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ACOG says no to routine lead testing in pregnancy

NEW YORK (Reuters Health) – Expectant and breastfeeding mothers should not routinely be screened for high lead levels in their blood, the American College of Obstetricians and Gynecologists (ACOG) said Monday.

Instead, the new recommendations say doctors should ask women a series of questions to see if they might be at risk for high lead exposure, and do the blood test when appropriate.

Only about one percent of American women of child-bearing age have high lead levels in their blood (5 mcg/dL or more).

“The majority of women in the U.S. have very low lead exposures,” said Dr. Eva K. Pressman, who worked on the new recommendations. “The current recommendation is not to do blood screening on every pregnant woman, but to do some sort of exposure history.”

The group lists a dozen risk factors that should trigger a blood test, including having remodeled older homes that have lead paint and using imported cosmetics or alternative medicines that may be contaminated.

The full document is available online at http://bit.ly/NH2LQa.

If the blood levels are elevated, a number of steps can be taken – from eliminating the environmental culprit to taking supplements like iron and calcium that curb lead absorption, or medical treatments.

Dr. Pressman stressed that high lead levels don’t necessarily mean a pregnant woman’s baby will have problems.

“Every pregnancy is affected slightly differently, so there are pregnancies with high exposures that are not affected and pregnancies with low exposures that are being affected,” she told Reuters Health.

Currently, states have different rules about screening or otherwise assessing pregnant or breastfeeding women for lead exposure. But Dr. Pressman said routine screening is not very common.

She acknowledged that asking women about their exposure to lead might have some unfortunate consequences, including leading some to consider abortion if they end up screening positive for high levels.

“I think the biggest harm is worry, and perhaps unnecessary worry because we don’t know that those levels will cause harm in a given pregnancy,” Dr. Pressman said.