) in the non-GBCA MRI group (adjusted RR 0.73, 95% CI 0.34 to 1.55), and NICU admission had adjusted RR 1.03 (95% CI 0.76 to 1.39). This study addressed death and NICU admission, not subacute outcomes, and excluded concurrent cancer. EMA's 2024 review specific to gadopentetic acid concluded that a causal relationship with risks from administration during pregnancy was at least a reasonable possibility; its product information states that pregnancy data are limited and fetal effects are unknown.
Breastfeeding
Kubik-Huch et al. (2000) measured gadopentetate in milk after an intravenous dose in 20 lactating women. The cumulative amount in milk over 24 hours was 0.57 ± 0.71 micromol (range 0.05 to 3.0); the amount was less than 0.04% of the maternal intravenous dose (mean 0.009%, range 0.001% to 0.04%). The study did not measure infant blood levels or infant outcomes. The ACR Manual estimates that less than 0.04% of the maternal dose enters milk and less than 1% of that is absorbed by the infant's gut, giving an estimated systemic infant dose below 0.0004% of the maternal dose. ACOG's Committee Opinion, reaffirmed in 2026, says breastfeeding need not be interrupted after gadolinium. The 2026 ACR Appropriateness Criteria also say gadolinium exposure through milk is negligible and does not require a nursing interruption. These are milk-transfer measurements and pharmacokinetic estimates plus clinical guidance, not direct evidence from a large infant-outcome study.
MRI is a scan that uses a strong magnetic field and radio waves to make images; it does not use ionizing radiation. MRI may be performed with or without contrast. Gadolinium-based contrast is usually injected into a vein and helps some organs, tissues, or blood vessels show more clearly. MotherToBaby says most MRI exams during pregnancy are done without contrast. The gadoterate label warnings apply to contrast use and do not describe the MRI scanner itself.
What was tested
Ray et al. (2016) used Ontario health databases to study births after 20 weeks from 2003 to 2015. The first-trimester MRI analysis covered stillbirth or neonatal death, congenital anomalies, neoplasms, and hearing or vision loss to age four; the separate GBCA analysis covered NSF-like conditions, a broader group of rheumatologic, inflammatory, or infiltrative skin conditions, and stillbirth or neonatal death. It did not assess miscarriage before 20 weeks. Chartier et al. (2019) compared birth weight and hearing in 81 healthy neonates exposed to 3T MRI at any gestational age and 162 controls. Winterstein et al. (2023) used Medicaid claims linked to medical records and birth and death records; of more than 11 million covered pregnancies, 5,991 met study criteria. The study compared GBCA MRI with non-GBCA MRI for fetal or neonatal death and NICU admission, but did not measure subacute outcomes and excluded concurrent cancer. Kubik-Huch et al. (2000) measured gadolinium in milk from 20 lactating women and did not measure infant outcomes.
Gadolinium contrast during pregnancy: general limits and cancer-specific care
- Source A says
- ACR says GBCAs should not be routinely administered and should be used only when considered critical and benefits justify unknown fetal risk. ACOG says gadolinium use should be limited to cases where it significantly improves diagnostic performance and is expected to improve maternal or fetal outcome. The FDA gadoterate label says to use the agent only when imaging is essential and cannot be delayed. (ACR Manual on Contrast Media: Pregnancy guidance, ACOG Committee Opinion No. 723: Guidelines for Diagnostic Imaging During Pregnancy and Lactation, DailyMed: Gadoterate meglumine injection label)
- Source B says
- The 2026 SMFM cancer consult says gadolinium contrast for MRI should not be withheld from a pregnant person if clinically indicated. (SMFM Consult Series #76: Cancer in pregnancy)
- Why they differ
- The SMFM statement addresses cancer diagnosis and treatment, where imaging is clinically indicated; the general ACR and ACOG guidance addresses routine use. These are different clinical settings. EMA's 2024 position applies specifically to gadopentetic acid, while the FDA warning quoted here is for gadoterate meglumine.
- Other sources
- The UK MHRA's 2026 MRI guidance says gadolinium-based contrast should generally be avoided during pregnancy unless potential benefit clearly outweighs fetal risk. Ray et al. reported associations in a small GBCA-exposed birth cohort; Winterstein et al. found no higher rate of fetal or neonatal death or NICU admission, but did not evaluate subacute outcomes. (MHRA Safety Guidelines for MRI Equipment in Clinical Use, fifth edition, Ray et al., JAMA 2016: Association Between MRI Exposure During Pregnancy and Fetal and Childhood Outcomes, Winterstein et al., American Journal of Obstetrics and Gynecology 2023: Fetal or neonatal death and NICU admission after GBCA MRI)
- What the evidence shows overall
- The two cohorts measured different outcomes and used different exposure comparisons, so they do not settle all fetal risks from GBCA. ACR does not recommend routine GBCA use, and ACOG limits it to situations where it improves diagnosis and expected outcome. SMFM's instruction applies to clinically indicated cancer care and does not replace the general contrast caution.
- ACOG identifies ultrasound and MRI as imaging techniques of choice during pregnancy and says they are used prudently when they answer a relevant clinical question or provide medical benefit. (ACOG Committee Opinion No. 723)
- The ACR Manual supports noncontrast MRI up to 3T in Normal Operating Mode when there is expected benefit to the patient or fetus and no other practical way to obtain the same information. (ACR Manual on MR Safety)
- The ACR Manual on Contrast Media says gadolinium contrast should be used during pregnancy only when its use is considered critical and the potential benefits justify the unknown fetal risk. (ACR Manual on Contrast Media)
- The FDA gadoterate label says to use it only when imaging is essential during pregnancy and cannot be delayed. (DailyMed gadoterate label)
- The ACR Manual says stopping breastfeeding for 24 hours after maternal IV or IA gadolinium exposure is not required. It also describes a 12- to 24-hour pause as an option for a parent who remains concerned after receiving the information. (ACR Manual on Contrast Media)
- SMFM's 2026 cancer consult recommends that clinically indicated gadolinium contrast for MRI not be withheld in cancer care during pregnancy; the same consult names ultrasound and noncontrast MRI as first-line imaging. (SMFM Consult Series #76)
General research, not specific to pregnancy.
The DailyMed label reports that gadolinium can remain in the body for months or years, even in people with normal kidney function; the clinical consequences of retention are unknown. The label also describes nephrogenic systemic fibrosis risk in people with impaired drug elimination.
- The gadoterate label says gadolinium is retained for months or years in the brain, bone, skin, and other organs in patients with normal renal function, and the clinical consequences are unknown. It says retention is greater after linear agents than after macrocyclic agents. (DailyMed: Gadoterate meglumine injection label)
- The FDA boxed warning states that GBCAs increase the risk of nephrogenic systemic fibrosis among patients with impaired drug elimination. It says the condition may result in fatal or debilitating fibrosis affecting skin, muscle, and internal organs. (DailyMed: Gadoterate meglumine injection label)
- MotherToBaby: Magnetic Resonance Imaging (MRI)Teratology serviceSecondary
- ACOG Committee Opinion No. 723: Guidelines for Diagnostic Imaging During Pregnancy and LactationProfessional societySecondaryIndependent check
- ACR Manual on MR Safety (current ACR download)SecondaryIndependent check
- ACR Manual on Contrast Media: Pregnancy guidanceSecondaryIndependent check
- Ray et al., JAMA 2016: Association Between MRI Exposure During Pregnancy and Fetal and Childhood OutcomesUS governmentPrimaryIndependent check
- Chartier et al., AJR 2019: The Safety of Maternal and Fetal MRI at 3 TUS governmentPrimaryIndependent check
- Winterstein et al., American Journal of Obstetrics and Gynecology 2023: Fetal or neonatal death and NICU admission after GBCA MRIUS governmentPrimaryIndependent check
- Kubik-Huch et al., Radiology 2000: Gadopentetate excretion into human breast milkUS governmentPrimaryIndependent check
- SMFM Consult Series #76: Cancer in pregnancyProfessional societySecondaryIndependent check
- EMA CMDh position on gadopentetic acid, PSUSA/00001504/202304EU agencySecondaryIndependent checkEuropean guidance
- MHRA Safety Guidelines for MRI Equipment in Clinical Use, fifth editionUK governmentSecondaryIndependent check
- DailyMed: Gadoterate meglumine injection labelDrug company labelTertiary
- ACR Appropriateness Criteria: Breast Imaging During Lactation, 2026US governmentSecondaryPage dated 2026-03-26Independent check
Last reviewed 2026-10-16
Independent check 2026-10-16
Not yet clinician-reviewed
Ask your provider about your situation.