Back to Annual Meeting Page		American Public Health Association 133rd Annual Meeting & Exposition December 10-14, 2005 Philadelphia, PA

Abstract #116056

Nathan M. Graber, MD¹, Joel Forman, MD¹, J. Leighton², Deborah Nagin, MPH³, and Philip Landrigan, MD, MSc⁴. (1) Department of Pediatrics, Mount Sinai School of Medicine, One Gustave Levy Place, Box 1512, New York, NY 10029, 212-241-2265, nathan.graber@mssm.edu, (2) Assistant Commissioner, Environmental Disease Prevention, New York City Department of Health, 253 Broadway 12th floor Box CN58, New York, NY 10007, (3) Lead Poisoning Prevention Branch, New York City Department of Health and Mental Hygiene, 253 Broadway, 11th Floor, CN-58, New York, NY 10007, (4) Department of Community and Preventive Medicine, Mount Sinai School of Medicine, One Gustave Levy Place, Box 1057, New York, NY 10029-6574

BACKGROUND: Lead is a neurodevelopmental toxin that has been associated with adverse health effects on pregnancy including: elevated maternal blood pressure, increased rates of spontaneous abortion and preterm birth, and decreases in infant head circumference and birth weight. An estimated 0.5-2% of the 4 million women giving birth in the United States this year have blood lead levels (BLLs) at or above the CDC action level of 10 µg/dL. However, a standardized approach to addressing prevention, identification and management of lead exposure during pregnancy does not exist. METHODS: We conducted a systematic review of the literature on health effects, prevalence, risk factors, medical management, nutritional interventions, breastfeeding and prevention of lead exposure during pregnancy. The findings were presented to a panel of experts with clinical and public health experience and a set of evidence-based guideline recommendations were developed. RESULTS: The panel concluded that a BLL should be measured on any woman who was; born outside of the US, engages in pica behavior, uses imported spices, foods, cosmetics, ceramics or folk remedies, lives in a home where there are any recent or ongoing renovations or works in an occupation which places them at risk for lead exposure. Interventions at various BLLs include education, environmental investigation, source reduction, calcium and iron supplementation, chelation therapy, temporary cessation of breastfeeding and follow-up testing. Affective approaches at primary and secondary prevention require additional research on prevalence, risk factors and cultural practices.

Learning Objectives:

• List the most common risk factors for lead exposure during pregnancy.
• Apply the guidelines to manage cases of lead-exposed pregnant and lactating women.
• Apply the guidelines to manage cases of nursing infants and infants exposed to lead in utero.
• Interpret the results of a blood lead level in terms of risk for adverse outcomes.

Keywords: Lead, Pregnancy

Presenting author's disclosure statement:

I wish to disclose that I have NO financial interests or other relationship with the manufactures of commercial products, suppliers of commercial services or commercial supporters.

Recorded presentation