Maternal-fetal transfer of indocyanine green: a systematic review

Rational In a survey of 1101 members of vitreoretinal trained physicians regarding the use of ICG angiography during pregnancy, 434 (83%) of 520 respondents had seen at least one pregnant woman requiring ICG angiography or fluorescein angiography. One hundred and five (24%) withheld ICG angiography, mostly because of fear of teratogenicity or lawsuit. Adverse reactions to fluorescein and ICG are rare and may be classified as toxic, hypersensitivity, and non-specific. This literature review aimed to review evaluate the maternal-to-fetal transfer of ICG and resume the most recent recommendations for ICG use in its obstetric applications. Methods The available literature was examined using PubMed-Medline, and web of science, and using the MeSH terms fluorescein, Indocyanine green, and pregnancy according to PRISMA-P guidelines. Results Studies in humans demonstrated that ICG is not detectable in fetal cord blood or umbilical vein blood collected immediately after birth. ICG maternal-to-fetal transfer is slow and is safe during pregnancy. ICG in the fetus accumulates in the liver and accumulation is enhanced by the administration of OATPs or P-gp inhibitors. Conclusions ICG's transplacental transfer is minimal and is probably medicine-mediated, like rifampin. The placenta is an effective protective barrier to ICG's distribution into the fetus.

Automated summary

ICG transfer from mother to fetus is slow and safe during pregnancy, with minimal accumulation in the fetus due to effective placental barrier. Adverse reactions to ICG are rare, with concerns mainly related to teratogenicity or lawsuits.