Lead Screening in Pregnancy

It seems that at a woman’s first prenatal visit she is screened for everything possible—but lead testing isn’t often brought up. With the recent media coverage that lead-contaminated water has received, should it be?

The simple answer is that there is not a straightforward answer when it comes to lead screening in pregnancy. We do know that, as of this time, blood tests for lead are not recommended for all pregnant women. Even though we know that being exposed to high levels of lead while pregnant can lead to health issues for both mom and baby (such as an increased risk of developing high blood pressure and an increased risk of behavior and intelligence problems in lead-exposed babies), the fact that only 1 percent of all U.S. women of childbearing age have elevated levels mean we would be subjecting the remaining 99 percent of women to unnecessary testing.

However, there is definitely a group of pregnant women who should be screened. Women who live in certain communities that are known to be exposed to dangerously high lead levels should be tested. This includes those with battery recycling plants, those where lead mines or smelting factories exist, or where products such as leaded gasoline are still used.

The Centers for Disease Control and Prevention and the American College of Obstetricians and Gynecologists recommend screening pregnant women for risk factors for lead exposure. If any one of the following risk factors are present, blood lead levels should be checked:

Living in an area or recently emigrating from an area where lead contamination is high

Living near a lead source (such as a lead mine)

Renovating an older home without proper lead hazard controls

Drinking water contaminated with lead (i.e. through lead pipes)

Working with or living with someone who works with lead (such as paint, battery, or plastic manufacturing)

Used lead-glazed ceramic pottery to cook, serve, or store food

Eating non-food substances (also known as pica)

Using certain alternative/complementary herbs or remedies

Using imported cosmetics or certain imported foods or spices that may be contaminated

Having a past history or living with someone who has had a history of high lead levels

If any single one of these risk factors is present, a pregnant woman should be screened as early as that risk factor is identified. This is so that appropriate measures, such as doing an environmental evaluation to help reduce her ongoing lead exposure, can be put in place as soon as possible.

Lead levels should be tested via a venous blood test, as opposed to a finger stick test as this can give inaccurate results. A blood lead level above 5 micrograms/dL is considered abnormal and requires further investigation and follow-up.

If you are pregnant and concerned that your risk for lead exposure has not been assessed, you can review the list above to see if you might fall into a category where you should be screened. If so, discuss it with your doctor or midwife so that the appropriate testing can be done.

Sources:

• The American Congress of Obstetricians and Gynecologists
• Committee Opinion #533: Lead screening during pregnancy and lactation
• August 2012.
  The Centers for Disease Control and Prevention
• Guidelines for the identification and management of lead exposure in pregnant and lactating women
• November 2010.

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