The Full Story
For thousands of years, we've known that lead is harmful. It is especially dangerous for young children. Lead damages the brain and nervous system, especially when children are still growing. They can have a lower IQ, behavior problems, damaged hearing, abdominal pains, and trouble learning.
Pregnant women with high lead levels can pass lead to their unborn children. (Lead also can be passed to children in breast milk.) Now, there are guidelines for when pregnant women should be tested for high lead levels.
The Centers for Disease Control and Prevention (CDC) and the American College of Obstetricians and Gynecologists recommend that all pregnant women be asked about their risk factors for lead poisoning.
Pregnant women should be tested for lead if they have any one of these risk factors:
- Recent arrival to the U.S. from a country with a lot of environmental lead.
- Living near a source of lead, for example lead mines or battery recycling plants.
- Working in a lead industry or living with someone who does.
- Having a lead-based hobby, for example stained glass.
- Using lead-based pottery for food or drinks.
- Using lead-based cosmetics, such as imported kohl or sarma.
- Using spices, herbs, or medicines that could be contaminated with lead. These are usually imported from other countries.
- Repairing or renovating a home with lead paint.
- Living in a home with lead in the water pipes.
- Having a history of lead poisoning; lead is stored in bone for decades and is released into the blood during pregnancy.
- Living with someone with a high lead level.
If a pregnant woman's level is less than 5 micrograms per deciliter (mcg/dL), nothing more needs to be done.
If the level is 5 or above, repeat testing is needed. How often a woman is re-tested depends on her blood lead level. Pregnant women with lead levels of 5 mcg/dL or above also need extra calcium and iron in their diets. These supplements help prevent higher blood lead levels.
Every pregnant woman should discuss possible lead risks with her health provider. For questions about lead and lead poisoning, call Poison Control at 1-800-222-1222.
Take Home Messages:
High blood lead levels are dangerous for a pregnant woman and her fetus. Possible problems include high blood pressure, spontaneous abortion, small babies, and brain damage in the infant. Now, there are specific guidelines for pregnant women:
- All pregnant women should talk to their doctors (or other health care providers) about risk factors for lead poisoning.
- All pregnant women with even one risk factor should have a blood lead level done.
- All pregnant women with lead levels at or above 5 micrograms/deciliter (mcg/dL) must have further assessment and treatment.
Rose Ann Gould Soloway, RN, BSN, MSEd, DABAT emerita
If you are pregnant, talk to your health care provider about lead. If you have risk factors for lead poisoning, have a blood test for lead.
This Really Happened
A 38-year-old woman who was 25 weeks pregnant came into the emergency room complaining of chronic abdominal pain, fatigue, constipation and body aches. Blood work obtained prior to her pregnancy revealed anemia and an abnormally high whole-blood lead level (67.5 mcg/dL; a normal level is less than 5). At that time, the woman did not seek treatment.
When she went to the emergency room during her pregnancy, her whole-blood lead level was again high (62.8 mcg/dL), her anemia had worsened, and her blood showed characteristics of lead poisoning when viewed under the microscope. The ultrasound of the fetus appeared normal at that time.
Four weeks after her diagnosis of lead poisoning, the patient was treated with oral chelators. These are medicines that help the body excrete some of the lead. The goal was to prevent some of the severe effects of lead poisoning in both the woman and her fetus.
At birth, the baby had a very high lead level (74.7 mcg/dL). Although the child was born 3 weeks early, she appeared normal and healthy at that time. The child was treated in the hospital with intravenous chelators for 3 days. Then, she was given an oral chelator for another 19 days. At 6 weeks old, the child's whole-blood lead level was still high (30.7 mcg/dL); she was treated with another 19 days of chelation therapy.
After 6 months of monitoring, the child's lead level was still elevated (30.5 mcg/dL). At that time, her pediatrician felt that she appeared normal. She did not have any apparent developmental delay. It is unknown if the child showed any problems with learning, behavior, or health as she continued to grow and develop.
Summarized from: Horowitz BZ, Mirkin, DB. Lead poisoning and chelation in a mother-neonate pair. Clinical Toxicology. 2001; 39(7):727-731.