Laurie's Blogs.

Hip-Hip-Hooray!  I love when science comes out with something that either proves or disproves a commonly cited (but not proven) statement!  This is one such thing.  For years (decades… over half a century actually), we’ve been told to not laser over or near a pregnant uterus.  Why?  Well, no reason, just because somebody figured, ‘better safe than sorry’.  As such, that has been the recommendation by manufacturers and textbooks alike.  However, a fresh-off-the-press systematic review gives us some up to date information on this subject!

Wilkerson EC, Van Acker MM, Bloom BS, Goldberg DJ.  Utilization of Laser Therapy During Pregnancy: A Systematic Review of the Maternal and Fetal Effects Reported From 1960 to 2017.  Dermatol Surg. 2019 Jun;45(6):818-828.

https://www.ncbi.nlm.nih.gov/pubmed/30998530

Abstract

BACKGROUND:

Due to concerns regarding maternal and fetal safety and the absence of evidence to the contrary, laser treatment during pregnancy has traditionally been limited to situations of absolute necessity.

OBJECTIVE:

This review seeks to examine the available evidence to determine the safety of laser therapy during pregnancy.

METHODS:

Medical databases were searched for relevant reports from all specialties regarding the use of lasers during pregnancy from 1960 to 2017. A legal case review was also performed.

RESULTS:

Twenty-two publications in the literature reported the use of various laser wavelengths in 380 pregnant women during all trimesters. Other than 1 case of premature rupture of membranes questionably related to the laser treatment, there were no cases of maternal or fetal morbidity or mortality, premature labor, or identifiable fetal stress.

CONCLUSION:

The available evidence, limited to low evidence level case reports and series, indicates cutaneous laser treatment during pregnancy is safe for both mother and fetus. Furthermore, laser physics and optics dictate there should theoretically be no risk of fetal laser exposure from commonly used cutaneous lasers.

Some of the interesting comments to come out of the Discussion within the paper are as follows:

• There are no randomized controlled trials on this subject.
• Recommended guidelines for laser therapy during pregnancy have not been established in the United States.
• In 2007, however, the European Society for Laser Dermatology reported vascular laser or intense pulsed light sources to have no direct impact on pregnancy; yet, their guidelines restricted laser treatment to the third trimester once the fetus is fully developed.

There are some interesting basic science research papers however:

• •Jacques and colleagues (1987) showed in an experiment that shining light into the abdomen of certain pregnant small mammals resulted in small but significant amounts of light reaching the uterus. This may result in changes in fetal circadian rhythm and potentially affect the physiologic development of the visual system, itself, although it is unknown whether the affect would be positive, negative, or inconsequential.
• •Based on a nonliving experimental model, even late gestation human fetuses can potentially see low light in utero depending on abdominal thickness and various other environmental conditions. Whether this affects development is unclear.
• •Given the thickness of the pregnant abdomen (30 mm on average in humans), the uterus, and amniotic fluid, clinically meaningful laser energy is very unlikely to penetrate to reach the fetus.

However, the final conclusion and recommendations are the same – that cutaneous laser therapy treatments are safe for both mother and fetus.  This is great news, because if you need to laser the lumbar spine, the iliopsoas, or an abdominal incision – you should be good to do so!

And now you know!