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Selected References:
- American College of Obstetricians and Gynecologists (ACOG). 2017. Reaffirmed 2021. Guidelines for diagnostic imaging during pregnancy. ACOG Committee Opinion No. 723. Obstet Gynecol; 130:e201-e216.
- Brent RL. 2009. Saving lives and changing family histories: appropriate counseling of pregnant women and men and women of reproductive age, concerning the risk of diagnostic radiation exposures during and before pregnancy. Am J Obstet Gynecol; 200(1):4-24.
- Groen RS, et al. 2012. Fear of the unknown: ionizing radiation exposure during pregnancy. Am J Obstet Gynecol; 206:456-462.
- Guilbaud L, et al. 2019. Pregnancy outcome after first trimester exposure to ionizing radiations. Eur J Obstet Gynecol Reprod Biol;232:18-21.
- Health Physics Society. 2021. Radiation Exposure From Medical Exams and Procedures. Available at: https://hps.org/wp-content/uploads/2024/12/Medical_Exposures_Fact_Sheet.pdf [Accessed 10/2024].
- Kelaranta A, et al. 2016. Radiation exposure to foetus and breasts from dental X-ray examinations: effect of lead shields. Dentomaxillofac Radiol; 45(1):20150095.
- Kumar R, De Jesus O. Radiation Effects On The Fetus. 2023. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing.
- Lojo Lendoiro S, Moreno Sánchez T. 2022. Occupational radiation and pregnancy: reality or disinformation? A review of the literature and summary of current clinical guidelines. Radiologia (Engl Ed). 64(2):128-135.
- Mainprize JG, et al. 2023. Effects of ionizing radiation exposure during pregnancy. Abdom Radiol (NY); 48(5):1564-1578.
- McKinney PA, et al. 2003. Parental occupation at periconception: findings from the United Kingdom Childhood Cancer Study. Occup Environ Med; 60:901-909.
- National Council on Radiation Protection and Measurements. 1979. Medical Radiation exposure of pregnant and potentially pregnant women. NCRP Report No. 54 32.
- Ramač JP, et al. 2016. Safety of radiographic imaging in pregnancy. Acta Clinica Croatica (Tisak), 55(2), 247–253.
- Schull WJ & Otake M. 1999. Cognitive function and prenatal exposure to ionizing radiation. Teratology; 59:222-226.
- Skrzypek M, et al. 2019. Effect of ionizing radiation on the female reproductive system. Ann Agric Environ Med; 26(4):606-616.
- Stlberg K, et al. 2007. Prenatal X-ray exposure and childhood brain tumors: a population-based case-controlled study on tumour subtypes. Br J Cancer. 97:1583-1587.
- Tirada N, et al. 2015. Imaging pregnant and lactating patients. Radiographics 35(6):1751-1765.
- United Nations Scientific Committee on the Effects of Atomic Radiation. 2000. Sources and effects of ionizing radiation. UNSCEAR 2000 Report to the General Assembly. Volume 1. https://www.unscear.org/docs/publications/2000/UNSCEAR_2000_Report_Vol.I.pdf
- U.S. Centers for Disease Control and Prevention (CDC). 2024. Facts About Radiation from Airport Security Screening. https://www.cdc.gov/radiation-health/data-research/facts-stats/airport-security-screening.html. [Accessed 10/2024].
- U.S. Environmental Protection Agency (EPA). 2024. Radiation Terms and Units. https://www.epa.gov/radiation/radiation-terms-and-units. [Accessed 10/2024].
- U.S. Food and Drug Administration (FDA). Radio Frequency Radiation and Cell Phones. https://www.fda.gov/radiation-emitting-products/cell-phones/radio-frequency-radiation-and-cell-phones. [Accessed 10/2024].
- U.S. Nuclear Regulatory Commission (NRC). 2020. What are the different types of radiation? https://www.nrc.gov/reading-rm/basic-ref/students/science-101/what-are-different-types-of-radiation.html. [Accessed 10/2024].
- Wall BF, & Hart D. 1997. Revised radiation doses for typical X-ray examinations. Report on a recent review of doses to patients from medical X-ray examinations in the UK by NRPB. National Radiological Protection Board. British Journal of Radiology, 70(833), 437–439.
- Yoon I, Slesinger TL. Radiation Exposure In Pregnancy. 2023. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing.
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Selected References:
- American College of Obstetricians and Gynecologists. 2017. Guidelines for diagnostic imaging during pregnancy. ACOG Committee Opinion No. 723. Obstet Gynecol; 130:e201-e216.
- Becker LS, et al; 2026. Occupational Prenatal Radiation Exposure and Occupational Safety: Position Paper for Pregnant and breastfeeding Personnel in Interventional Procedures with Ionizing Radiation. Rofo; 198(1):64-73.
- Brent RL. 2009. Saving lives and changing family histories: appropriate counseling of pregnant women and men and women of reproductive age, concerning the risk of diagnostic radiation exposures during and before pregnancy. Am J Obstet Gynecol; 200(1):4-24.
- Bunch KJ, et al. 2009. Cancer in the offspring of female radiation workers: a record linkage study. Br J Cancer; 100(1):213-218.
- Cohen-Karem R, et al. 2003. Diagnostic radiation in pregnancy: termination of pregnancy due to risk misperception. Birth Defects Res Part A: Clin Mol Teratol; 67(5):392.
- Flanagan E, et al. 2020. Abdominal imaging in pregnancy (maternal and foetal risks). Best Pract Res Clin Gastroenterol; Feb-Apr: 44-45.
- Felice FD, et al. 2019. Radiation effects on male fertility. Andrology; 7(1):2-7.
- Frangione B, et al. 2023. Low-dose ionizing radiation and adverse birth outcomes: a systematic review and meta-analysis. International archives of occupational and environmental health, 96(1):77–92.
- Green LM, et al. 1997. Risk of congenital anomalies in children of parents occupationally exposed to low level ionizing radiation. Occup Environ Med; 54:629-35.
- Groen RS, et al. 2012. Fear of the unknown: ionizing radiation exposure during pregnancy. Am J Obstet Gynecol; 206:456-462.
- Lojo Lendoiro S, Moreno Sánchez T. 2022. Occupational radiation and pregnancy: reality or disinformation? A review of the literature and summary of current clinical guidelines. Radiologia (Engl Ed). 64(2):128-135.
- McKinney PA, et al. 2003. Parental occupation at periconception: findings from the United Kingdom Childhood Cancer Study. Occup Environ Med; 60:901-909.
- Mole RH. 1993. The biology and radiobiology of in utero development in relation to radiological protection. Br J Radiol; 66:1095-1102.
- National Council on Radiation Protection and Measurements. 1979. Medical Radiation exposure of pregnant and potentially pregnant women. NCRP Report No. 54 32.
- Raman AS, et al. 2015. Minimal use of fluoroscopy to reduce fetal radiation exposure during radiofrequency catheter ablation of maternal supraventricular tachycardia. Tex Heart Inst J; 42(2):152-154.
- Schull WJ, Otake M. 1999. Cognitive function and prenatal exposure to ionizing radiation. Teratology; 59:222-226.
- Skrzypek M, et al. 2019. Effect of ionizing radiation on the female reproductive system. Ann Agric Environ Med; 26(4):606-616.
- Stlberg K, et al. 2007. Prenatal X-ray exposure and childhood brain tumors: a population-based case-controlled study on tumour subtypes. Br J Cancer; 97:1583-1587.
- Tirada N, et al. 2015. Imaging pregnant and lactating patients. Radiographics 35(6):1751-1765.
- U.S. Department of Labor, Occupational Safety and Health Administration, Ionizing Radiation https://www.osha.gov/ionizing-radiation.
- Wiesel A, et al. 2016. Evidence for a teratogenic risk in the offspring of health personnel exposed to ionizing radiation?! Birth Defects Res A Clin Mol Teratol; 106(6):475-479.
- Yamamoto S, et al; Japan Environment and Children’s Study (JECS) Group. 2025. Parental occupational exposure to anticancer drugs and radiation: Risk of fetal loss and physical abnormalities in The Japan Environment and Children’s Study. Early Hum Dev; 201:106195.
- Zadeh HG, Briggs TW. 1997. Ionising radiation: are orthopaedic surgeons’ offspring at risk? Ann R Coll Surg Engl; 79:214-220.
X-rays
Selected References:
- Byington CL, et al. 2026. Milk as a Transmission Vehicle for Highly Pathogenic Avian Influenza A (H5N1). Pediatrics; 157(2):e2025072525.
- Fiore AE et al. 2010. Prevention and control of influenza with vaccines: recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR Recomm Rep. 59(RR-8):1-62. Er ratum: Vol . 59, No. RR-8.
- Gu J, et al. 2007. H5N1 infection of respiratory tract and beyond: a molecular pathology study. Lancet; 370:1137-1145.
- Le TV, et al. 2019. Fatal avian influenza A(H5N1) infection in a 36‐week pregnant woman survived by her newborn in Sóc Trăng Province, Vietnam, 2012. Influenza Other Respir Viruses; 13(3):292-297.
- Liu S, et al. 2016. Avian influenza virus in pregnancy. Rev Med Virol; 26(4):268-284.
- Purcell R, et al. 2025. Systematic Review of Avian Influenza Virus Infection and Outcomes during Pregnancy. Emerg Infect Dis. 31(1):50-56.
- The Centers for Disease Control and Prevention (CDC). 2008. Prevention and control of influenza: Recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR; 57(RR07):1-60.
- The Centers for Disease Control and Prevention (CDC). 2024. Clinical Overview of Evaluating and Managing Patients Exposed to Birds Infected with Avian Influenza A Viruses of Public Health Concern. Available at: https://www.cdc.gov/bird-flu/hcp/clinicians-evaluating-patients/?CDC_AAref_Val=https://www.cdc.gov/flu/avianflu/clinicians-evaluating-patients.htm. Last Accessed August 2026.
- The Centers for Disease Control and Prevention (CDC). 2025. Current Situation: H5N1 Bird Flu in People . Available at: https://www.cdc.gov/bird-flu/situation-summary/inhumans.html. Last Accessed August 2026.
- The Centers for Disease Control and Prevention (CDC). 2024. Highly Pathogenic Avian Influenza A(H5N1) Virus in Animals: Interim Recommendations for Prevention, Monitoring, and Public Health Investigations. Available at: https://www.cdc.gov/bird-flu/prevention/hpai-interim-recommendations.html. Last Accessed August 2026.
- The Centers for Disease Control and Prevention (CDC). 2025. Preventing Bird Flu Infections. Available at: https://www.cdc.gov/bird-flu/prevention/index.html. Last Accessed August 2026.
- The Centers for Disease Control and Prevention (CDC). 2025. Reducing Risk for People Working with or Exposed to Animals. Available at: https://www.cdc.gov/bird-flu/prevention/worker-protection-ppe.html. Last Accessed August 2026.
- Writing Committee of the Second World Health Organization Consultation on Clinical Aspects of Human Infection with Avian Influenza A (H5N1) Virus. 2008. Update on Avian Influenza A (H5N1) Virus Infection in Humans. N Engl J Med; 358(3):261-273.
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X-rays
Selected References:
- Abduljalil K, at al. 2026. Physiologically based pharmacokinetic modelling of hydroxyurea in patients with sickle cell disease: a special focus on lactating women and breastfed infants to inform safe dosing and breastfeeding strategies. pharmaceuticals (Basel), 19(2):220.
- Al Sulaimani R, et al. 2025. Safety of hydroxyurea in pregnancy: a systematic review of the literature. J Obstet Gynaecol Can, 47(7):102924.
- American Health Packaging. Updated 2026. Hydroxyurea Product Label. National Institute of Health DailyMed database. Available at https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=c84a2241-6c05-480f-8a5b-049e08c27d73#. [Accessed May 2026.]
- Ballas SK, et al. 2009. Exposure to hydroxyurea and pregnancy outcomes in patients with sickle cell anemia. J Natl Med Assoc, 101(10):1046-1051.
- Bykal C, et al. 2000. Use of hydroxyurea and alpha-interferon in chronic myeloid leukemia during pregnancy: a case report. Eur J Gynaecol Oncol, 21:89-90.
- Bhattacharjee U, et al. 2024. Maternal and foetal outcomes of newly diagnosed chronic myeloid leukemia during pregnancy and its long-term impact. Indian J Hematol Blood Transfus, 40(4):687-693.
- Boafor TK, et al. 2016. Pregnancy outcomes in women with sickle-cell disease in low and high income countries: a systematic review and meta-analysis. BJOG, 123:691-698.
- Byrd DC, et al. 1999. Hydroxyurea in two pregnant women with sickle cell anemia. Pharmacotherapy, 19:1459-1462.
- Celiloglu M, et al. 2000. Hydroxyurea treatment for chronic myeloid leukemia during pregnancy. Acta Obstet Gynecol Scand, 79:803-804.
- Charache S, et al. 1995. Effect of hydroxyurea on the frequency of painful crises in sickle cell anemia. N Engl J Med, 332:1317-1322.
- Cinkotai KI, et al. 1994. Pregnancy after treatment with hydroxyurea in a patient with primary thrombocythaemia and a history of recurrent abortion. J Clin Pathol, 47:769-770.
- Corsia A, et al. 2025. Maternal and perinatal outcomes of sickle cell disease in pregnancy: a nationwide study in France. Br J Haematol, 206(4):1218-1227.
- de Montalembert M, et al, All ESCORT HU Investigators. 2021. Real-Life experience with hydroxyurea in patients with sickle cell disease: results from the prospective ESCORT-HU cohort study. Am J Hematol, 96(10):1223-1231.
- DeBaun MR. 2014. Hydroxyurea therapy contributes to infertility in adult men with sickle cell disease: a review. Expert Review of Hematology, 7(6):767–773.
- Dell’Isola A, et al. 1997. Essential thrombocythemia in pregnancy. a case report and general considerations. Minerva Ginecol, 49:165-172.
- Delmer A, et al. 1992. Pregnancy during myelosuppressive treatment for chronic myelogenous leukaemia. Br J Haematol, 82:783-784.
- Desai G, et al. 2025. Lower rates of maternal morbidities among pregnant women suffering from sickle cell disease who are exposed to hydroxyurea, a retrospective study from tribal area of Western India. Expert Rev Hematol, 18(12):1099-1105.
- Diav-Citrin O, et al. 1999. Hydroxyurea use during pregnancy: a case report in sickle cell disease and review of the literature. Am J Hematol, 60:148-150.
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- Fadilah SA, et al. 2002. Successful treatment of chronic myeloid leukemia during pregnancy with hydroxyurea. Leukemia, 16:1202-1203.
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- Fitzgerald JM, et al. 1993. The combination of hydroxyurea and leucapheresis in the treatment of chronic myeloid leukaemia in pregnancy. Clin Lab Haematol, 15:63-65.
- Grigg A. 2007. Effect of hydroxyurea on sperm count, motility and morphology in adult men with sickle cell or myeloproliferative disease. Intern Med J, 37(3):190-192.
- Habibi A, et al. 2023. Outcomes of pregnancy in sickle cell disease patients: results from the prospective ESCORT-HU cohort study. Biomed, 11(2):597.
- Idris IM, et al. 2025. A controlled trial for preventing priapism in sickle cell anemia: hydroxyurea plus placebo vs hydroxyurea plus tadalafil. Blood, 145(26):3101-3112.
- Italia KY, et al. 2010. Exposure to hydroxyurea during pregnancy in sickle-beta thalassemia: a report of 2 cases. J Clin Pharmacol, 50(2):231-234.
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- Koh LP, et al. 2002. Four pregnancies in two patients with essential thrombocythaemia – a case report. Ann Acad Med Singapore, 31:353-356.
- Kroner BL, et al. 2022. Pregnancy outcomes with hydroxyurea use in women with sickle cell disease. Am J Hematol, 97(5):603–612.
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- Marahatta A, Ware RE. 2017. Hydroxyurea: analytical techniques and quantitative analysis. Blood Cells Mol Dis, 67:135–142.
- Medunik. Updated 2026. Hydroxyurea Product Label. National Institute of Health Dailymed Database. Available at https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=76957c0d-0f98-4376-bb06-eee651adc09d. [Accessed May 2026].
- National Heart, Lung, and Blood Institute. 2014. Evidence-based management of sickle cell disease: expert panel report, 2014. U.S. Department of Health and Human Services, National Institutes of Health.
- Oskuie AE, et al. 2011. Successful outcome of pregnancy in a case of essential thrombocytosis treated with hydroxyurea. Indian J Cancer, 48(2):268-269.
- Oteng-Ntim E, et al. 2015. Adverse maternal and perinatal outcomes in pregnant women with sickle cell disease: systematic review and meta-analysis. Blood, 125:3316–3325.
- Pata O, et al. 2004. Polycythemia vera and pregnancy: a case report with the use of hydroxyurea in the first trimester. Am J Perinatol, 21:135-137.
- Patel M, et al. 1991. Use of hydroxyurea in chronic myeloid leukemia during pregnancy: a case report. Am J Obstet Gynecol, 165:565-566.
- Pecker LH, Kuo KHM. 2022. Go the distance: reproductive healthcare for people with sickle cell disease. Hematol Oncol Clin North Am, 36(6):1255–1270.
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- Rustin GJS, et al. 1984. Pregnancy after cytotoxic chemotherapy for gestational trophoblastic tumours. Br Med J, 288:103-106.
- Rogers DT, Molokie R. 2010. Sickle cell disease in pregnancy. Obstetrics and gynecology clinics of North America, 7(2):223–237.
- Saleh AJM, et al. 2014. Leukemia during pregnancy: long term follow up of 32 cases from a single institution. Hematol Oncol Stem Cell Ther, 7(2):63-68.
- Silva FAC, Ferreira ALCG, Pimentel LM, et al. 2021. The use of hydroxyurea during pregnancy in sickle cell anemia women: a case series and literature review. J Hematol Res, 8:6-10.
- Sulaimani, A. et al. 2025. Safety of hydroxyurea in pregnancy: a systematic review of the literature. Journal of Obstetrics and Gynaecology, JOGC, 47(7):102924.
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- Tertian G, et al. 1992. Hydroxyurea and pregnancy. Am J Obstet Gynecol, 166:1868.
- Thauvin-Robinet C, et al. 2001. Exposure to hydroxyurea during pregnancy: a case series. Leukemia, 15:1309-1311.
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- Warncke K, et al. 2025. Hyperhemolysis in a sickle cell disease patient in pregnancy. Ann Hematol, 104(8):4245-4249.
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Selected References: