Laser Treatment of Cutaneous Angiomas During Pregnancy
Cutaneous laser treatment of angiomas during pregnancy appears to be safe for both mother and fetus based on available evidence, with no reported cases of maternal or fetal morbidity, mortality, premature labor, or fetal stress in 380 treated pregnant women across all trimesters. 1
Safety Evidence for Cutaneous Laser Treatment
- A systematic review examining laser therapy during pregnancy from 1960 to 2017 found 22 publications reporting various laser wavelengths used in 380 pregnant women during all trimesters 1
- Only one case of premature rupture of membranes was questionably related to laser treatment, with no other adverse maternal or fetal outcomes reported 1
- Laser physics and optics theoretically indicate no risk of fetal laser exposure from commonly used cutaneous lasers 1
- The flashlamp pumped pulsed dye laser has proven effective for superficial hemangiomas in numerous studies 2
- For hemangiomas with subcutaneous components, the Nd:YAG laser is the treatment of choice 2
Important Distinction: Placental vs. Cutaneous Angiomas
It is critical to distinguish between cutaneous angiomas (skin lesions) and placental vascular lesions, as the safety profiles differ dramatically:
- Placental chorioangiomas treated with fetoscopic laser coagulation carry significant risks including fetal bleeding, exsanguination, and death 3
- Endoscopic laser coagulation of feeding vessels in placental chorioangiomas resulted in fetal death in one of three cases, chronic renal insufficiency in another, and success in only one case 3
- These invasive fetal procedures should be used with extreme caution and only for large, symptomatic placental lesions 3, 4, 5
Clinical Recommendations
For cutaneous angiomas:
- Laser treatment can be safely performed during pregnancy when clinically indicated 1
- The evidence level is limited to case reports and series, but consistently demonstrates safety 1
- Traditional concerns about maternal and fetal safety appear unfounded for cutaneous laser applications 1
For hepatic hemangiomas:
- Even giant hepatic hemangiomas (>4 cm) do not preclude pregnancy 6
- These lesions can be managed conservatively during pregnancy 6
- Close ultrasound monitoring is recommended but routine intervention is not required 6
Key Caveat
The available evidence for cutaneous laser treatment consists entirely of low-level case reports and series rather than randomized controlled trials 1. However, the consistent absence of adverse events across 380 pregnancies, combined with the theoretical safety based on laser physics, provides reasonable reassurance for clinical practice.