BACKGROUND: Lead poisoning is an important concern for women of preconception age, and especially for pregnant women. Adverse effects of lead exposure are being identified at lower levels of exposure than previously recognized in both children and adults. The Centers for Disease Control and Prevention (CDC) and the New York State Department of Health (NYSDOH) recommends that pregnant mothers with an elevated blood lead level (BLL) (5 µg/dL or higher) during pregnancy should make sure that their newborns are tested for lead before leaving the birthing facility.
METHODS: Although NYS law does not require testing all pregnant women for blood lead, regulations state that a health care provider should test those pregnant women at high risk, and the state has established guidelines for health care practitioners to assist them in determining a woman’s risk of lead poisoning on her initial prenatal visit. Women of childbearing age (16-45) with BLLs of 10 ug/dL or higher are routinely interviewed by NYSDOH staff to determine the possible sources of exposure, and if a women is identified as pregnant, information is obtained on her expected due date and the name and contact information of her physician. NYSDOH staff contacts both the woman’s obstetrician and local health department to share information learned during the interview and to identify the pediatrician. Staff then serve as the liaison between the obstetrician and pediatrician to ensure lead testing occurs on all newborns who are born to mothers with elevated BLLs sometime during their pregnancy.
RESULTS: The follow-up of pregnant women and their newborn babies has been ongoing since 2013. Since that time, a total of 127 pregnant women with elevated blood lead levels have been identified. Thirty-three percent are first pregnancies, while 67% are subsequent pregnancies. Exposures among this population include spice consumption, residential, Ayurvedic, pica, cosmetics, and occupational and many women have multiple sources of lead exposure.
CONCLUSIONS: When identified by NYSDOH program staff, in both 2014 and 2015, 100% of all newborns born to mothers with elevated blood lead levels were tested before NYS’s recommended age of one. The collaboration between NYSDOH staff and county health departments are providing the all-important link between pediatric providers and obstetric practices to ensure that no baby born to a mother with an elevated blood lead level, falls through the lead testing cracks.