Risk-factor Based Lead Screening and Correlation with Blood Lead Levels in Pregnancy

Johnson, Katherine M.; Specht, Aaron J.; Hart, Jessica M.; Salahuddin, Saira; Erlinger, Adrienne L.; Hacker, Michele R.; Woolf, Alan D.; Hauptman, Marissa; Karumanchi, S. Ananth; O’Brien, Karen; Wylie, Blair J.

doi:10.1007/s10995-021-03325-x

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Risk-factor Based Lead Screening and Correlation with Blood Lead Levels in Pregnancy

1 2022
By Johnson, Katherine M. ; Specht, Aaron J. ; Hart, Jessica M. ; ...
http://dx.doi.org/10.1007/s10995-021-03325-x
Source: Matern Child Health J. 26(1):185-192

[PDF-585.76 KB]

English

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Details:

Alternative Title:

Matern Child Health J
Personal Author:

Johnson, Katherine M. ; Specht, Aaron J. ; Hart, Jessica M. ; Salahuddin, Saira ; Erlinger, Adrienne L. ; ... More +

Johnson, Katherine M. ; Specht, Aaron J. ; Hart, Jessica M. ; Salahuddin, Saira ; Erlinger, Adrienne L. ; Hacker, Michele R. ; Woolf, Alan D. ; Hauptman, Marissa ; Karumanchi, S. Ananth ; O’Brien, Karen ; Wylie, Blair J. Less -
Description:

Objectives

Lead exposure has devastating neurologic consequences for children and may begin in utero. The American College of Obstetricians and Gynecologists recommends prenatal lead screening using a risk factor-based approach rather than universal blood testing. The clinical utility of this approach has not been studied. We evaluated a risk-factor based questionnaire to detect elevated blood lead levels in pregnancy.

Methods

We performed a secondary analysis of a cohort of parturients enrolled to evaluate the association of lead with hypertensive disorders of pregnancy. We included participants in this analysis if they had a singleton pregnancy ≥34 weeks’ gestation with blood lead levels recorded. Participants completed a lead risk factor survey modified for pregnancy. We defined elevated blood lead as ≥2 μg/dL, as this was the clinically reportable level.

Results

Of 102 participants enrolled in the cohort, 92 had blood lead measured as part of the study. The vast majority (78%) had 1 or more risk factor for elevated lead using the questionnaire yet none had clinical blood lead testing during routine visits. Only two participants (2.2%) had elevated blood lead levels. The questionnaire had high sensitivity but poor specificity for predicting detectable lead levels (sensitivity 100%, specificity 22%).

Conclusions for Practice

Prenatal risk-factor based lead screening appears underutilized in practice and does not adequately discriminate between those with and without elevated blood levels. Given the complexity of the risk factor-based approach and underutilization, the benefit and cost-effectiveness of universal lead testing should be further explored.
Subjects:

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Child Female Gestational Age Humans Hypertension Lead Mass Screening Pregnancy Risk Factors
Keywords:

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Buprenorphine Lead Exposure Methadone Mortality Naltrexone Pregnancy Prenatal Screening Risk Factors Treatment
Source:

Matern Child Health J. 26(1):185-192
Pubmed ID:

35020085
Pubmed Central ID:

PMC8826746
Document Type:

Journal Article
Funding:

UL1 TR002541/TR/NCATS NIH HHSUnited States/ ; NIOSH 1K01 OH011648/NH/NIH HHSUnited States/ ; 1 NU61TS000296-01-00/TS/ATSDR CDC HHSUnited States/ ; UL 1TR002541/TR/NCATS NIH HHSUnited States/

UL1 TR002541/TR/NCATS NIH HHSUnited States/ ; NIOSH 1K01 OH011648/NH/NIH HHSUnited States/ ; 1 NU61TS000296-01-00/TS/ATSDR CDC HHSUnited States/ ; UL 1TR002541/TR/NCATS NIH HHSUnited States/ Less -
Volume:

26
Issue:

1
Collection(s):

CDC Public Access
Main Document Checksum:

[+]

urn:sha-512:fe701ec3262d82f7915151f6871d5186edd7932378c658b5c1db57581ec75d2b497381bab50d024a2a20e9030a6feb6e9f4448cb60bf22b6dc2a2cd35bc16a07
Download URL:

https://stacks.cdc.gov/view/cdc/114365/cdc_114365_DS1.pdf
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