The 131st Annual Meeting (November 15-19, 2003) of APHA

Abstract #70195

Margaret A. Handley, PhD¹, Eric D Sanford, MD², Celeste Hall, RN³, and Mary Croughan, PhD¹. (1) Department of Family and Community Medicine, University of California, San Francisco, 500 Parnassus Ave., San Francisco, CA 94143-0900, (415) 476-5581, handley@itsa.ucsf.edu, (2) Seaside Family Health Center, Monterey County Health Department, 1150 Fremont Ave, Seaside, CA 93955, (3) Alisal Health Center, Monterey County Health Department, 559 E. Alisal St., Salinas, CA 93905

Background: We conducted an investigation of lead poisoning among children and pregnant women in a primary care clinic in Monterey County, California where the prevalence of elevated lead levels (>10 ug/dl) is over 5%. Chart review confirmed that 39% of the cases over a three year period had venous lead levels >20 ug/dl and that the prevalence of elevated lead levels in pregnant women selectively screened at the clinic was >10%. Case management data from the Monterey County Childhood Lead Prevention Program indicates that lead sources are not related to paint, and may result from exposures from imported foods from Mexico or from preparation of food in lead-glazed pottery.

Methods: To identify and reduce sources of lead exposure, we implemented the following program for prenatal patients seen in Monterey County Health Department clinics: (1) universal lead testing which is reimbursed under State Medi-Cal programs; (2) ongoing surveillance of the prevalence of elevated lead levels; (3) individual counseling for lead results; (4) provision of prenatal educational counselling about lead and nutrition through the 'Medi-Cal Comprehensive Perinatal Services Program; (5) and assessment of risk factors for lead, targetted to exposures that may occur more frequently in Mexican immigrant communities.

Results: Over 500 women have been screened for lead in Monterey County and 100 women have been enrolled in the education program.

Conclusions: Surveillance of elevated lead levels through prenatal screening programs can be effectively linked to targetted lead education within Medi-Cal programs, and may be an effective strategy to reduce lead exposures.

Learning Objectives:

• -develop a program to screen pregnant women for lead under Medi-Cal
• -develop a strategy to monitor the prevalence of elevated lead levels in prenatal populations in order to target prevention efforts
• -develop education plans for clinics with high prenatal prevalences of lead that can be reimbursed within Medi-Cal prenatal education programs

Keywords: Prenatal Care, Lead

Presenting author's disclosure statement:
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.