by Heidi Green
January 23, 2011

There are numerous reports about the adverse health effects of lead exposure for children, including developmental delays, reduced IQ, and behavior problems. While lead-based paint on toys and other products is the most common source of lead exposure, some children are exposed before they are even born, or while breastfeeding, due to lead in their mothers’ bodies. This puts newborns at risk for health problems that can affect growth and development before and after they are born.

Now, the Centers for Disease Control and Prevention (CDC) have issued guidelines for addressing this risk. Guidelines for the Identification and Management of Lead Exposure in Pregnant and Lactating Women, a comprehensive, 302-page report, reviews the effects of lead exposure on maternal and fetal health and recommends screening and care strategies for pregnant women and their infants.

Identify women at risk
The new report does not recommend blood lead level (BLL) testing for all pregnant women. The CDC estimates that approximately 600,000 U.S. women between the ages of 15–44 have high lead levels. However, this is just 1 percent of potential mothers, making universal screening impractical and costly.

Instead, the CDC recommends that physicians step up their role in screening pregnant women for lead risk. “Providers of care for pregnant women need to be aware that there are certain at-risk populations that need to be screened,” explains Crystal Cash, MD, a leading family and community medicine specialist, medical school professor, and representative to the CDC workgroup that created the report.

Women at higher risk of lead exposure include:

• women with a child in the home who has lead poisoning
• recent immigrants, especially those from areas with high environmental lead
• women who work with lead
• women belonging to certain ethnic groups (foreign-born women who recently immigrated to the US from countries where lead exposure is higher such as Mexico, Asia, and Central and South America)
• women who eat nonfood items, such as pottery, clay, or dirt (pica)
• women who may have been exposed during renovation of an older home (one built prior to 1979)

Screening recommendations
The CDC’s report includes some specific recommendations for evaluating lead exposure risk:

• Local and state health departments: Identify populations at risk within each community. Share that information with health care providers to guide decisions about blood lead level (BLL) testing.

• Health care providers: Discuss lead exposure risk with each woman at the earliest prenatal appointment. Share information with patients, including print materials and screening questionnaires.

• Pregnant women and breastfeeding mothers: Be aware of lead exposure risks (e.g., work-related exposure, home renovations, exposure through cosmetics or nutritional supplements, pica). Discuss screening (a simple blood test) with your physician.

Care recommendations
The CDC report also provides treatment guidelines for pregnant and breastfeeding women with high blood lead levels (5 mcg/dL or more):

• Identify and remove the source. Some local health departments can help with inspection and advice. Physicians should discuss available resources with their patients. Women whose exposure is 10 mcg/dL or more should be removed from work-related exposure.

• Consider nutrition. Adequate dietary intake of certain nutrients (calcium, iron, zinc, vitamin C, vitamin D, vitamin E) is known to decrease lead absorption. Iron and calcium deficiencies are of particular concern for pregnant women.

• Screen infants. For infants born to mothers with high blood lead levels:

1. Check baby’s blood lead level (umbilical cord blood may be used).
2. Monitor baby’s blood lead level as needed. (If initial test is 45 mcg/dL or more, repeat within 24 hours; if 25–44 mcg/dL, repeat within two weeks; if 5–24 mcg/dL, repeat within one month.)

• Treat infants with high blood lead levels. Consult with a pediatric lead expert if blood levels are equal to or greater than 45 mcg/dL.

• Consider breastfeeding. The CDC expert panel recognizes the risk of lead exposure through mother’s milk as less than the risks of formula-feeding. In addition, the lead transfer that occurs through the mother’s milk is approximately 3 percent of the maternal blood lead concentration.

1. Mothers with blood lead levels of 39 mcg/dL or less are urged to breastfeed.
2. Mothers with blood lead levels of 40 mcg/dL or higher are advised to pump and discard their milk, until their blood lead levels fall below 40 mcg/dL.

• Monitor blood levels. Identify and remove sources of lead and start immediate treatment. Continue with periodic testing until blood lead levels are less than 5 mcg/dL.

• Know the signs of lead poisoning. Signs of lead poisoning include learning disabilities, memory loss, poor academic performance, difficulty following directions, hyperactivity, aggressive behavior, hearing loss, loss of eye-hand coordination, anemia, abdominal pain, constipation, vomiting, decreased appetite, and weight loss.

While the effects of lead poisoning are irreversible, they can be minimized. Quick and early treatment will keep problems from worsening. Monitoring children for signs of lead poisoning will ensure early diagnosis and treatment. Better yet, if elevated lead levels are found in a mother during her pregnancy, the source of the lead can be addressed before the baby is directly exposed. Making lead screening a standard part of prenatal care could reduce the risk for lead poisoning. Just as health care providers screen women for potential abuse, “Do you feel safe at home?,” and nicotine and alcohol use, “Do you smoke or drink?,” they should screen women for lead exposure, “Do you live in an old house?” “Is soil/clay part of your normal diet?” If women are aware of the potential for lead exposure, they can take the necessary steps to prevent it.