Lead Screening in Pregnancy Can Protect Maternal and Newborn Health. Why Is It Not Universal?  

Rutgers Health experts lead the charge to set mandatory screening for heavy metals during pregnancy and at birth

Doctors have long known that lead exposure during pregnancy poses significant health risks for both mothers and newborns, but universal screening is not mandated in New Jersey or nationwide. In 2019, a pioneering program launched by Rutgers Health with support by the Centers for Disease Control and Prevention introduced lead and heavy-metal screening at University Hospital in Newark, N.J., the main teaching hospital for Rutgers New Jersey Medical School (NJMS), to detect and address exposure early. Rutgers and the hospital are collaborating on the project with the New Jersey Department of Health.

Onajovwe Fofah, a professor and chair of the Department of Pediatrics at Rutgers New Jersey Medical School and director of the division of neonatal-perinatal medicine at University Hospital, is the principal investigator for heavy-metal screening for pregnant women and children at University Hospital. If exposure is found, Diane Calello, professor of emergency medicine at NJMS and executive and medical director of New Jersey Poison Control Center, offers guidance on treatment.

Fofah is preparing to share his findings with the American Academy of Pediatrics and request that the first lead screenings move from nine months of age to screening at birth.

Fofah and Calello discuss the program’s impact and the importance of advancing lead screening standards.

Expectant mothers exposed to lead may experience a higher risk of pregnancy-related complications and adverse health outcomes including miscarriages, while babies exposed in-utero to lead may also experience higher risks of adverse health outcomes.

Onajovwe Fofah

Professor and Chair, Department of Pediatrics, Rutgers New Jersey Medical School

Why is lead screening during pregnancy and at birth essential?
Fofah: The clinical evidence suggests that expectant mothers exposed to lead may experience a higher risk of pregnancy-related complications and adverse health outcomes including miscarriages, while babies exposed in-utero to lead may also experience higher risks of adverse health outcomes. Maternal and infant health outcomes are intertwined; therefore, screening pregnant mothers for lead can improve health equity in diverse socioeconomic backgrounds while also affording the opportunity to intervene through education and pharmacologic treatment to lower the lead level, preventing the health burden of the elevated lead on the mother and baby.

Data from collaborators—such as Xiaobin Wang, who established the Boston Birth Cohort to investigate persistently high rates of preterm birth and the disparity of preterm birth among Black, Indigenous and people of color—offer strong baseline epidemiological evidence on which we began our work five years ago. 

How does the Rutgers Health program help to address this need for heavy-metal screening in mothers and babies?
Fofah: This program brings universal lead and mercury screening to all pregnant patients and is the first of its kind in New Jersey. Newark—the most populated city in New Jersey, located between two highways, an international airport and a population consisting primarily of racial minorities, including immigrant groups—has identified disparities in maternal and child health, such as hypertension, preeclampsia, obesity, prematurity and low birthweight. This screening offers an opportunity to address health equity and justice while offering opportunities to intervene and address these health disparities.

Screening for lead and mercury in pregnant mothers at the start of their prenatal care and at the time of delivery using the umbilical cord blood at University Hospital is a standard-of-care practice. Unfortunately, some pregnant patients are at high risk of metal exposure and may not be diagnosed until the infant reaches nine to 12 months of age.

Discuss the importance of advocating that the American Academy of Pediatrics move babies’ first lead screenings from nine months to at birth.  
Fofah: University Hospital sees about 1,400 births a year. We have screened more than 17,000 samples from mothers and babies since June 2019 and discovered about 14% of those births are babies with elevated lead levels. This program offers the evidence that pregnant mothers remain at risk for exposure to lead and that screening at intake and at the time of delivery will help early detection, intervention and detect any new exposures that may occur all through the pregnancy.

We are also watching a bill that has been proposed in the New Jersey Legislature that would allow for lead screening of pregnant individuals.

Most of what we know about lead is from children 1 to 2 years of age with environmental lead exposure, such as from residential lead in older homes. In those populations, elevated lead level is associated with decreases in IQ, speech delay, gross and fine motor delay, and other developmental and behavioral concerns.

Diane Calello

Professor of Emergency Medicine, Rutgers New Jersey Medical School and Executive and Medical Director, New Jersey Poison Control Center

What are the potential health complications of lead exposure in pregnant women and their infants?
Calello: Lead is a developmental neurotoxin. Most of what we know about lead is from children 1 to 2 years of age with environmental lead exposure, such as from residential lead in older homes. In those populations, elevated lead level is associated with decreases in IQ, speech delay, gross and fine motor delay, and other developmental and behavioral concerns, such as hyperactivity. While we don’t know what the effect may be on a newborn exposed in utero, identifying the exposure and addressing it is the only way to mitigate this risk. 

Are there symptoms of lead exposure that expectant mothers can look for and would they be able to tell they’ve been exposed to lead?
Calello: Symptoms in adults with elevated lead levels can be vague but may include constipation, abdominal pain and decreased appetite. People with more severe cases may feel lethargy or decreased coordination. If you are pregnant and have questions about lead poisoning or think someone was exposed to lead, call Poison Help [800-222-1222] to reach the New Jersey Poison Control Center at Rutgers New Jersey Medical School. The poison control center’s medical providers are available 24/7 for information and guidance on treatment.

What treatments can reduce lead levels in the body?
Calello: Chelation therapy involves the administration of a drug which binds the metal and forms a compound that can then be excreted. It removes metals from the blood and helps to extract them from other compartments in the body such as the bone and soft tissue.

Other treatments include calcium and iron supplementation. Calcium can help remove lead from the body. A deficiency in iron can lead to more avid lead absorption. We make sure children have diets with sufficient calcium and iron.

The primary and most essential treatment of elevated lead levels is to remove the source. None of the other treatments can accomplish anything without stopping the behavior or changing the environment causing the lead exposure. This is why we work hard to evaluate older children’s home environments and talk to pregnant women about where lead might be coming from in their surroundings.