Pre-conception radiation exposure from CT scans increases risk for miscarriage and birth defects

Embargoed for release until 5:00 p.m. ET on Monday 8 September 2025   

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Below please find summaries of new articles that will be published in the next issue of Annals of Internal Medicine. The summaries are not intended to substitute for the full articles as a source of information. This information is under strict embargo and by taking it into possession, media representatives are committing to the terms of the embargo not only on their own behalf, but also on behalf of the organization they represent.   
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1. Pre-conception radiation exposure from CT scans increases risk for miscarriage and birth defects

Abstract: https://www.acpjournals.org/doi/10.7326/ANNALS-24-03479

Editorial: https://www.acpjournals.org/doi/10.7326/ANNALS-25-03528

URL goes live when the embargo lifts             

A population-based cohort study evaluated the risk for spontaneous pregnancy loss and congenital anomalies in offspring of women exposed to computed tomography (CT) ionizing radiation before conception. The study found that exposure to CT imaging prior to conception may be associated with higher risks for spontaneous pregnancy loss and congenital anomalies. The findings suggest that alternative imaging methods to CT should be considered in young women when appropriate. The study is published in Annals of Internal Medicine. 

Researchers from Jewish General Hospital in Montreal, Canada and colleagues studied data from 5,142,339 recognized pregnancies and 3,451,968 live births in Ontario, Canada between 1 April 1992 and 31 March 2023 among women aged 16 to 45 years. The primary exposure was the cumulative number of CT scans up to 4 weeks before estimated date of conception, and the secondary exposure was the number of CT scans limited to the abdomen, pelvis, lumbar spine, or sacral spine up to 4 weeks before the estimated date of conception. Outcomes were spontaneous pregnancy loss (miscarriage, ectopic pregnancy, or stillbirth) among recognized pregnancies and congenital anomalies diagnosed within the first year of life among live births. Of 5,142,339 women with recognized pregnancies, 687,692 had a CT scan before conception. Of all recognized pregnancies, 10.4% ended in spontaneous pregnancy loss, including 468,092 miscarriages, 47,228 ectopic pregnancies, and 19,845 stillbirths. Relative to those without a prior CT scan (101 per 1000 recognized pregnancies), the rate of spontaneous pregnancy loss increased to 117 per 1000 in those with 1 CT scan, 130 per 1000 with 2 CT scans, and 142 per 1000 with 3 or more CT scans. The absolute rates of pregnancy loss were slightly higher when limited to CT imaging of abdomen, pelvis, and lower spine. Among those with a CT scan, the risk for spontaneous pregnancy loss gradually increased as the timing of the most recent CT scan became closer to the estimated conception date. Relative to those without a prior CT scan (62 per 1000 live birth pregnancies), the rate of congenital anomaly increased to 84 per 1000 in those with 1 CT scan, 96 per 1000 with 2 CT scans, and 105 per 1000 with 3 or more CT scans. These findings suggest exposure to radiation from CT imaging before conception increases the risks of pregnancy loss and congenital anomalies. The results can inform clinical practice and guidelines on radiologic imaging in women of reproductive age.

Media contacts: For an embargoed PDF, please contact Gabby Macrina at gmacrina@acponline.org. To contact corresponding author Camille Simard, MD, MSc please email camille.simard@mcgill.ca.

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2. Ryan White HIV/AIDS program cuts could trigger a substantial spike in infections by 2030

Abstract: https://www.acpjournals.org/doi/10.7326/ANNALS-25-01737

URL goes live when the embargo lifts             

A simulation study estimated the impact of disruptions of the Ryan White HIV/AIDS Program in 31 U.S. cities. The study found that both indefinite and temporary disruptions to Ryan White services could sharply increase HIV incidence, with more severe effects in cities in Medicaid nonexpansion states. The results illustrate the value Ryan White programs in preventing the spread of HIV and show how even brief interruptions in services have serious impacts at the municipal level. The study is published in Annals of Internal Medicine.

Researchers from Johns Hopkins Bloomberg School of Public Health and colleagues used a mathematical simulation model, informed by data from surveys, the U.S. Centers for Disease Control and Prevention, and Ryan White programs, to estimate the impact of indefinite and temporary disruptions of the Ryan White HIV/AIDS Program in 31 U.S. cities with high disease burden of HIV. They simulated four scenarios for each city examined: the “continuation” scenario where Ryan White services continue at current levels and viral suppression continues its current trajectory; the “cessation” scenario where Ryan White services stop in July 2025 and viral suppression among Ryan White clients decreases and never recovers; the “brief interruption” scenario where Ryan White services stop in July 2025, suppression among Ryan White clients begins to improve in January 2027, and suppression recovers to prior levels by December 2027; and the “prolonged interruption” scenario where Ryan White services stop in July 2025 and suppression among Ryan White clients recovers from January 2029 to December 2029. The primary outcome was the projected excess incident HIV infections from 2025 to 2030 that would be incurred by either cessation or interruption of Ryan White services versus continuation. The researchers found that after a halt to Ryan White services in July 2025, average viral suppression across all cities was projected to decrease from 74% (95% CrI, 72% to 75%) in 2025 to 49% (95% CrI, 27% to 68%) in 2026. In the cessation scenario, they projected 75,436 additional infections (95% CrI, 19,251 to 134,175 infections) across all 31 cities from 2025 to 2030, an excess of 49% (95% CrI, 12% to 86%), occurring disproportionately among adults younger than 25 years. This excess varied widely across cities, with cities in Medicaid nonexpansion states experiencing more infections than those in expansion states. In the brief interruption and prolonged interruption scenarios, they project an 19% (95% CrI, 5% to 33%) and 38% (95% CrI, 10% to 66%) more infections, respectively. The findings highlight the critical public health value of services provided through the Ryan White HIV/AIDS program. 

Media contacts: For an embargoed PDF, please contact Gabby Macrina at gmacrina@acponline.org. To contact corresponding author Anthony T. Fojo, MD, MHS please email Michel Morris at melben1@jhmi.edu.

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Also new this issue:

Addressing Missingness in Predictive Models That Use Electronic Health Record Data

Shanshan Lin, ScM; Rolf H.H. Groenwold, MD, PhD; Hemalkumar B. Mehta, MS, PhD; Ji Soo Kim, PhD; and Jodi B. Segal, MD, MPH

Research and Reporting Methods

Abstract: https://www.acpjournals.org/doi/10.7326/ANNALS-24-01516

Chronic Kidney Disease

Morgan E. Grams, MD, PhD and Michal L. Melamed, MD, MHS

In the Clinic

Abstract: https://www.acpjournals.org/doi/10.7326/ANNALS-25-02684