X-ray Radiation Risks in Pregnant Women: A Comprehensive Review of Medical Imaging Safety and Fetal Health Implications

This comprehensive review discusses the status of knowledge in regard to the risks associated with X-ray radiation when being undertaken during pregnancy with a primary focus on fetal safety, the courses of diagnostic imaging, and how clinicians navigate clinical decision-making regarding each case. The review explores peer-reviewed literature published between 2015-2025 in order to determine the potential of teratogenic effects caused by diagnostic X-ray procedures when undertaken during pregnancy. The consensus has led to the assertion, with current evidence suggesting, that diagnostic X-ray examinations undertaken as part of routine clinical practice can cause minimal risks to fetal development when individuals are exposed to radiation doses equal to less than or equal to 100 mSv, and in the case of most routine diagnostic procedures, the radiation dose should be less than respective to this amount. Nevertheless, the timing of exposure during pregnancy, cumulative radiation dose, and the anatomical region of the pregnant patient further influences the risk assessment. In considering risk assessment, the review promotes that the ALARA (As low as reasonably achievable) principle is incorporated into clinical practice and encourages medical practitioners to consider the role of imaging techniques (e.g., ultrasound, MRI) during pregnancy differently – as a safe course of imaging. To ensure a case-by-case basis, the clinical guidelines appeared to recommend assessing the risk and benefits as part of a documented dialogue and counseling with patients who are imminently planning to undergo diagnostic imaging during pregnancy. Overall, the findings point towards safe and evidence-based prescriptions related to medical imaging for pregnant individuals; the review considers impactful fear mongering and misunderstanding about radiation as a threat, which plagued the ability to proceed with the appropriate treatment/modalities when indicated and potentially resulted in the termination of wanted pregnancies.