204780 Lead poisoning and lactation: An integrative review

Wednesday, November 11, 2009

Mikki Meadows-Oliver, PhD, APRN , School of Nursing, Yale University, New Haven, CT
Monica Ordway, MSN, APRN , School of Nursing, Yale University, New Haven, CT
Problem: In recent years, there has been an increase in research studying the effects of elemental lead on women during lactation. In order to enhance the clinical utility of the findings from the individual studies, they must be integrated.

Method: The following terms or combination of terms were used to conduct the article search: lead poisoning, plumbism, lactation, and breastfeeding. The computerized databases of MEDLINE and CINAHL were used to conduct the search.

Findings: Sixteen articles were included in this review. Findings revealed there were significantly larger increases in the mobilization of skeletal lead during the postpartum period than during pregnancy. The major sources of lead in breast milk were found to be from maternal bone and maternal diet. Breast milk lead levels were noted to significantly decrease over the course of lactation. Breast milk lead levels were shown to have a strong influence on infant blood levels over and above the influence of maternal blood lead levels.

Summary: Public health workers that work with lactating women must educate them about the effects of lead poisoning for themselves and their infants. Lactating mothers should be screened for lead poisoning using the risk assessment questions provided by the Centers for Disease Control and Prevention (CDC). If mothers answer “yes” to any of the risk assessment questions, she and her breastfeeding child should be considered for blood lead screening. Early intervention with lead hazards may prevent blood lead levels from rising and causing irreversible damage to the neurodevelopmental status of the infant.

Learning Objectives:
1. To describe the effect of maternal bone lead levels on maternal postpartum breast milk lead levels. 2. To discuss the environmental factors associated with increased breast milk lead levels. 3. To describe the associations between maternal levels (blood or breast milk) and infant blood lead levels.

Keywords: Lead, Lactation

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I have practiced as a pediatric nurse practitioner in the Yale Lead Poisoning Prevention Program since 2001. I have served on governmental panels related to lead poisoning prevention: 2004-2005--State of CT Lead Poisoning Elimination Task Force-Screening and Case Management Committee Member 2006-present--New Haven Health Education Lead Poisoning Prevention Initiative I have done presentations related to childhood lead poisoning: Pediatric Lead Poisoning. Quinnipiac University School of Nursing, Hamden, CT. (Invited Presentation). April 17, 2003. Lead Poisoning: An Integrative Review of Its Effects on Pregnancy. 13th Annual All Connecticut Chapters Sigma Theta Tau Research Day. March 3, 2005, New Haven, CT. The Effects of Lead Poisoning on Pregnancy: An Integrative Review. University of Connecticut Spring Distinguished Scholars Event. April 14, 2005.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.