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Screening for Elevated Blood Lead Levels in Children and Pregnant Women: US Preventive Services Task Force
, Susan J Curry1, Alex H Krist2,3
1University of Iowa, Iowa City.
Insights
Screening for elevated blood lead levels in children and pregnant women lacks sufficient evidence. The US Preventive Services Task Force found current data inadequate to determine the benefits and harms of screening for lead exposure.
Area of Science:
- Public Health
- Pediatrics
- Obstetrics
Background:
- Elevated blood lead levels in children are linked to irreversible neurologic effects, including behavioral problems and lower IQ.
- Lead exposure in pregnant women can harm organ systems and increase risks for preeclampsia and adverse perinatal outcomes.
Purpose of the Study:
- To update the 2006 US Preventive Services Task Force (USPSTF) recommendation on screening for elevated blood lead levels in children and pregnant women.
Main Methods:
- The USPSTF reviewed evidence on the benefits and harms of screening and treatment for elevated blood lead levels, defining an elevated level as 5 μg/dL.
- Evaluated the accuracy of questionnaires and clinical prediction tools versus capillary blood testing for identifying elevated blood lead levels.
Main Results:
- Capillary blood testing accurately identifies elevated blood lead levels in children.
- Evidence on the effectiveness and harms of screening and treatment for elevated blood lead levels in asymptomatic children and pregnant women was found to be inadequate.
- Questionnaires and clinical prediction tools were found to be inaccurate for identifying asymptomatic children and pregnant women with elevated blood lead levels.
Conclusions:
- The USPSTF concluded that current evidence is insufficient to assess the balance of benefits and harms of screening for elevated blood lead levels in asymptomatic children and pregnant persons.
Importance:
Elevated blood lead levels in children are associated with neurologic effects such as behavioral and learning problems, lower IQ, hyperactivity, hearing problems, and impaired growth. In pregnant women, lead exposure can impair organ systems such as the hematopoietic, hepatic, renal, and nervous systems, and increase the risk of preeclampsia and adverse perinatal outcomes. Many of the adverse health effects of lead exposure are irreversible.
Objective:
To update the 2006 US Preventive Services Task Force (USPSTF) recommendation on screening for elevated blood lead levels in children and pregnant women.
Evidence Review:
The USPSTF reviewed the evidence on the benefits and harms of screening for and treatment of elevated blood lead levels. In this update, an elevated blood lead level was defined according to the Centers for Disease Control and Prevention reference level of 5 μg/dL.
Findings:
The USPSTF found adequate evidence that questionnaires and other clinical prediction tools to identify asymptomatic children with elevated blood lead levels are inaccurate. The USPSTF found adequate evidence that capillary blood testing accurately identifies children with elevated blood lead levels. The USPSTF found inadequate evidence on the effectiveness of treatment of elevated blood lead levels in asymptomatic children 5 years and younger and in pregnant women. The USPSTF found inadequate evidence regarding the accuracy of questionnaires and other clinical prediction tools to identify asymptomatic pregnant women with elevated blood lead levels. The USPSTF found inadequate evidence on the harms of screening for or treatment of elevated blood lead levels in asymptomatic children and pregnant women. The USPSTF concluded that the current evidence is insufficient, and that the balance of benefits and harms of screening for elevated blood lead levels in asymptomatic children 5 years and younger and in pregnant women cannot be determined.
Conclusions And Recommendation:
The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of screening for elevated blood lead levels in asymptomatic children. (I statement) The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of screening for elevated blood lead levels in asymptomatic pregnant persons. (I statement).
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