Guidelines for the Identification and Management of Lead Exposure

PREFACELead exposure during pregnancy and breastfeeding can result in lasting adverse health effects independentof lead exposure during other life stages. However, to date there has been limited guidance available for cliniciansand the public health community regarding the screening and management of pregnant and lactatingwomen exposed to high levels of lead. Recognizing the need for national recommendations, the Centersfor Disease Control and Prevention and the Advisory Committee on Childhood Lead Poisoning Preventionconvened a workgroup of recognized experts to review the existing evidence for adverse effects of past andcurrent maternal lead exposure on maternal health and fertility and on the developing fetus, infant, and childin prenatal and postnatal states and to propose evidence-based strategies for intervention.These Guidelines for the Identification and Management of Lead Exposure in Pregnant and Lactating Women arebased on scientific data and practical considerations regarding preventing lead exposure during pregnancy,assessment and blood lead testing during pregnancy, medical and environmental management to reducefetal exposure, breastfeeding, and follow up of infants and children exposed to lead in utero.The guidelines also outline a research agenda that will provide crucial information for future efforts to preventand treat lead exposure during pregnancy and lactation. Further research is needed for a better understandingof lead’s effect on pregnancy outcomes and infant development; lead kinetics across the placenta and inbreast milk and their relationship to long-term health effects; genetic susceptibility to damage from lead; aswell as the pharmacokinetics, effectiveness, and safety of chelating agents in the pregnant woman. Researchis also needed to address important clinical and public health needs including validation of risk questionnairesfor pregnant women, optimal timing of blood lead testing, and effective strategies for identification andtreatment of pica in pregnant women.I wish to thank the members of the Advisory Committee on Childhood Lead Poisoning Prevention, membersof the Lead in Pregnancy Workgroup, and consultants who developed this document and acknowledgetheir contribution to the health of the nation’s children. This document was voted on and approved with oneabstention at the October 21-22, 2009, meeting of the Advisory Committee on Childhood Lead Poisoning Prevention.I believe this document represents a major advance in our efforts to prevent lead exposure in thosemost vulnerable.Christopher Portier, PhDDirectorNational Center for Environmental Health/Agencyfor Toxic Substances and Disease RegistryCenters for Disease Control and Preventioni