No to Routine Lead Testing of Pregnant Women

Ob-Gyns Should Evaluate Individual Risk Factors

July 23, 2012

Washington, DC -- All pregnant and breastfeeding women should be evaluated for their individual risk of environmental lead exposure, but only those with one or more risk factors should actually be tested for lead, preferably at their first office visit, according to The American College of Obstetricians and Gynecologists (The College). Because of the significant health risks of moderate to high lead levels in pregnant women, fetuses, and young children, The College issued new recommendations on screening and blood testing for lead.

The number of cases of lead exposure in the US have decreased considerably, thanks to environmental policies and public health education programs. Despite these improvements, approximately 1% of childbearing-age women (15–49) have above-normal blood lead levels. Blood lead levels less than 5 ug/dL (micrograms per deciliter) are considered normal. Levels between 5 and 10 ug/dL require follow-up, and levels higher than 10 ug/dL need an environmental assessment and abatement of exposures.

Pregnant women with moderate to high levels of lead in the blood have an increased risk of miscarriage, low birth weight, gestational hypertension, and impaired brain development in children. In all people, high levels of lead in the blood can result in delirium, seizures, coma, or death. Symptoms of lead poisoning include hypertension, headache, loss of appetite, weight loss, muscle and joint pain, and changes in behavior and concentration. Even low levels of lead can affect the brain, heart, kidneys, and reproductive organs.

A few of the 12 primary risk factors for lead exposure are:

  • Consumption of lead-contaminated water
  • Renovating/remodeling older homes that have lead paint
  • Recent immigration from countries where leaded gas is still being used
  • Living near a lead mine or battery recycling plant
  • Working with lead or living with someone who does
  • Use of contaminated alternative or complementary medicines and herbs
  • Using imported cosmetics or certain food products
  • Using lead-glazed ceramic pottery for food preparation or storage

* For the full list of risk factors, see Committee Opinion #533 (below).

Pregnant women with higher than normal levels of lead should identify the source of the lead, avoid further exposure, and make sure they are eating a daily balanced diet containing 2,000 mg of calcium and 60–120 mg of iron, which is known to decrease absorption of lead by the body. Women at risk for elevated lead levels who were not screened during pregnancy should be screened postpartum if they plan to breastfeed.

Committee Opinion #533 “Lead Screening During Pregnancy and Lactation” is published in the August issue of Obstetrics & Gynecology.

Other recommendations issued in this month’s Obstetrics & Gynecology:

Committee Opinion #531 “Improving Medication Safety (Revised)
ABSTRACT: Despite significant national attention, medical errors continue to pervade the US health care system. Medication-related errors consistently rank at the top of all medical errors, which account for thousands of preventable deaths annually in the United States. There are a variety of methods—ranging from broad-based error reduction strategies to the adoption of sophisticated health information technologies—that can assist obstetrician–gynecologists in minimizing the risk of medication errors. Practicing obstetrician–gynecologists should be familiar with these various approaches that, along with efforts directed at assisting the patient in understanding the medical condition for which a medication is prescribed, can improve the safety and efficacy of medication usage.

Committee Opinion #532 “Compounded Bioidentical Menopausal Hormone Therapy (Revised)
ABSTRACT: Although improvement in long-term health is no longer an indication for menopausal hormone therapy, evidence supporting fewer adverse events in younger women, combined with its high overall effective¬≠ness, has reinforced its usefulness for short-term treatment of menopausal symptoms. Menopausal therapy has been provided not only by commercially available products but also by compounding, or creation of an indi¬≠vidualized preparation in response to a health care provider’s prescription to create a medication tailored to the specialized needs of an individual patient. The Women’s Health Initiative findings, coupled with an increase in the direct-to-consumer marketing and media promotion of compounded bioidentical hormonal preparations as safe and effective alternatives to conventional menopausal hormone therapy, have led to a recent increase in the popularity of compounded bioidentical hormones as well as an increase in questions about the use of these preparations. Not only is evidence lacking to support superiority claims of compounded bioidentical hormones over conventional menopausal hormone therapy, but these claims also pose the additional risks of variable purity and potency and lack efficacy and safety data. The College’s Committee on Gynecologic Practice and the Practice Committee of the American Society for Reproductive Medicine provide an overview of the major issues of concern surrounding compounded bioidentical menopausal hormone therapy and provide recommendations for patient counseling.

Committee Opinion #535 “Reproductive Health Care for Incarcerated Women and Adolescent Females (NEW!)
: Increasing numbers of women and adolescent females are incarcerated each year in the United States and represent an increasing proportion of inmates in the US correctional system. Incarcerated women and adolescent females often come from disadvantaged environments and have high rates of chronic illness, substance abuse, and undetected health problems. Most of these females are of reproductive age and are at high risk of unintended pregnancy and sexually transmitted infections, including human immunodeficiency virus (HIV). Understanding the needs of incarcerated women and adolescent females can help improve the provision of health care in the correctional system.

The American College of Obstetricians and Gynecologists (The College), a 501(c)(3) organization, is the nation’s leading group of physicians providing health care for women. As a private, voluntary, nonprofit membership organization of approximately 56,000 members, The College strongly advocates for quality health care for women, maintains the highest standards of clinical practice and continuing education of its members, promotes patient education, and increases awareness among its members and the public of the changing issues facing women’s health care. The American Congress of Obstetricians and Gynecologists (ACOG), a 501(c)(6) organization, is its companion organization.


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