October 30, 2018
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USPSTF: Insufficient evidence to screen asymptomatic pregnant women, young children for elevated blood lead levels

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The USPSTF released a draft recommendation statement concluding there is currently insufficient evidence to “assess the balance of benefits and harms” of screening asymptomatic pregnant women and children aged younger than 5 years for elevated blood lead levels.

“The best prevention is no exposure to lead in the first place,” Michael Silverstein, MD, MPH, task force member and staff pediatrician and associate chief medical officer for research and population health at Boston Medical Center, said in a press release. “Until there is more research, clinicians should use their best judgment about when to screen for lead exposure and keep up-to-date on any concerns about lead in their community.”

Another task force member Alex Kemper, MD, MPH, MS, cautioned any amount of lead in asymptomatic pregnant women and children is dangerous.

“There is no safe level of lead in the blood. Finding and removing sources of lead in the environment that might affect children is essential,” he said in the press release.

“The task force is calling for more research so clinicians can have better screening tools and effective treatments to help prevent health problems that can result from lead exposure,” Kemper, who is also chief of the division of ambulatory pediatrics at Nationwide Children’s Hospital in Ohio and deputy editor of Pediatrics, added.

The task force highlighted the need for more research on the effectiveness of treatments for elevated blood lead levels in trials with adequate sample sizes to inform treatment strategies; the benefits of nutritional supplementation in lowering blood lead levels in children; and newer approaches to detecting elevated blood lead levels, such as point-of-care testing, that include intra-individual and interlaboratory reliability.

In addition, the task force stressed the need for validated questionnaires that determine at-risk populations most likely to benefit from screening, studies that provide information regarding intermediate and health outcomes, outcomes in newborns, and harms in both women and infants are needed, as well as studies that assess effective interventions for lowering blood lead levels in pregnant women.

In developing its recommendation, the task force noted that the American Academy of Family Physicians recommends against routine screening for elevated blood lead levels in asymptomatic pregnant women, while the American College of Obstetricians and Gynecologists and CDC recommend targeted screening during pregnancy, specifically lead testing for pregnant and lactating women with one or more risk factors for lead exposure, such as occupational or environmental exposures or pica.

According to the task force, the AAFP also recommends against routine screening for elevated blood lead levels in asymptomatic children aged 1 to 5 years at average risk and found insufficient evidence on screening in children at increased risk. The American Academy of Pediatrics recommends performing risk assessments or screenings as appropriate, based on universal screening requirements for patients with Medicaid or those living in high-prevalence areas.

The USPSTF’s draft statement and evidence review has been posted for public comment on the USPSTF website: www.uspreventiveservicestaskforce.org. Input will be accepted through Dec. 3, 2018, at www.uspreventiveservicestaskforce.org/tfcomment.htm. - by Janel Miller

Disclosures: Kemper reports no relevant financial disclosures. Silverstein reports being a co-investigator on a RO1 grant from the CDC on the prevention of child maltreatment, (including interventions for child maltreatment), authoring publications on interventions for perinatal depression and serving as investigator on two active randomized, controlled trials funded by the NIH and the Patient-Centered Outcomes Research Institute concerning perinatal depression.