Prenatal Remediation Strategy Significantly Reduces Lead Poisoning In Children

Results of study published in the American Journal of Obstetrics & Gynecology

Philadelphia, PA, March 2, 2012 – An initiative in St. Louis targeted the homes of pregnant women to receive inspection and remediation of lead hazards before the birth of a child. According to a study just published in the American Journal of Obstetrics and Gynecology this measure prevented childhood lead poisoning and reduced the overall burden of lead toxicity in children. Historically, the city had used an approach that waited until a child tested positive for lead poisoning, and then addressed home lead hazards to prevent future harm. 

“Our data provide evidence that a program of prenatal home screening and lead hazard remediation is effective,” reports lead author Daniel R. Berg, MD, MPH, of the Department of Internal Medicine, Family Care Health Centers, St. Louis, Missouri. “Children not only had a lower rate of poisoning, but also a lower average blood lead level. This is significant, since decreased intelligence in children is observed at blood lead levels below the government definition of lead poisoning, and no safe threshold of lead exposure in children has been found.”

The Heavy Metal Project targeted the homes of pregnant women from a clinic primarily serving African-American women on Medicaid to receive prenatal home inspection and remediation of lead hazards. Home inspections were conducted by certified inspectors, and when lead was found, remediation efforts included paint stabilization, window replacement, and cleaning. Blood lead levels were obtained from 60 children. The average blood lead level among participants was 2.70 micrograms per deciliter (µg/dL) versus 3.63 µg/dL for controls. Blood lead levels greater than 5 µg/dL were found in 13.3% of study participants and 22.5% of controls. 

A recent study in Philadelphia that screened and remediated newborns’ homes did not show similar results. However, 62.5% of the homes in the St. Louis study underwent remediation, while only 28.2% of the homes in Philadelphia did. The control population in St. Louis was older at the time of blood testing, and St. Louis possibly has a riskier housing environment. 

The authors note that ideally, cities would be able to correct lead hazards in all available housing, but this is not financially possible. “Long term solutions will only be possible with well-designed public policies which make use of both private and public monies for building repair, demolition, creation of new affordable housing developments, and targeted home screenings such as the one in our study,” says Dr. Berg.

Obstetricians should refer high-risk patients for prenatal home lead hazard screening and remediation, the authors recommend. “Philosophically, this screening is similar to screening pregnancies for potential complications, and newborns for congenital metabolic diseases. Lead poisoning, however, is more prevalent than many disorders,” Dr. Berg notes. “Neonatal screening can detect a treatable disease in 1 of 800 newborns, but screening the homes of pregnant women for lead hazards can prevent lead poisoning in 1 of 27 children in the City of St. Louis.”

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Notes for editors
“Childhood Lead Poisoning Prevention through Prenatal Housing Inspection and Remediation in St. Louis, Missouri,” by D.R. Berg, E.T. Eckstein, M.S. Steiner, J.A. Gavard, G.A. Gross (DOI: 10.1016/j.ajog.2012.01.001). It will appear in the American Journal of Obstetrics & Gynecology, Volume 206, Issue 3 (March 2012), published by Elsevier.

Full text of the article is available to credentialed journalists upon request. Contact Francesca Costanzo at +1 215 239 3249or ajogmedia@elsevier.com to obtain a copy. Journalists wishing to schedule interviews with the author should contact Kat Steck at +1 314 481 1615 x1301 ksteck@fchcstl.org or Bob Massie at +1 314 481 1615 x1315, bmassie@fchcstl.org,

About the American Journal of Obstetrics & Gynecology
The American Journal of Obstetrics & Gynecology known as “The Gray Journal,” presents coverage of the entire spectrum of the field, from the newest diagnostic procedures to leading-edge research. The journal provides comprehensive coverage of the specialty, including maternal-fetal medicine, reproductive endocrinology/infertility, and gynecologic oncology. It also publishes the annual meeting papers of several of its 7 sponsoring societies, including the Society for Maternal-Fetal Medicine and the Society of Gynecologic Surgeons.

The American Journal of Obstetrics & Gynecology's 2010 Impact Factor is 3.313. It is ranked 8th out of 75 and continues to be ranked #1 in citations in the Obstetrics & Gynecology category, according to the latest Journal Citation Reports® 2011, published by Thomson Reuters. The journal’s standard of excellence and continued success can be attributed to the strong leadership of Editors-in-Chief Thomas J. Garite, MD, and Moon H. Kim, MD, and their outstanding nationally and internationally recognized editorial board and reviewers. The journal has also been recognized as one of the 100 most influential journals in Biology & Medicine over the last 100 years, as determined by the BioMedical & Life Sciences Division of the Special Libraries Association (2009).

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