Antepartum lead screening typically involves identification of current environmental or occupational risk and pica habits. However, for foreign-born women who have immigrated to the United States, distant exposure years prior may be a more significant factor contributing to elevated lead levels. Because lead can be stored in bone for decades and mobilized to the blood when calcium needs increase in pregnancy, women and their children can be at risk for lead-related complications like anemia, gestational hypertension, preterm labor, low birth weight, and developmental delays without any identifiable current exposure. Midwives and other women's health clinicians must carefully evaluate the history of every woman under their care, individualizing screening and treatment to identify risk and provide timely intervention.