New Guidelines Focus on Identifying Lead Exposure in Pregnant Women

The CDC has issued new guidelines to help physicians more effectively identify and treat lead exposure in pregnant and lactating women who have been exposed to the hazardous material. The guidelines also address management strategies for infants exposed to lead in utero.

“Providers of care for pregnant women need to be aware that there are certain at-risk populations that need to be screened, especially if they find that a child in the home has lead poisoning," said Crystal Cash, MD, chair of the department of family and community medicine for the Cook County Health and Hospital Systems in Chicago, IL, in an AAFP News Now article.

The groups who are at highest risk for lead exposure, according to the CDC, include:

• Recent immigrants from areas with high lead levels in the environment;
• Women who work with lead;
• Certain racial and ethnic groups;
• Women who practice pica (i.e., eating nonfood items such as pottery, clay and dirt.

"(Lead exposure) tends to be more of a problem in areas that have heavy immigrant populations," Cash said. "If you're in an area that has a large Central and South American population, and you're finding elevated lead (levels) in children, you should be checking the pregnant women."

Women and children also can be exposed to lead during renovations of older homes.

Mary Jean Brown, RN, ScD, chief of the Healthy Homes and Lead Poisoning and Prevention Branch of the CDCs' National Center for Environmental Health, said during an interview with the CDC that state and local public health officials should identify populations at risk and share that information with physicians to guide them in determining the need for population-based blood lead testing.

The CDC guidelines will be reviewed by the AAFP's Commission on Health of the Public and Science. In 2006, the Academy endorsed the US Preventive Services Task Force (USPSTF) recommendation against routine screening of pregnant women for elevated blood lead levels. At that time, however, the USPSTF acknowledged that certain groups of women were at increased risk for lead exposure, including those who meet the following criteria:

• Low income
• Living in an urban residence
• Low educational attainment
• Use ethnic remedies
• Use certain cosmetics
• Have exposure to lead-glazed pottery
• Use alcohol
• Smoke or use tobacco products

Brown said that physicians and their pregnant patients should discuss each woman's potential for lead exposure. She also said assessment for exposure based on risk-factor questionnaires or blood level testing should take place during a physician's earliest contact with a pregnant woman.

The USPSTF recommendations also call for the use of screening questionnaires and stress that such documents should be tailored and validated for clinical use in specific communities.

According to the CDC guidelines, blood lead levels of 5 micrograms per deciliter, or 5mcg/dL, or higher in pregnant women indicate previous or ongoing lead exposure.

Finally, the CDC recommendations state that lactating mothers should pump and discard their breast milk until their blood lead level falls to less than 40 mcg/dL before starting to breastfeed their infants.

For more:

• CDC Issues Screening, Care Recommendations for Lead Exposure during Pregnancy
• Guidelines for the Identification and Management of Lead Exposure in Pregnant and Lactating Women
• Maternal Low-Level Lead Exposure and Fetal Growth