Prevention of Lead Exposure in the Perinatal Period

The effects of lead exposure on children and the importance of lead screening in the pediatric period are well-established, but little emphasis is placed on prevention in the perinatal period. Variability in screening guidelines and practices results in inconsistent and often insufficient lead screening during pregnancy. No blood lead level is safe, and lead stored in a woman's bones can be released during pregnancy, exposing the fetus. Women and children of color face disproportionately high blood lead levels as compared with their White counterparts. In utero exposure to lead is associated with preterm birth, low birth weight, and neurodevelopmental delays in children. Prenatal lead screening through blood tests and occupational and social history can help to identify, prevent, and mitigate maternal and fetal exposure. In this article, I review existing guidelines and practices; make recommendations for primary, secondary, and tertiary prevention of lead; and advocate for universal lead screening during pregnancy.