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Poor, urban, and immigrant populations are at far greater risk for lead exposure than are other groups in the United States. Children with even slightly elevated blood lead levels are at increased risk for significant neurobehavioral problems that can extend through adolescence. Research has shown that elevated blood lead levels in pregnant women, even those well below 10 micrograms per deciliter-the Centers for Disease Control and Prevention's "level of concern"-can cause miscarriage, premature birth, low birth weight, and subsequent developmental delays in their children. Despite these well-established dangers, routine prenatal lead screening and lead education is not a standard of care. Part 1 of this two-part article presents a short case example of a pregnant mother with lead poisoning and describes the epidemiology of lead exposure in the United States, the main sources of lead exposure, and the effects of lead on the pregnant mother and the developing fetus and child. Prevention is crucial. Treatment options such as chelation must be used selectively and will not reverse damage once it's occurred. Part 2 will describe recommendations for screening, education, nutrition, reducing environmental exposures, and treatment.

In the United States the risk of lead exposure is far higher among poor, urban, and immigrant populations than among other groups. And even slightly elevated blood lead levels increase children's risk of significant neurobehavioral problems extending through adolescence. Research has shown that blood lead levels in pregnant women well below the Centers for Disease Control and Prevention's "level of concern" of 10 micrograms per deciliter can cause miscarriage, premature birth, low birth weight, and subsequent developmental delays in their children. Despite these well-established dangers of lead exposure, routine prenatal lead screening and education is not a standard of care in the United States. Part 1 of this two-part article (October) presented the case of a pregnant woman with lead poisoning and described the epidemiology of lead exposure in the United States, the main sources of it, and its effects on a pregnant woman and her developing fetus and child. Part 2 describes recommendations for prenatal screening and strategies for dealing with lead exposure when it occurs: education, reduction in environmental exposure, treatment options, and developmental surveillance.

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