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  • Original Article
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Effect of magnitude and timing of maternal pregnancy blood lead (Pb) levels on birth outcomes

Journal of Perinatology volume 26, pages 154–162 (2006)Cite this article

Abstract

Objective:

Associations between magnitude and timing of maternal pregnancy blood lead (Pb) levels (BLLs), birth weight, and total days of gestation were examined, as well as associations with related clinical diagnoses of low birth weight (LBW), preterm, and small-for-gestational-age (SGA) birth.

Study Design:

Among a sample of 262 mother–infant pairs studied retrospectively, one-way analysis of variance and regression statistics were used to measure the relationship between level of maternal pregnancy BLLs and birth outcomes while controlling for key maternal and newborn factors.

Results:

Women with maximum pregnancy BLLs (max-PBLLs) ⩾10 μg/dl tended to give birth earlier and their babies were at substantially increased risk for preterm and SGA birth. By holding other explanatory factors constant, each unit increase in max-PBLL above 10 μg/dl was found to be associated with a decrease of −0.3 in total days of gestation. Compared to women with lower levels, women with max-PBLLs ⩾10 μg/dl were at a threefold increased risk for preterm birth (adjusted OR=3.2, 95% CI 1.2–7.4) and more than a fourfold increased risk for having an SGA infant (adjusted OR=4.2, 1.3–13.9). Second trimester maximum BLLs ⩾10 μg/dl were associated with a steep decrease in total days of gestation (a decrease of −1.0 days per each unit increase above 10 μg/dl).

Conclusions:

These data provide evidence of the adverse effects of maternal pregnancy BLLs, particularly when levels are ⩾10 μg/dl. Prenatal Pb exposure at these levels was associated with significant decreases in total days of gestation and an increased risk of preterm and SGA birth.

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References

  1. Gardella C . Lead exposure in pregnancy: a review of the literature and argument for routine prenatal screening. Obstet Gynecol Surv 2001; 56: 231–238.

    Article  CAS  Google Scholar 

  2. Charlton V . The small for gestational age infant. In: Rudolph A (ed). Pediatrics. Appleton and Lange: Norwalk, 1996, pp 245–248.

    Google Scholar 

  3. Gutbrod T, Wolke D, Soehne B, Ohrt B, Riegel K . Effects of gestation and birth weight on the growth and development of very low birthweight small for gestational age infants: a matched group comparison. Arch Dis Child Fetal Neonatal Ed 2000; 82: F208–F214.

    Article  CAS  Google Scholar 

  4. Jelliffe-Pawlowski LL, Hansen RL . Neurodevelopmental outcome at 8 months and 4 years among infants born full-term small-for-gestational-age. J Perinatol 2004; 24: 505–514.

    Article  Google Scholar 

  5. Frisbie WP, Biegler M, de Turk P, Forbes D, Pullum SG . Racial and ethnic differences in determinants of intrauterine growth retardation and other compromised birth outcomes. Am J Public Health 1997; 87: 1977–1983.

    Article  CAS  Google Scholar 

  6. Savitz DA, Kaufman JS, Dole N, Siega-Riz AM, Thorp Jr JM, Kaczor DT . Poverty, education, race, and pregnancy outcome. Ethn Dis 2004; 14: 322–329.

    PubMed  Google Scholar 

  7. Rothenberg SJ, Manalo M, Jiang J, Khan F, Cuellar R, Reyes S et al. Maternal blood lead level during pregnancy in South Central Los Angeles. Arch Environ Health 1999; 54: 151–157.

    Article  CAS  Google Scholar 

  8. Bernard SM, McGeehin MA . Prevalence of blood lead levels > or =5 micro g/dl among US children 1–5 years of age and socioeconomic and demographic factors associated with blood lead levels 5–10 micro g/dl, Third National Health and Nutrition Examination Survey, 1988–1994. Pediatrics 2003; 112 (6 Part 1): 1308–1313.

    Article  Google Scholar 

  9. Lin C, Kim R, Tsaih SW, Sparrow D, Hu H . Determinants of bone and blood lead levels among minorities living in the Boston area. Environ Health Perspect 2004; 112: 1147–1151.

    Article  CAS  Google Scholar 

  10. McMichael AJ, Vimpani GV, Robertson EF, Baghurst PA, Clark PD . The Port Pirie cohort study: maternal blood lead and pregnancy outcome. J Epidemiol Commun Health 1986; 40: 18–25.

    Article  CAS  Google Scholar 

  11. Baghurst PA, Robertson EF, Oldfield RK, King BM, McMichael AJ, Vimpani GV et al. Lead in the placenta, membranes, and umbilical cord in relation to pregnancy outcome in a lead-smelter community. Environ Health Perspect 1991; 90: 315–320.

    CAS  PubMed  PubMed Central  Google Scholar 

  12. Satin KP, Neutra RR, Guirguis G, Flessel P . Umbilical cord blood lead levels in California. Arch Environ Health 1991; 46: 167–173.

    Article  CAS  Google Scholar 

  13. Factor-Litvak P, Graziano JH, Kline JK, Popovac D, Mehmeti A, Ahmedi G et al. A prospective study of birthweight and length of gestation in a population surrounding a lead smelter in Kosovo, Yugoslavia. Int J Epidemiol 1991; 20: 722–728.

    Article  CAS  Google Scholar 

  14. Bellinger D, Leviton A, Rabinowitz M, Allred E, Needleman H, Schoenbaum S . Weight gain and maturity in fetuses exposed to low levels of lead. Environ Res 1991; 54: 151–158.

    Article  CAS  Google Scholar 

  15. West WL, Knight EM, Edwards CH, Manning M, Spurlock B, James H et al. Maternal low level lead and pregnancy outcomes. J Nutr 1994; 124 (6 Suppl): 981S–986S.

    CAS  PubMed  Google Scholar 

  16. Sowers M, Jannausch M, Scholl T, Li W, Kemp FW, Bogden JD . Blood lead concentrations and pregnancy outcomes. Arch Environ Health 2002; 57: 489–495.

    Article  CAS  Google Scholar 

  17. Andrews KW, Savitz DA, Hertz-Picciotto I . Prenatal lead exposure in relation to gestational age and birth weight: a review of epidemiologic studies. Am J Ind Med 1994; 26: 13–32.

    Article  CAS  Google Scholar 

  18. Dearth RK, Hiney JK, Srivastava V, Burdick SB, Bratton GR, Dees WL . Effects of lead (Pb) exposure during gestation and lactation on female pubertal development in the rat. Reprod Toxicol 2002; 16: 343–352.

    Article  CAS  Google Scholar 

  19. Epstein HT, Newton JT, Fenton K . Lead effects on offspring depend on when mouse mothers were exposed to lead. Biol Neonate 1999; 75: 272–278.

    Article  CAS  Google Scholar 

  20. Borja-Aburto VH, Hertz-Picciotto I, Rojas LM, Farias P, Rios C, Blanco J . Blood lead levels measured prospectively and risk of spontaneous abortion. Am J Epidemiol 1999; 150: 590–597.

    Article  CAS  Google Scholar 

  21. New York State Department of Health and American College of Obstetrics and Gynecology District II. Lead Poisoning Prevention Guidelines for Prenatal Care Providers. State of New York: Department of Health: Albany, NY, 1995.

  22. Minnesota Department of Health EHD. Blood Screening Guidelines for Pregnant Women in Minnesota. Environmental Health Division. Minnesota Department of Health: Minnesota, 2005.

  23. Centers for Disease Control and Prevention. Screening Young Children for Lead Poisoning: Guidance for State and Local Public Health Officials. US Department of Health and Human Services: Atlanta, GA, 1997.

  24. Centers for Disease Control and Prevention. In: Harrey B (ed). Managing Elevated Blood Lead Levels Among Young Children: Recommendations from the Advisory Committee on Childhood Lead Poisoning Prevention. US Department of Health and Human Services: Atlanta, GA, 2002.

  25. Balcazar H . The prevalence of intrauterine growth retardation in Mexican Americans. Am J Public Health 1994; 84: 462–465.

    Article  CAS  Google Scholar 

  26. Goldenberg RL, Cliver SP, Neggers Y, Copper RL, DuBard MD, Davis RO et al. The relationship between maternal characteristics and fetal and neonatal anthropometric measurements in women delivering at term: a summary. Acta Obstet Gynecol Scand Suppl 1997; 165: 8–13.

    CAS  PubMed  Google Scholar 

  27. Olausson PM, Cnattingius S, Goldenberg RL . Determinants of poor pregnancy outcomes among teenagers in Sweden. Obstet Gynecol 1997; 89: 451–457.

    Article  CAS  Google Scholar 

  28. Statistical Analysis Software (SAS). Version 8.0. SAS Institute Inc. Cary, NC, 1999.

  29. Dietrich KN, Krafft KM, Bornschein RL, Hammond PB, Berger O, Succop PA et al. Low-level fetal lead exposure effect on neurobehavioral development in early infancy. Pediatrics 1987; 80: 721–730.

    CAS  PubMed  Google Scholar 

  30. Falcon M, Vinas P, Luna A . Placental lead and outcome of pregnancy. Toxicology 2003; 185: 59–66.

    Article  CAS  Google Scholar 

  31. Bellinger D, Leviton A, Allred E, Rabinowitz M . Pre- and postnatal lead exposure and behavior problems in school-aged children. Environ Res 1994; 66: 12–30.

    Article  CAS  Google Scholar 

  32. Bunn TL, Parsons PJ, Kao E, Dietert RR . Exposure to lead during critical windows of embryonic development: differential immunotoxic outcome based on stage of exposure and gender. Toxicol Sci 2001; 64: 57–66.

    Article  CAS  Google Scholar 

  33. Han S, Pfizenmaier DH, Garcia E, Eguez ML, Ling M, Kemp FW et al. Effects of lead exposure before pregnancy and dietary calcium during pregnancy on fetal development and lead accumulation. Environ Health Perspect 2000; 108: 527–531.

    Article  CAS  Google Scholar 

  34. Hanada T, Yoshimura A . Regulation of cytokine signaling and inflammation. Cytokine Growth Factor Rev 2002; 13: 413–421.

    Article  CAS  Google Scholar 

  35. Baghurst PA, McMichael AJ, Vimpani GV, Robertson EF, Clark PD, Wigg NR . Determinants of blood lead concentrations of pregnant women living in Port Pirie and surrounding areas. Med J Aust 1987; 146: 69–73.

    CAS  PubMed  Google Scholar 

  36. Agency for Toxic Substances and Disease Registry (ATSDR). Toxicological Profile for Lead. US Department of Health and Human Services, Public Health Service: Atlanta, GA, 1999.

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Acknowledgements

This work was supported in part by cooperative agreement number: US7/CCU918557-03 from the Centers for Disease Control and Prevention.

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Authors and Affiliations

  1. California Department of Health Services, Childhood Lead Poisoning Prevention Branch, Oakland, CA, USA

    L L Jelliffe-Pawlowski, S Q Miles, J G Courtney & V Charlton

  2. California Department of Health Services, Occupational Lead Poisoning Prevention Program, Oakland, CA, USA

    B Materna

Authors
  1. L L Jelliffe-Pawlowski
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  2. S Q Miles
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  3. J G Courtney
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  4. B Materna
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  5. V Charlton
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Correspondence to L L Jelliffe-Pawlowski.

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Supplementary Information accompanies the paper on Journal of Perinatology website (http://www.nature.com/jp)

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Jelliffe-Pawlowski, L., Miles, S., Courtney, J. et al. Effect of magnitude and timing of maternal pregnancy blood lead (Pb) levels on birth outcomes. J Perinatol 26, 154–162 (2006). https://doi.org/10.1038/sj.jp.7211453

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