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

Details

• Alternative Title:
  Matern Child Health J
• Personal Author:
  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.
• 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:
  Child Female Gestational Age Humans Hypertension Lead Mass Screening Pregnancy Risk Factors
• Keywords:
  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/
• 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
• File Type:
  [PDF - 585.76 KB ]