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

Details

• Personal Author:
  Erlinger AL ; Hacker MR ; Hart JM ; Hauptman M ; Johnson KM ; Karumanchi SA ; O'Brien K ; Salahuddin S ; Specht AJ ; Woolf AD ; Wylie BJ
• 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. [Description provided by NIOSH]
• Subjects:
  Cohort Studies Occupational Health Pregnancy Risk Assessment Risk Factors Safety Surveys And Questionnaires Women
• Keywords:
  Author Keywords: Lead Exposure Blood Lead Levels Children Cohort Studies In Utero Exposure Prenatal Exposure Prenatal Screening Questionnaires Risk Factors
• ISSN:
  1092-7875
• Document Type:
  Text
• Funding:
  Grant
• Genre:
  Journal Article
• Place as Subject:
  California ; Indiana ; Massachusetts ; OSHA Region 1 ; OSHA Region 5 ; OSHA Region 9
• CIO:
  National Institute for Occupational Safety and Health (NIOSH)
• Topic:
  Workplace Safety & Health
• Location:
  North America
• Pages in Document:
  185-192
• Volume:
  26
• Issue:
  1
• NIOSHTIC Number:
  nn:20064357
• Citation:
  Matern Child Health J 2022 Jan; 26(1):185-192
• Contact Point Address:
  Katherine M. Johnson, Department of Obstetrics and Gynecology, University of Massachusetts Medical School/University of Massachusetts Memorial Medical Center, 119 Belmont Street, Worcester, MA 01605, USA
• Email:
  katherine.johnson@umassmemorial.org
• CAS Registry Number:
  Lead (CAS RN 7439-92-1)
• Federal Fiscal Year:
  2022
• Performing Organization:
  Harvard School of Public Health, Boston, Massachusetts
• Peer Reviewed:
  True
• Start Date:
  20190901
• Source Full Name:
  Maternal and Child Health Journal
• End Date:
  20220831
• Collection(s):
  National Institute for Occupational Safety and Health
• Main Document Checksum:
  urn:sha-512:954a6f36248a5846f3078e0d8cdcc81a8ef8b651b07485ffbe0870522117ab4ff89fdabdc6845df056f19187c5b600c8327c3eb477cb613e3a79af6eb5b220d7
• Download URL:
  https://stacks.cdc.gov/view/cdc/222840/cdc_222840_DS1.pdf
• File Type:
  [PDF - 2.64 MB ]