{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,18]],"date-time":"2026-10-18T05:56:42Z","timestamp":1792303002156,"version":"4.4.0"},"reference-count":53,"publisher":"MDPI AG","issue":"2","license":[{"start":{"date-parts":[[2025,1,17]],"date-time":"2025-01-17T00:00:00Z","timestamp":1737072000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Diagnostics"],"abstract":"<jats:p>As medical imaging continues to expand, concerns about the potential risks of ionizing radiation to the developing fetus have led to a preference for non-radiation-based alternatives such as ultrasonography and fetal MRI. This review examines the current evidence on the safety of MRI during pregnancy, with a focus on 3 T MRI and contrast agents, aiming to provide a comprehensive synthesis that informs clinical decision-making, ensures fetal safety and supports the safe use of all available modalities that could impact management. We conducted a comprehensive review of studies from 2000 to 2024 on MRI safety during pregnancy, focusing on 3 T MRI and gadolinium use. The review included peer-reviewed articles and large database studies, summarizing key findings and identifying areas for further research. Fetal MRI, used alongside ultrasound, enhances diagnostic accuracy for fetal anomalies, particularly in the brain, thorax, gastrointestinal and genitourinary systems, with no conclusive evidence of adverse effects on fetal development. While theoretical risks such as tissue heating and acoustic damage exist, studies show no significant harm at 1.5 T or 3 T, though caution is still advised in the first trimester. Regarding gadolinium-based contrast agents, the evidence is conflicting: while some studies suggest risks such as stillbirth and rheumatological conditions, animal studies show minimal fetal retention and no significant toxicity, and later clinical research has not substantiated these risks. The existing literature on fetal MRI is encouraging, suggesting minimal risks; however, further investigation through larger, prospective and long-term follow-up studies is essential to comprehensively determine its safety and late effects.<\/jats:p>","DOI":"10.3390\/diagnostics15020208","type":"journal-article","created":{"date-parts":[[2025,1,17]],"date-time":"2025-01-17T10:27:58Z","timestamp":1737109678000},"page":"208","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":14,"title":["Fetal Safety in MRI During Pregnancy: A Comprehensive Review"],"prefix":"10.3390","volume":"15","author":[{"given":"Gal","family":"Puris","sequence":"first","affiliation":[{"name":"Arrow Program for Medical Research Education, Sheba Medical Center, Tel Hashomer, Ramat Gan 52621, Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7129-5497","authenticated-orcid":false,"given":"Angela","family":"Chetrit","sequence":"additional","affiliation":[{"name":"Gertner Institute for Epidemiology and Health Policy Research, Chaim Sheba Medical Center, Tel Hashomer, Ramat Gan 52621, Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eldad","family":"Katorza","sequence":"additional","affiliation":[{"name":"Arrow Program for Medical Research Education, Sheba Medical Center, Tel Hashomer, Ramat Gan 52621, Israel"},{"name":"Gertner Institute for Epidemiology and Health Policy Research, Chaim Sheba Medical Center, Tel Hashomer, Ramat Gan 52621, Israel"},{"name":"Department of Obstetrics and Gynecology, Sheba Medical Center, Tel Hashomer, Ramat Gan 52621, Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,1,17]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1491","DOI":"10.1377\/hlthaff.27.6.1491","article-title":"Rising use of diagnostic medical imaging in a large integrated health system","volume":"27","author":"Miglioretti","year":"2008","journal-title":"Health Aff."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"517","DOI":"10.1148\/radiol.2512080736","article-title":"Utilization of Imaging in Pregnant Patients: 10-year Review of 5270 Examinations in 3285 Patients\u20141997\u20132006","volume":"251","author":"Lazarus","year":"2009","journal-title":"Radiology"},{"key":"ref_3","first-page":"e54346","article-title":"Medical Imaging in Pregnancy: Safety, Appropriate Utilization, and Alternative Modalities for Imaging Pregnant Patients","volume":"16","author":"Albakri","year":"2024","journal-title":"Cureus"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"507","DOI":"10.1016\/j.jare.2013.06.001","article-title":"Fetal MRI: An approach to practice: A review","volume":"5","author":"Saleem","year":"2014","journal-title":"J. Adv. Res."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"335","DOI":"10.1016\/j.pbiomolbio.2004.08.010","article-title":"A review of the current use of magnetic resonance imaging in pregnancy and safety implications for the fetus","volume":"87","author":"Rivers","year":"2005","journal-title":"Prog. Biophys. Mol. Biol."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"333","DOI":"10.1097\/AOG.0b013e318180a505","article-title":"Guidelines for Computed Tomography and Magnetic Resonance Imaging Use During Pregnancy and Lactation","volume":"112","author":"Chen","year":"2008","journal-title":"Obstet. Gynecol."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"1989","DOI":"10.3174\/ajnr.A6771","article-title":"Fetal Exposure to MR Imaging: Long-Term Neurodevelopmental Outcome","volume":"41","author":"Zvi","year":"2020","journal-title":"Am. J. Neuroradiol."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"195","DOI":"10.2214\/AJR.14.14205","article-title":"Comparison Between 1.5-T and 3-T MRI for Fetal Imaging: Is There an Advantage to Imaging with a Higher Field Strength?","volume":"206","author":"Victoria","year":"2016","journal-title":"Am. J. Roentgenol."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"664","DOI":"10.1148\/radiol.2020191550","article-title":"Specific Absorption Rate and Specific Energy Dose: Comparison of 1.5-T versus 3.0-T Fetal MRI","volume":"295","author":"Barrera","year":"2020","journal-title":"Radiology"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"385","DOI":"10.1016\/j.mric.2024.02.007","article-title":"3 Tesla Fetal MR Imaging Quality and Safety Considerations","volume":"32","author":"Kirsch","year":"2024","journal-title":"Magn. Reson. Imaging Clin."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"25","DOI":"10.1097\/00002142-200102000-00004","article-title":"Ultrasound versus magnetic resonance imaging in fetal evaluation","volume":"12","author":"Levine","year":"2001","journal-title":"Top. Magn. Reson. Imaging"},{"key":"ref_12","first-page":"1688","article-title":"Fast MR imaging of fetal CNS anomalies in utero","volume":"21","author":"Simon","year":"2000","journal-title":"Am. J. Neuroradiol."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"398","DOI":"10.1148\/radiol.2322030504","article-title":"Fetal anomalies: Comparison of MR imaging and US for diagnosis","volume":"232","author":"Frates","year":"2004","journal-title":"Radiology"},{"key":"ref_14","first-page":"1011","article-title":"Central nervous system abnormalities assessed with prenatal magnetic resonance imaging","volume":"94","author":"Levine","year":"1999","journal-title":"Obstet. Gynecol."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"538","DOI":"10.1016\/S0140-6736(16)31723-8","article-title":"Use of MRI in the diagnosis of fetal brain abnormalities in utero (MERIDIAN): A multicentre, prospective cohort study","volume":"389","author":"Griffiths","year":"2017","journal-title":"Lancet"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"882","DOI":"10.1002\/jmri.23502","article-title":"Contribution of MRI to ultrasound in the diagnosis of fetal anomalies","volume":"35","author":"Kul","year":"2012","journal-title":"J. Magn. Reason. Imaging"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"203","DOI":"10.3171\/ped.2006.105.3.203","article-title":"Impact of prenatal magnetic resonance imaging on postnatal neurosurgical treatment","volume":"105","author":"Miller","year":"2006","journal-title":"J. Neurosurg. Pediatr."},{"key":"ref_18","unstructured":"Radiology ACo (2025, January 13). ACR-SPR Practice Parameter for the Safe and Optimal Performance of Fetal Magnetic Resonance Imaging (MRI). Available online: https:\/\/www.acr.org\/-\/media\/ACR\/Files\/Practice-Parameters\/mr-fetal.pdf."},{"key":"ref_19","unstructured":"American Psychological Association (APA) (2023). Mental Health and Productivity in the Military, American Psychological Association (APA). APA Report."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"278","DOI":"10.1002\/uog.26129","article-title":"ISUOG Practice Guidelines (updated): Performance of fetal magnetic resonance imaging","volume":"61","author":"Prayer","year":"2023","journal-title":"Ultrasound Obstet. Gynecol."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"37","DOI":"10.1007\/s00247-018-4261-2","article-title":"Does 3-T fetal MRI induce adverse acoustic effects in the neonate? A preliminary study comparing postnatal auditory test performance of fetuses scanned at 1.5 and 3 T","volume":"49","author":"Jaimes","year":"2019","journal-title":"Pediatr. Radiol."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"1170","DOI":"10.2214\/AJR.19.21400","article-title":"The Safety of Maternal and Fetal MRI at 3 T","volume":"213","author":"Chartier","year":"2019","journal-title":"Am. J. Roentgenol."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"871","DOI":"10.3109\/01443615.2015.1017559","article-title":"A case series of 15 women inadvertently exposed to magnetic resonance imaging in the first trimester of pregnancy","volume":"35","author":"Choi","year":"2015","journal-title":"J. Obstet. Gynaecol."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"530","DOI":"10.1148\/radiol.14141382","article-title":"Safety of MR Imaging at 1.5 T in Fetuses: A Retrospective Case-Control Study of Birth Weights and the Effects of Acoustic Noise","volume":"275","author":"Strizek","year":"2015","journal-title":"Radiology"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"952","DOI":"10.1001\/jama.2016.12126","article-title":"Association Between MRI Exposure During Pregnancy and Fetal and Childhood Outcomes","volume":"316","author":"Ray","year":"2016","journal-title":"JAMA"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"1823","DOI":"10.1007\/s00247-015-3408-7","article-title":"Fetal magnetic resonance imaging: Exposure times and functional outcomes at preschool age","volume":"45","author":"Robertson","year":"2015","journal-title":"Pediatr. Radiol."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"526","DOI":"10.1016\/j.nicl.2014.01.013","article-title":"Data on the safety of repeated MRI in healthy children","volume":"4","author":"Holland","year":"2014","journal-title":"Neuroimage Clin."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"1085","DOI":"10.1007\/s00247-023-05629-2","article-title":"Effects of 1.5-T versus 3-T magnetic resonance imaging in fetuses: Is there a difference in postnatal neurodevelopmental outcome? Evaluation in a fetal population with left-sided congenital diaphragmatic hernia","volume":"53","author":"Danzer","year":"2023","journal-title":"Pediatr. Radiol."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"214","DOI":"10.1016\/j.ejrad.2008.06.031","article-title":"Prenatal ultrasound and fetal MRI: The comparative value of each modality in prenatal diagnosis","volume":"68","author":"Pugash","year":"2008","journal-title":"Eur. J. Radiol."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"56","DOI":"10.1177\/08465371211015657","article-title":"Canadian Association of Radiologists Recommendations for the Safe Use of MRI During Pregnancy","volume":"73","author":"Kapadia","year":"2022","journal-title":"Can. Assoc. Radiol. J."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"376","DOI":"10.1007\/s00247-013-2857-0","article-title":"Fetal magnetic resonance imaging: Jumping from 1.5 to 3 tesla (preliminary experience)","volume":"44","author":"Victoria","year":"2014","journal-title":"Pediatr. Radiol."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"754","DOI":"10.1148\/radiol.2015151258","article-title":"Potential Heating Effect in the Gravid Uterus by Using 3-T MR Imaging Protocols: Experimental Study in Miniature Pigs","volume":"279","author":"Cannie","year":"2016","journal-title":"Radiology"},{"key":"ref_33","unstructured":"(2010). Medical Electrical Equipment-Part 2-33: Particular Requirements for the Basic Safety and Essential Performance of Magnetic Resonance Equipment for Medical Diagnosis (Standard No. IEC 60601-2-33 Ed 30)."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"7987","DOI":"10.21037\/qims-23-708","article-title":"Estimate of fetal brain temperature using proton resonance frequency thermometry during 3 Tesla fetal magnetic resonance imaging","volume":"13","author":"Ellison","year":"2023","journal-title":"Quant. Imaging Med. Surg."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"37","DOI":"10.1002\/1522-2586(200007)12:1<37::AID-JMRI5>3.0.CO;2-I","article-title":"Auditory noise associated with MR procedures: A review","volume":"12","author":"McJury","year":"2000","journal-title":"J. Magn. Reson. Imaging"},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"851","DOI":"10.1016\/j.mri.2004.01.047","article-title":"Absence of harmful effects of magnetic resonance exposure at 1.5 T in utero during the third trimester of pregnancy: A follow-up study","volume":"22","author":"Kok","year":"2004","journal-title":"Magn. Reason. Imaging"},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"193","DOI":"10.1148\/radiol.2019190563","article-title":"First-Trimester Exposure to Gadolinium-based Contrast Agents: A Utilization Study of 4.6 Million U.S. Pregnancies","volume":"293","author":"Bird","year":"2019","journal-title":"Radiology"},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"247","DOI":"10.2214\/AJR.15.14976","article-title":"How to Manage Allergic Reactions to Contrast Agent in Pregnant Patients","volume":"206","author":"Sikka","year":"2016","journal-title":"Am. J. Roentgenol."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"138","DOI":"10.1097\/01.rli.0000112789.57341.01","article-title":"Comparison of Gd DTPA-BMA (Omniscan) versus Gd HP-DO3A (ProHance) retention in human bone tissue by inductively coupled plasma atomic emission spectroscopy","volume":"39","author":"Gibby","year":"2004","journal-title":"Invest. Radiol."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"272","DOI":"10.1097\/01.rli.0000186569.32408.95","article-title":"Comparison of Gd(DTPA-BMA) (Omniscan) versus Gd(HP-DO3A) (ProHance) relative to gadolinium retention in human bone tissue by inductively coupled plasma mass spectroscopy","volume":"41","author":"White","year":"2006","journal-title":"Invest. Radiol."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"479","DOI":"10.1039\/b905145g","article-title":"Incorporation of excess gadolinium into human bone from medical contrast agents","volume":"1","author":"Darrah","year":"2009","journal-title":"Metallomics"},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"705","DOI":"10.1001\/jamapediatrics.2017.0264","article-title":"Intracranial Gadolinium Deposition Following Gadodiamide-Enhanced Magnetic Resonance Imaging in Pediatric Patients: A Case-Control Study","volume":"171","author":"McDonald","year":"2017","journal-title":"JAMA Pediatr."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"772","DOI":"10.1148\/radiol.15150025","article-title":"Intracranial Gadolinium Deposition after Contrast-enhanced MR Imaging","volume":"275","author":"McDonald","year":"2015","journal-title":"Radiology"},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"546","DOI":"10.1148\/radiol.2017161595","article-title":"Gadolinium Deposition in Human Brain Tissues after Contrast-enhanced MR Imaging in Adult Patients without Intracranial Abnormalities","volume":"285","author":"McDonald","year":"2017","journal-title":"Radiology"},{"key":"ref_45","doi-asserted-by":"crossref","unstructured":"Gatta, G., Di Grezia, G., Cuccurullo, V., Sardu, C., Iovino, F., Comune, R., Ruggiero, A., Chirico, M., La Forgia, D., and Fanizzi, A. (2021). MRI in Pregnancy and Precision Medicine: A Review from Literature. J. Pers. Med., 12.","DOI":"10.3390\/jpm12010009"},{"key":"ref_46","first-page":"e38493","article-title":"Gadolinium-Based Contrast Agents in Pregnant Women: A Literature Review of MRI Safety","volume":"15","author":"Alghamdi","year":"2023","journal-title":"Cureus"},{"key":"ref_47","doi-asserted-by":"crossref","unstructured":"Bookwalter, C.A., McDonald, R.J., Packard, A.T., Little, J.T., McDonald, J.S., and Watson, R.E. (2024). Contrast Media in Pregnant and Lactating Patients, From the AJR Special Series on Contrast Media. Am. J. Roentgenol.","DOI":"10.2214\/AJR.24.31415"},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"750","DOI":"10.1002\/jmri.22413","article-title":"Is administration of gadolinium-based contrast media to pregnant women and small children justified?","volume":"34","author":"Sundgren","year":"2011","journal-title":"J. Magn. Reson. Imaging"},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"110","DOI":"10.1148\/radiol.15141488","article-title":"Gadolinium Chelate Contrast Material in Pregnancy: Fetal Biodistribution in the Nonhuman Primate","volume":"276","author":"Oh","year":"2015","journal-title":"Radiology"},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"122","DOI":"10.1148\/radiol.2017162534","article-title":"Gadolinium Chelate Safety in Pregnancy: Barely Detectable Gadolinium Levels in the Juvenile Nonhuman Primate after in Utero Exposure","volume":"286","author":"Woods","year":"2018","journal-title":"Radiology"},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"448","DOI":"10.1007\/s00247-018-4304-8","article-title":"Gadolinium-based contrast agents\u2014Review of recent literature on magnetic resonance imaging signal intensity changes and tissue deposits, with emphasis on pediatric patients","volume":"49","author":"Blumfield","year":"2019","journal-title":"Pediatr. Radiol."},{"key":"ref_52","first-page":"592","article-title":"No Meta-analytic Evidence for Risks due to Prenatal Magnetic Resonance Imaging in Animal Models","volume":"8","author":"Pagliaccio","year":"2023","journal-title":"Biol. Psychiatry Cogn. Neurosci. Neuroimaging"},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"465.e1","DOI":"10.1016\/j.ajog.2022.10.005","article-title":"Risk of fetal or neonatal death or neonatal intensive care unit admission associated with gadolinium magnetic resonance imaging exposure during pregnancy","volume":"228","author":"Winterstein","year":"2023","journal-title":"Am. J. Obstet. Gynecol."}],"container-title":["Diagnostics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2075-4418\/15\/2\/208\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,8]],"date-time":"2025-10-08T10:30:50Z","timestamp":1759919450000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2075-4418\/15\/2\/208"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,1,17]]},"references-count":53,"journal-issue":{"issue":"2","published-online":{"date-parts":[[2025,1]]}},"alternative-id":["diagnostics15020208"],"URL":"https:\/\/doi.org\/10.3390\/diagnostics15020208","relation":{},"ISSN":["2075-4418"],"issn-type":[{"value":"2075-4418","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,1,17]]}}}