Risk-Factor Based Lead Screening and Correlation with Blood Lead Levels in Pregnancy.
Risk-Factor Based Lead Screening and Correlation with Blood Lead Levels in Pregnancy.
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DOI：
10.1007/s10995-021-03325-x
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发表时间：
2022-01
影响因子：
2.3
通讯作者：
Wylie BJ
中科院分区：
文献类型：
--
作者：
Johnson KM;Specht AJ;Hart JM;Salahuddin S;Erlinger AL;Hacker MR;Woolf AD;Hauptman M;Karumanchi SA;O'Brien K;Wylie BJ
铅暴露会对儿童造成毁灭性的神经系统后果，并且可能从子宫内开始。美国妇产科学院建议使用基于危险因素的方法进行产前铅筛查，而不是进行普遍的血液检测。尚未研究这种方法的临床实用性。我们评估了基于危险因素的调查问卷，以检测妊娠期血铅水平升高。我们对一组孕妇进行了二次分析，以评估铅与妊娠期高血压疾病的关联。如果参与者是妊娠 ≥ 34 周且记录了血铅水平的单胎妊娠，我们将其纳入本次分析。参与者完成了针对怀孕修改的主要危险因素调查。我们将血铅升高定义为≥2 μg/dL，因为这是临床可报告的水平。作为研究的一部分，在该队列的 102 名参与者中，有 92 人测量了血铅。通过问卷调查，绝大多数人 (78%) 有 1 个或多个铅升高的危险因素，但没有人在例行就诊期间进行临床血铅检测。只有两名参与者 (2.2%) 血铅水平升高。该问卷对于预测可检测铅水平具有较高的敏感性，但特异性较差（敏感性 100%，特异性 22%）。基于产前危险因素的铅筛查在实践中似乎未得到充分利用，并且不能充分区分血液水平升高和未升高的人群。鉴于基于风险因素的方法的复杂性和未充分利用，应进一步探讨通用铅测试的益处和成本效益。
Lead exposure has devastating neurologic consequences for children and may begin in utero. The American College of Obstetricians and Gynecologists recommends prenatal lead screening using a risk factor-based approach rather than universal blood testing. The clinical utility of this approach has not been studied. We evaluated a risk-factor based questionnaire to detect elevated blood lead levels in pregnancy. We performed a secondary analysis of a cohort of parturients enrolled to evaluate the association of lead with hypertensive disorders of pregnancy. We included participants in this analysis if they had a singleton pregnancy ≥34 weeks’ gestation with blood lead levels recorded. Participants completed a lead risk factor survey modified for pregnancy. We defined elevated blood lead as ≥2 μg/dL, as this was the clinically reportable level. Of 102 participants enrolled in the cohort, 92 had blood lead measured as part of the study. The vast majority (78%) had 1 or more risk factor for elevated lead using the questionnaire yet none had clinical blood lead testing during routine visits. Only two participants (2.2%) had elevated blood lead levels. The questionnaire had high sensitivity but poor specificity for predicting detectable lead levels (sensitivity 100%, specificity 22%). Prenatal risk-factor based lead screening appears underutilized in practice and does not adequately discriminate between those with and without elevated blood levels. Given the complexity of the risk factor-based approach and underutilization, the benefit and cost-effectiveness of universal lead testing should be further explored.
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低血铅浓度对中国儿童的智商和学校表现的影响。
影响因子：
3.7
作者：
Liu J;Li L;Wang Y;Yan C;Liu X
通讯作者：
Liu X
影响因子：
2.3
作者：
Bakhireva LN;Rowland AS;Young BN;Cano S;Phelan ST;Artyushkova K;Rayburn WF;Lewis J
通讯作者：
Lewis J
DOI：
10.1093/jurban/79.2.225
发表时间：
2002-06-01
影响因子：
6.6
作者：
Klitzman, S;Sharma, A;Leighton, J
通讯作者：
Leighton, J
DOI：
10.1016/j.preghy.2020.07.014
发表时间：
2020-10
期刊：
Pregnancy hypertension
影响因子：
--
作者：
Johnson KM;Specht AJ;Hart JM;Salahuddin S;Erlinger AL;Hacker MR;Woolf AD;Hauptman M;Karumanchi SA;Wylie BJ;O'Brien K
通讯作者：
O'Brien K
血液铅浓度<10 microg/dl和6岁的儿童智力。
影响因子：
10.4
作者：
Jusko, Todd A.;Henderson, ChaKes R., Jr.;Lanphear, Bruce P.;Cory-Slechta, Deborah A.;Parsons, Patrick J.;Canfield, Richard L.
通讯作者：
Canfield, Richard L.