Guidelines for the Identification and Management of Lead Exposure

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Table 2-1. Summary of Studies Estimating Association of Prenatal Lead Exposure with Neurodevelopmental Eff ectsYear Study2008Low-level prenataland postnatal bloodlead exposure andadrenocorticalresponses to acutestress in children(Gump et al. 2008)StudySiteOswego, NYStudyTypeCohortstudyN154Estimateof PrenatalExposureMeasuredUmbilicalcord bloodlead level(BLL)Lead Levels(in µg/dL)Range:
EstimateStudy Study of Prenatal Lead Levels Outcome Age atYear Study N ResultsSite Type Exposure (in µg/dL) Measure(s) OutcomeMeasuredMeanAssociation of(standardprenatal and Maternaldeviation [SD]) Number of criminalchildhood blood prenatal Increased arrest rates associatedCohort BLL = 8.3 (3.8); arrests since 19-242008 lead concentrations Cincinnati, OH 250 BLL at 1st with prenatal BLL, relative riskstudy Median 7.8 turning 18 years yearswith criminal arrests or early 2nd (RR) = 1.40 (95% CI = 1.07 – 1.85).(5th to 95th of agein early adulthood trimesterpercentile(Wright et al. 2008)2.9–16).Plasma leadmean (SD):1st trimesterSingle-trimester models of MDIFetal lead exposure scores suggested a negative0.016 (0.014),at each stage of relationship between prenatalMaternal N = 119; 2nd Bayley Mentalpregnancy as a Mexico City, Cohort lead and MDI at 24 months2006 146 prenatal trimester Development Index 24 monthspredictor of infant Mexico study adjusting for covariates. Maternalplasma lead 0.014 (0.011), (MDI)mental development plasma lead in 1st trimester mostN = 136; 3rd(Hu et al. 2006) strongly associated with MDI (β =trimester 0.016–4.13, p = 0.03)(0.024), N =132BLL mean (SD):1st trimesterSingle-trimester models of MDI7.1 (5.1), NFetal lead exposure scores suggested a negative= 119; 2ndat each stage of relationship between prenatalMaternal trimester 6.1pregnancy as a Mexico City, Cohort lead and MDI at 24 months2006 146 prenatal (3.2), N = 136; Bayley MDI 24 monthspredictor of infant Mexico study adjusting for covariates. MaternalBLL 3rd trimestermental development blood lead in 1st trimester most6.9 (4.2), N =(Hu et al. 2006) strongly associated with MDI (β =132; delivery–3.77, p = 0.03).7.3 (4.3), N =111Fetal lead exposure Umbilical cord blood lead wasat each stage of Umbilical cord not statistically significantlypregnancy as a Mexico City, Cohort Umbilical lead (mean 6.2 associated with MDI (β = –0.35,2006 146 Bayley MDI 24 monthspredictor of infant Mexico study cord BLL SD 3.9) (for N = p = 0.88), but this exposuremental development 83 only) measure was only available on a(Hu et al. 2006) subset of subjects.14
Page 1 and 2: GUIDELINES FOR THE IDENTIFICATION A
Page 3 and 4: This document is dedicated to the m
Page 5 and 6: XIV Template for Letter to Construc
Page 8 and 9: EXECUTIVE SUMMARYDespite improvemen
Page 10 and 11: pregnant women with BLL
Page 12 and 13: MEMBERS OF THE WORK GROUP ON LEAD A
Page 14 and 15: MEMBERS OF THE ADVISORY COMMITTEE O
Page 16 and 17: Sally OdlePresident and Owner, Safe
Page 18 and 19: GLOSSARYabatement: any set of measu
Page 20 and 21: cumulative: increasing by successiv
Page 22 and 23: lead-safe work practices: low-techn
Page 24: enovation: construction and/or home
Page 27 and 28: Finally, there is evidence that a s
Page 30 and 31: CHAPTER 2.ADVERSE HEALTH EFFECTS OF
Page 32 and 33: lead exposure (Tabacova et al. 1994
Page 34 and 35: The strongest evidence to date is a
Page 36 and 37: Epidemiologic Evidence for Neurodev
Page 40 and 41: EstimateStudy Study of Prenatal Lea
Page 52 and 53: CHAPTER 3.BIOKINETICS AND B
Page 54 and 55: this biomarker may be a useful rese
Page 56 and 57: Recent studies have documented that
Page 58: Figure 3-1. Major Lead Exposure Pat
Page 61 and 62: Additionally, recent evidence has s
Page 63 and 64: in the study population was 12%
Page 65 and 66: Mobilization of Endogenous Bone Lea
Page 67 and 68: Most of the published literature re
Page 69 and 70: On occasion, imported foods and foo
Page 71 and 72: Case Study 4-3. A Case of Lead Pois
Page 73 and 74: Table 4-1. Risk Factors for Lea
Page 76 and 77: CHAPTER 5.BLOOD LEAD TESTING
Page 78 and 79: Blood Lead Testing in the General P
Page 80 and 81: absorption spectrophotometry (GFAAS
Page 82 and 83: ally, the measured BLL of pregnant
Page 84 and 85: Table 5-2. Schedule for Follow-up B
Page 86 and 87: Figure 5-1. New York City Departmen
Page 88 and 89:
CHAPTER 6.MANAGEMENT OF PRE
Page 90 and 91:
y providing information to health d
Page 92 and 93:
upon eliciting accurate information
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tivity that disturbs paint can incr
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Case management of pregnant women w
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Interpretation and follow-up of blo
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Table 6-2. Suggested Factors to Ass
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Decades of laboratory and clinical
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tion of skeletal mineral. Observati
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of follow up, suggesting decreased
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Supplemental Nutrition Program for
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Inadequate vitamin D status is comm
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CHAPTER 8.CHELATION OF PREGNANT
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CLINICAL EVIDENCE IN PREGNANCY AND
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Table 8-1. Chelating Agents Used
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Table 8-3. Published Experience wit
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CHAPTER 9.BREASTFEEDINGKey Consid
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maternal blood exceeds 40 µg/dL (L
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guidance for breastfeeding by women
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Table 9-1. Frequency of Maternal Bl
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Table 9-3. Estimated a Increase in
Page 132 and 133:
CHAPTER 10.RESEARCH, POLICY, AND HE
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Identification and development of n
Page 136 and 137:
Mandatory Reporting of All Adult Bl
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CHAPTER 11. RESOURCES AND REFERRAL
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Offce of Pollution Prevention and T
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Marino PE, Landrigan PJ, Graef J, N
Page 144 and 145:
Dietrich KN, Ris MD, Succop PA, Ber
Page 146 and 147:
McMichael AJ, Vimpani GV, Robertson
Page 148 and 149:
Vigeh M, Yokoyama K, Mazaheri M, Be
Page 150 and 151:
Gulson BL, Jameson CW, Mahaffey KR,
Page 152 and 153:
Satin KP, Neutra RR, Guirguis G, Fl
Page 154 and 155:
Centers for Disease Control and Pre
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Lee MG, Chun OK, Song WO. 2005. Det
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Simpson E, Mull JD, Longley E, East
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Rothenberg SJ, Khan F, Manalo M, Ji
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Piazza C, Fisher W, Hanley G, LeBla
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Godwin HA. 2001. The biological che
Page 166 and 167:
Looker AC, Loyevsky M, Gordeuk VR.
Page 168 and 169:
Willoughby RA, Thirapatsakun T, McS
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Bachrach VR, Schwarz E, Bachrach LR
Page 172 and 173:
U.S. Food and Drug Administration.
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Appendices 149
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Appendix IExisting State Legislatio
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Guidelines for the Identification &
Page 180 and 181:
Appendix IICharge Questions to the
Page 182 and 183:
Page 184 and 185:
Appendix IIICommonly Ingested Subst
Page 186 and 187:
Page 188 and 189:
Appendix IVList of Occupations and
Page 190 and 191:
Page 192 and 193:
Appendix VAlternative Cosmetics, Fo
Page 194 and 195:
Page 196 and 197:
Appendix VIRecommendations for Medi
Page 198 and 199:
Research | Mini-Monograph Recommend
Page 200 and 201:
Recommendations for medical manag
Page 202 and 203:
Recommendations for medical manag
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Recommendations for medical managem
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Recommendations for medical managem
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Appendix VIIMedical Management Guid
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Medical Management Guidelines for L
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Because lead interferes with bioche
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The clinician, with the patient’s
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i.e., at least monthly. In general,
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If elevated maternal blood lead is
Page 220 and 221:
TABLE 2Non-occupational and Environ
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TABLE 4TABLE 4Health Based Health M
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Gulson BL, Mizon KJ, Korsch MJ, Pal
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Appendix VIIIPregnancy Risk Assessm
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EDC:_________________ID:___________
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ID:___________________________B. HO
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ID:___________________________10. I
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ID:___________________________14a.
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ID:___________________________G. NO
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ID:___________________________I. PA
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SUMMARYInstructions: Check all thos
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ID:___________________________APPEN
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Appendix IXAssessment Interview For
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RISK ASSESSMENT INTERVIEW FORMDate:
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Appendix XLead Based Paint Risk Ass
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Lead-Based Paint Risk Assessment Re
Page 252 and 253:
(Use one of the following sentences
Page 254 and 255:
Appendix ATesting Locations229
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Appendix CDust Wipe and Soil Sample
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Appendix XIPrimary Prevention Infor
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LI #:NEW YORK CITY DEPARTMENT OF HE
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LI #:8a. If yes >> Please tell me h
Page 264 and 265:
Appendix XIIChild Risk Assessment F
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CHILD ID: Page 1 of 12PNEW YORK CIT
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CHILD ID: Page 3 of 126. Does [chil
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CHILD ID: Page 5 of 1217a. If yes >
Page 272 and 273:
CHILD ID: Page 7 of 1224. [Imported
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CHILD ID: Page 9 of 12Home renovati
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CHILD ID: Page 11 of 12Provide the
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Appendix XIIINutritional Reference
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Nutrition Reference InformationRECO
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Blood hemoglobin levels are routine
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Beef, chuck, blade roast, lean, coo
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Sunflower oil, 1 TbspCottonseed oil
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Appendix XIVTemplate for Letter to
Page 290 and 291:
Template for Letter to Construction
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Appendix XVWorkplace Hazard Alert f
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WORKPLACE HAZARD ALERTNew Health Da
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What should I tell my doctor?Your d
Page 298 and 299:
Make sure you don’t accidentally
Page 300 and 301:
Worksite Evaluation FormWhat your e
Page 302:
CS2016857
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Guidelines for the Identification and Management of Lead Exposure

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