Guidelines: Lead screening in pregnancy

3/31/2018




Written by Jennifer Lincoln, MD, IBCLC

 
It seems that at a woman’s first prenatal visit she is screened for everything under the sun, but lead screening is often overlooking. Given the recent media coverage of lead-contaminated city water, should you be tested for lead if you’re pregnant?
 
Unfortunately, there isn’t a straightforward answer. We do know that, as of this time, routine blood testing is not recommended for all pregnant women. We also know that being exposed to lead during pregnancy can lead to problems for both mom and baby (preeclampsia and an increased risk of behavior and intelligence problems in lead-exposed babies). Yet, only 1 percent of all U.S. women of childbearing age have elevated levels, so testing all pregnant women means we would be subjecting 99 percent to unnecessary testing.
 
However, both the Centers for Disease Control and Prevention (CDC) and the American College of Obstetricians and Gynecologists (ACOG) recommend screening all pregnant women for lead exposure risk factors using a questionnaire. If any of the following risk factors are present, a blood lead test is recommended:
 
  1. Living in, or recently emigrating from, an area where lead contamination is high.
  2. Living near a lead source (such as a lead mine, small airport, battery recycling facility).
  3. Renovating an older home without proper lead hazard controls.
  4. Drinking water contaminated with lead (i.e., via lead pipes).
  5. Working with or living with someone who works with lead (such as paint, battery, or plastic manufacturing).
  6. Used lead-glazed ceramic pottery to cook, serve, or store food.
  7. Eating non-food substances (also known as pica).
  8. Using certain alternative/complementary herbs or remedies such as Greta or Azarcon.
  9. Using imported cosmetics, foods or spices that may be contaminated.
  10. Previous exposure to lead or living with someone who has a history of high lead levels.
 
If any one of these risk factors is present, a pregnant woman should be tested as early as possible. This is so that appropriate measures, such as doing an environmental evaluation to help reduce ongoing lead exposure, can be put in place as soon as possible.
 
Lead levels are tested with a blood test: a finger stick or venous blood sample. There is no “safe” blood lead level, but in general a level above 5 micrograms/dL 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 fall into a category where you should be tested. If so, discuss it with your doctor or midwife so that the appropriate testing can be done.
 

Takeaways
  1. The CDC and ACOG recommend screening all pregnant women for lead exposure risks using a questionnaire.
  2. A blood lead test is recommended when a single factor is present.
  3. Lead levels are tested via a simple blood test.
  4. If a level is high, identifying and removing the source of exposure should be immediate.
 

References
  1. The American Congress of Obstetricians and Gynecologists. Committee Opinion #533: Lead screening during pregnancy and lactation. August 2012.
  2. 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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