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JAMA. 2019 Apr 16;321(15):1502-1509. doi: 10.1001/jama.2019.3326.

Screening for Elevated Blood Lead Levels in Children and Pregnant Women: US Preventive Services Task Force Recommendation Statement.

Author information

1
University of Iowa, Iowa City.
2
Fairfax Family Practice Residency, Fairfax, Virginia.
3
Virginia Commonwealth University, Richmond.
4
Veterans Affairs Palo Alto Health Care System, Palo Alto, California.
5
Stanford University, Stanford, California.
6
Harvard Medical School, Boston, Massachusetts.
7
University of California, San Francisco.
8
Oregon Health & Science University, Portland.
9
University of Pennsylvania, Philadelphia.
10
Virginia Tech Carilion School of Medicine, Roanoke.
11
Nationwide Children's Hospital, Columbus, Ohio.
12
Temple University, Philadelphia, Pennsylvania.
13
University of Alabama at Birmingham.
14
University of California, Los Angeles.
15
University of Massachusetts Medical School, Worcester.
16
Boston University, Boston, Massachusetts.
17
Northwestern University, Evanston, Illinois.
18
University of Hawaii, Honolulu.
19
Pacific Health Research and Education Institute, Honolulu, Hawaii.
20
Tufts University, Medford, Massachusetts.

Abstract

Importance:

Elevated blood lead levels in children are associated with neurologic effects such as behavioral and learning problems, lower IQ, hyperactivity, hearing problems, and impaired growth. In pregnant women, lead exposure can impair organ systems such as the hematopoietic, hepatic, renal, and nervous systems, and increase the risk of preeclampsia and adverse perinatal outcomes. Many of the adverse health effects of lead exposure are irreversible.

Objective:

To update the 2006 US Preventive Services Task Force (USPSTF) recommendation on screening for elevated blood lead levels in children and pregnant women.

Evidence Review:

The USPSTF reviewed the evidence on the benefits and harms of screening for and treatment of elevated blood lead levels. In this update, an elevated blood lead level was defined according to the Centers for Disease Control and Prevention reference level of 5 μg/dL.

Findings:

The USPSTF found adequate evidence that questionnaires and other clinical prediction tools to identify asymptomatic children with elevated blood lead levels are inaccurate. The USPSTF found adequate evidence that capillary blood testing accurately identifies children with elevated blood lead levels. The USPSTF found inadequate evidence on the effectiveness of treatment of elevated blood lead levels in asymptomatic children 5 years and younger and in pregnant women. The USPSTF found inadequate evidence regarding the accuracy of questionnaires and other clinical prediction tools to identify asymptomatic pregnant women with elevated blood lead levels. The USPSTF found inadequate evidence on the harms of screening for or treatment of elevated blood lead levels in asymptomatic children and pregnant women. The USPSTF concluded that the current evidence is insufficient, and that the balance of benefits and harms of screening for elevated blood lead levels in asymptomatic children 5 years and younger and in pregnant women cannot be determined.

Conclusions and Recommendation:

The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of screening for elevated blood lead levels in asymptomatic children. (I statement) The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of screening for elevated blood lead levels in asymptomatic pregnant persons. (I statement).

PMID:
30990556
DOI:
10.1001/jama.2019.3326
[Indexed for MEDLINE]

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