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Universal Prenatal Lead Screen Lauded


 

PHILADELPHIA — Universal prenatal screening of maternal blood lead levels significantly increases the identification rate of women with abnormal levels, allowing earlier identification of infants born at risk, Dr. Tatyana Gabinsky said at the annual meeting of the Eastern Society for Pediatric Research.

Dr. Gabinsky of Elmhurst (N.Y.) Hospital Center, presented a 4-year retrospective study (2002–2006) of more than 20,000 women who received blood lead screenings during their first prenatal visits.

Before 2002, her institution followed the Centers for Disease Control and Prevention recommendation for screening only women identified by questionnaire as being at increased risk for elevated lead levels. Beginning in 2004, the hospital began screening all women as part of routine care.

In all, 20,263 women were screened. The blood lead level was at least 5 mcg/dL in 6% and 7–10 mcg/dL in 5%.

About 1% of the women had extremely high levels (median 17 mcg/dL; range 11–56 mcg/dL).

With the selective screen, the identification rate of women with levels in the 5- to 10-mcg/dL range was 2.2%, and only 0.28% in those with a level greater than 10 mcg/dL.

With universal screening, those identification rates increased to 7% in women in the 5- to 10-mcg/dL range and 1.6% in women with a level greater than 10 mcg/dL.

Universal screening also allowed staff to increase their identification rate of infants born with elevated blood lead levels (2%–11%), Dr. Gabinsky said.

Most (91%) of the women with elevated blood lead levels were foreign born, she added. The most common nationalities were Mexican (35%), Bangladeshi (21%), and Pakistani (16%).

She is conducting a follow-up study of infants born to mothers with a blood lead level greater than 10 mcg/dL. Infants with a newborn level greater than 10 mcg/dL are retested on a monthly basis, while those with a newborn level of 5- to 10-mcg/dL are tested every 2–3 months. Most of them are able to clear the lead by 1 year of age, she said.

“By the time they are 12 months old, the majority are almost normal. Even in babies with a level as high as 42 mcg/dL, by 12 months they are only at 5 mcg/dL,” said Dr. Gabinsky.

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