Lead toxicity during pregnancy

Abstract

Lead poisoning among pregnant women is a significant public health problem, especially in urban settings with large immigrant populations. Serious toxic effects of lead on the fetus are well established, and prenatal exposure is a major cause of childhood lead poisoning. Symptomatic lead poisoning with very high maternal blood lead levels is a medical emergency and warrants immediate intervention for maternal indications. Special efforts should be made to identify asymptomatic women with blood lead levels ≥10 μg/dL. An office screening questionnaire can be used for this purpose. Other approaches are identification of women at risk by zip code or immigrant status. In inner-city prenatal populations universal testing of blood lead levels is often advisable. The appropriate health authorities should be notified when a woman is found to have an elevated blood lead level, and a thorough search for the source of exposure must be initiated. Removal from the source is the most crucial step in management. There are insufficient data about the fetal safety of chelation agents in pregnancy, and their use should be limited to maternal indications. Other important measures to reduce lead levels include smoking cessation, improvement of diet, and calcium and other nutritional supplementation.