COMMENTARY

Lead--The Problem in Pregnancy That We May Forget

Hansa Bhargava, MD

Disclosures

December 13, 2018

Hello. I'm Dr Hansa Bhargava, a practicing pediatrician and a senior medical director for Medscape and WebMD.

Lead, a neurotoxic metal, bioaccumulates in the body. Its risk to children is well known, but it is also important to note the effects that exposure to lead and other heavy metals have on pregnant women as well as those attempting to get pregnant.

The impact of the Flint, Michigan, lead crisis on that city's children sparked a national conversation, but there was less discussion about the effect in women of childbearing age. Fertility rates in the region decreased by 12%, while fetal death rates increased by 58%.[1]

These outcomes are not unique to Flint.

Across the United States, increases in water contamination, and the resultant effect on health outcomes,[2] have become an issue that we as physicians should keep on our radar.

While 10% of women can face infertility issues,[3] those numbers can increase exponentially with exposure to lead.

A study by Carnegie Mellon University that analyzed county-level data from a range of sources concluded that reductions in airborne lead increased fertility rates and that higher lead in topsoil decreased fertility rates in both men and women.[4]

Exposure to lead in vitro can also lead to premature birth, issues in neurologic development, and low birthweight. In a cross-sectional study of 147 newborns, higher levels of lead in umbilical samples were associated with decreases in head circumference, length, and weight.[5]

There is also some evidence that the current increases in incidence of autism spectrum disorders, attention-deficit/hyperactivity disorder, and even Alzheimer's may be linked to an accumulation of several heavy metal neurotoxins. Could this start in utero? More research is needed.

As we become more aware of potential health harms in the perinatal period, educating prospective parents pre-conception or during pregnancy in how to reduce lead exposure is paramount. The Centers for Disease Control and Prevention provide some simple ways to do that—many of which may not be common knowledge. That information is available on their website. That is an easy first step to share with families.

For Medscape and WebMD, I'm Dr Hansa Bhargava.

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