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Chelation during sequential pregnancies: A case report with a twist.

Morri E Markowitz¹, Joann Mercedes¹, Olga Apt-Dudfield¹

¹Montefiore Hospital and Medical Center, New York, NY, USA.

Obstetric Medicine

|April 21, 2022

Summary

This case study details managing recurrent lead poisoning in pregnancy using succimer, a rarely reported treatment. It highlights the challenges of co-existing vitamin D deficiency and hyperparathyroidism impacting bone lead release.

Keywords:

Chelation during pregnancy hyperparathyroidism lead poisoning neonatal lead poisoning succimer

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Area of Science:

Toxicology
Obstetrics
Endocrinology

Background:

Lead poisoning poses risks during pregnancy, affecting both maternal and fetal health.
Bone lead stores can be mobilized, especially during physiological changes like pregnancy.
Management strategies for lead poisoning in pregnancy require careful consideration of safety and efficacy.

Observation:

A patient experienced recurrent lead poisoning across sequential pregnancies.
Treatment involved succimer (meso-2,3-dimercaptosuccinic acid), a chelating agent with limited reported use in pregnant individuals.
The patient presented with co-existent vitamin D deficiency and hyperparathyroidism.

Findings:

Succimer administration was utilized for chelation therapy in the context of pregnancy.
Vitamin D deficiency and hyperparathyroidism were identified as potential contributing factors to ongoing bone lead release.
The successful management of recurrent lead poisoning during pregnancy was achieved.

Implications:

This case expands the understanding of succimer's use in managing lead poisoning during pregnancy.
It underscores the importance of addressing underlying metabolic conditions like vitamin D deficiency and hyperparathyroidism in cases of recurrent lead poisoning.
Findings suggest a need for further research into chelation therapies and management protocols for pregnant women with lead exposure.