Lead hazards for pregnant women and children: part 2: more can still be done to reduce the chance of exposure to lead in at-risk populations

In the United States the risk of lead exposure is far higher among poor, urban, and immigrant populations than among other groups. And even slightly elevated blood lead levels increase children's risk of significant neurobehavioral problems extending through adolescence. Research has shown that blood lead levels in pregnant women well below the Centers for Disease Control and Prevention's "level of concern" of 10 micrograms per deciliter can cause miscarriage, premature birth, low birth weight, and subsequent developmental delays in their children. Despite these well-established dangers of lead exposure, routine prenatal lead screening and education is not a standard of care in the United States. Part 1 of this two-part article (October) presented the case of a pregnant woman with lead poisoning and described the epidemiology of lead exposure in the United States, the main sources of it, and its effects on a pregnant woman and her developing fetus and child. Part 2 describes recommendations for prenatal screening and strategies for dealing with lead exposure when it occurs: education, reduction in environmental exposure, treatment options, and developmental surveillance.