Not many people know this, New York is the only state that requires that every pregnant woman have her risk of lead exposure assessed at the first prenatal visit. As a doctor seeing pregnant patients regularly, this is unbelievable to me! Highlighting this topic is particularly appropriate during October as this month we’ll celebrate National Lead Poisoning Prevention Week. This awareness week was created because lead exposure can have such serious consequences, for pregnant women and particularly for developing children.

What is lead?
Lead is a heavy metal found in many different places, like dust, air, soil, water, food and inside our homes. For generations, lead has been used in many products, like paint. People didn’t even realize it was there and that is could be harmful. It was also used in gasoline, and continue to be used in batteries, electronics, pipes, solder, ceramics, glass, toys and jewelry among many other things. In 1978, lead was removed from the manufacture of household paints. But even today the remodeling of homes with old lead paint that had been applied years before continues to be a common source of lead exposure, especially when the paint is peeling or chipping off of the walls.

What is lead poisoning?
Lead poisoning may result in one symptom or many vague symptoms that sometimes are overlooked by health care providers. They can sneak up on an exposed person and he/she may not even realize he/she’s sick. Symptoms of lead poisoning can include abdominal pain, constipation, diarrhea, aggressiveness, anxiousness, hyperactivity, shortened attention span, muscle pain, weakness, weight loss, learning disabilities, convulsions, and (with significant lead exposure) even death. Someone with lead poisoning might also develop anemia (low blood iron).

It can be devastating for developing babies and kids.
In pregnancy, lead can cross the placenta and reach the baby; so if a pregnant woman is lead-exposed, so is her baby. In addition, young children tend to put everything in their mouths, so their risk for possible exposure is high. Low doses of lead can do lasting damage to infants and young children, as well as babies developing in mom’s womb. Potential effects include:

1. Lower IQ
2. Distractibility and hyperactivity
3. Hearing loss
4. Anemia
5. Growth and behavioral problems
6. Kidney and brain damage
7. Bone weakness/osteoporosis

So what can you do to reduce your and your child’s exposure to lead?

• All pregnant women should consider being tested for lead exposure. It is a simple and inexpensive test that can be included with the blood tests being done at your first prenatal visit. If your obstetric health-care provider does not suggest testing, ask your provider to order a blood lead test.
• Have your child tested for lead starting before age 1, with regular testing occurring until age 6. Children under 6 are especially at risk, and the long-term effects of lead in a child can be severe!
• Keep your house clean. Dust contaminated with lead that is accessible to young children can cause an increased blood lead level. Help young children wash their hands with soap and water frequently and discourage them from putting their fingers in their mouths. Use a wet mop to dust, clean windowsills regularly and wash toys frequently.
• Lead in soil does not break down with time; it remains there forever. Don’t allow children to play in areas of bare soil.
• Don’t burn painted wood, as it may contain lead.
• If you work with lead, shower and change your clothes before going home.
• Don’t remove lead paint yourself; it’s a job best left to the professionals.
• Run the cold water in your kitchen faucet at a high rate for at least 30 seconds before drinking it, using it for mixing infant formula or for cooking, especially if it hasn’t been used in several hours.
• Don’t store food or drink in lead crystal glassware or old pottery.
• Beware of herbal products that are not certified because a range of heavy metals have been found in uncertified herbal products.
• Make sure children have adequate amounts of calcium, iron and Vitamin C in their diets. If their diets are low in these minerals or vitamins, they can potentially absorb more lead if they ingest it.

As much as I am discouraged to see the lack of testing required nationwide for lead exposure, I am still filled with hope. My hope is that awareness, like this blog, will prevent one more child from being exposed to lead. Spread the word, share this info and remember, lead poisoning is entirely preventable! #kNOwLEAD this month and every month!

Rogelio Perez D’Gregorio, MD, MS is an Assistant Director of MotherToBaby UR Medicine and Assistant Professor of Obstetrics and Gynecology at the University of Rochester.

Other blog contributions were made by:

Stanley Schaffer, MD, Director of the Western New York Lead Resource Center in Rochester and an Associate Professor of Pediatrics, at U of R.

Richard K. Miller, PhD, Director of MotherToBaby UR Medicine and Co-Director of the Finger Lakes Children’s Environmental Health Center. He also Professor of Obstetrics/Gynecology, of Environmental Medicine and of Pathology and Clinical Laboratory Medicine at U of R.

About MotherToBaby
MotherToBaby is a service of the Organization of Teratology Information Specialists (OTIS), suggested resources by many agencies including the Centers for Disease Control and Prevention (CDC). If you have questions about exposures during pregnancy and breastfeeding, please call MotherToBaby toll-FREE at 866-626-6847 or try out MotherToBaby’s new text information service by texting questions to (855) 999-3525. You can also visit MotherToBaby.org to browse a library of fact sheets about dozens of viruses, medications, vaccines, alcohol, diseases, or other exposures during pregnancy and breastfeeding or connect with all of our resources by downloading the new MotherToBaby free app, available on Android and iOS markets.

References

• ATSDA. 2017. Lead Toxicity. What Are Possible Health Effects from Lead Exposure?. https://www.atsdr.cdc.gov/csem/csem.asp?csem=34&po=10
• CDC. What do parents need to know to protect their children. 2017. https://www.cdc.gov/nceh/lead/ACCLPP/blood_lead_levels.htm
• Ettinger AS et al. 2010. CDC Guidelines for the identification and management of lead exposure in pregnant and lactating women https://www.cdc.gov/nceh/lead/publications/leadandpregnancy2010.pdf
• Etzel RA, et al. 2012. Pediatric Environmental Health. 3rd Edition. American Academy of Pediatrics.
• MotherToBaby Lead Fact Sheet. 2018. https://mothertobaby.org/fact-sheets/lead-pregnancy/pdf/
• Schneyer J, Pell MB. 2016. Millions of American children missing early lead tests, Reuters finds. https://www.reuters.com/investigates/special-report/lead-poisoning-testing-gaps/
• The New York City Department of Health and Mental Hygiene 2018 Guidelines for Health Care Providers. 2018. https://www1.nyc.gov/assets/doh/downloads/pdf/lead/lead-guidelines-preg.pdf
• For additional Information – MotherToBaby@urmc.rochester.edu

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