Blood Lead Levels ≥ 45 mcg/ <scp>dL</scp> in Pregnancy: An Observational Study

OBJECTIVE: To describe pregnant individuals with blood lead levels (BLLs) ≥ 45 mcg/dL and their pregnancy outcomes to inform clinical practice and public health policy. DESIGN: Inclusion criteria required New York City (NYC) residence and a venous BLL ≥ 45 mcg/dL during pregnancy. BLL data were linked to case events notes, risk assessment findings, and newborn data. SETTING: NYC, 2004 to 2023. POPULATION: Pregnant individuals with BLLs ≥ 45 mcg/dL. METHODS: Characteristics of pregnant individuals and pregnancy outcomes were summarised using descriptive statistics. Birth outcomes were compared with WHO standards and across trimesters of referral. Fisher's exact and Z tests were used to assess the significance of differences. MAIN OUTCOMES MEASURES: Demographic characteristics, pregnancy outcome data, chelation of mother, and chelation of newborn. RESULTS: EDTA alone had newborns with significant BLL declines. For the newborns, the prevalence of birth lengths and head circumferences below 5% was higher than expected, and if chelated, the BLL took about 27 months to decline < 5 mcg/dL. CONCLUSIONS: Cultural practices, pica, and using traditional remedies were frequently identified in pregnant individuals with BLLs ≥ 45 mcg/dL.