Tattooed Mothers: Implications for Medical Procedures

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An increasingly high prevalence of tattoos is found in the late Generation X and the early Millennial generation, in other words, people who were born from the late 1970s to the turn of the 21st century. Notably, this includes women who are getting pregnant and giving birth at the present time. If you’re in a major city, at a public event full of participants ages 20 to 40, it is extremely likely that you will see many tattooed people walking about. Sitting in a Starbucks while writing this article in Portland, Oregon, for instance, looking up randomly each time when noticing the face of a young adult approaching over the past 20 minutes, I have observed multiple tattoos on the arms and legs in a least 50 percent of them, plus at least two with markings on the neck, and this is counting only the visible body parts. That’s my anecdotal observation here and now, but it is reported that some 36 percent of Americans ages 18 to 29 have a tattoo, among who 70 percent have multiple tattoos. The high prevalence of tattoos among young adults includes both genders. This situation introduces a range of health issues, including issues that were covered here on The Pulse two years ago relevant for women who desire a new permanent tattoo during pregnancy, but also issues stemming from tattoos that a woman has obtained prior to pregnancy or that she is considering obtaining later.

To sum up the take home message of the aforementioned The Pulse article, it is best to avoid getting a tattoo during pregnancy, because even potential risks that are generally thought to be low in an adult who receives a tattoo, such as toxicity of pigments and dyes in tattoo ink have not been researched adequately in terms of potential effects on the embryo or fetus. Furthermore, if indeed you are cleared by your obstetrician and family physician to get a tattoo while pregnant and you decide to go through with it, you must make sure that the tattoo parlor and tattoo artist follow proper techniques surrounding the use of sterilized instruments and ink, and antiseptic procedure, such as the use of sterile gloves. Permanent tattooing works by way of needles injecting ink through the epidermis into the dermis layer of the skin, and so basically a tattoo starts out as an open wound. This means there is the potential for transmission of infectious agents, including human immunodeficiency virus (HIV), hepatitis B virus, and hepatitis C virus, all of which are profoundly dangerous, not just to you, but to your fetus as well. One more factor that you might consider is that more women than men are reported to regret obtaining a tattoo.

Another health issue that has not been studied adequately over the long-term is that tattoo ink usually contains heavy metals of different variety, because different metals, present as metal salts and metal oxides, absorb and reflect different regions of the visible light spectrum, so they can produce different colors. The definition of a heavy metal includes metals with high atomic number (meaning a lot of protons in the nucleus of its atoms), high atomic weight (the atomic nuclei have a high number of protons plus neutrons), and high density (a piece of the metal is heavy when you weigh it), and usually these three properties coincide. However, some heavy metals have been investigated more thoroughly than others. It is well established that lead, for instance, is dangerous during pregnancy. It can cause birth defects and learning difficulties during childhood. Red tattoo pigments are notorious for often containing mercury, whereas other heavy metals are often contained within other color pigments. As noted earlier, tattoo ink is injected into the dermis layer of the skin. This is the layer below the epidermis, the layer that sheds. Since the ink gets into the dermis, it remains there, but there is a question whether and to what degree the heavy metals, and other components of tattoo ink, such as plastic pigments and dyes, get into the bloodstream and spread through the body. On top of this, although fairly rare, there are also a host of skin reactions that have been reported to occur at tattoo sites, some types of reactions associated with particular tattoo colors.

Now, some women also choose to have a tattoo placed on the lower back, precisely over the area on the lumbar spine that normally provides safe needle access for a physician to obtain cerebral spinal fluid (CSF) that is needed to diagnose certain conditions and to administer what is called neuraxial anesthesia, which includes epidural anesthesia, the most common type of anesthesia given in labor and delivery. Although there is not yet enough evidence to conclude that it is dangerous to provide epidural anesthesia through a lower back tattoo, there is concern about it, and consequently, there are substantial numbers of anesthesiologists who are reluctant to administer epidurals on women with tattoos at that location. This brings that body art potentially can complicate various medical procedures that you might require in the future. As an example, the reason why a tattoo remains is that the pigments, which often include heavy metals, remain in the dermis at the injection site. However, metals are affected by magnetic fields, such as the strong magnetic fields that applied during magnetic resonance imaging (MRI). Consequently, people with tattoos have reported burning and irritation of tattoo sites stimulated by MRI.

David Warmflash
Dr. David Warmflash is a science communicator and physician with a research background in astrobiology and space medicine. He has completed research fellowships at NASA Johnson Space Center, the University of Pennsylvania, and Brandeis University. Since 2002, he has been collaborating with The Planetary Society on experiments helping us to understand the effects of deep space radiation on life forms, and since 2011 has worked nearly full time in medical writing and science journalism. His focus area includes the emergence of new biotechnologies and their impact on biomedicine, public health, and society.

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