Lead exposure in pregnancy: A review of the literature and argument for routine prenatal screening

Despite a steady decline in average blood lead levels in the U.S. population, approximately 0.5% of women of childbearing age may have blood levels exceeding 10 mug/dl. Strong correlations between maternal and umbilical cord blood lead levels demonstrate that lead is transferred from the mother to the fetus. High lead levels are known to cause neurobehavioral effects in infants and children, and the cumulative effects of low levels of lead exposure in utero and after birth can have similar detrimental effects. Modern sources of exposure include occupational exposure during automotive or aircraft paint manufacturing, lead production or smeltering, exposure to stained glass soder, and environmental exposure during home renovation. Prenatal screening for lead exposure may include use of a five-item questionnaire similar to the pediatric questionnaire. Management of prenatal lead exposure focuses on removal of the lead source. Rarely, highly toxic chelation therapy is needed for maternal indications. Recognition and removal of lead sources during the prenatal period can prevent maternal and neonatal morbidity.