Lead poisoning among pregnant women in New York City: Risk factors and screening practices
Lead poisoning among pregnant women in New York City: Risk factors and screening practices
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DOI：
10.1093/jurban/79.2.225
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发表时间：
2002-06-01
影响因子：
6.6
通讯作者：
Leighton, J
中科院分区：
文献类型：
--
作者：
Klitzman, S;Sharma, A;Leighton, J
本文介绍了1996年9月至1999年6月期间向纽约市卫生局报告的血铅水平(BLL)为每分升20杯或更高的孕妇的资料(n=33)。几乎一半的妇女是在怀孕的最后三个月被确诊的，通常是在第一次产前检查时。在重新测试的女性中，发病率和最后报告的BLL的中位数分别为25和15伽马/分升，下降了40%。新生儿(n=25)中BLL发生率的中位数为12µg/dL。在美国，BLL与母亲的年龄和时间长短呈负相关，而与孕龄和异食癖行为直接相关。病例中外国出生的女性的可能性是所有在纽约分娩的女性的两倍多。产前保健机构采用在所有孕妇首次就诊时对其进行普遍血铅检测的政策，报告的病例数量不成比例，占病例的77%，但仅占全市新生儿总数的11%。研究结果表明：(1)最近颁布的孕妇铅风险评估和筛查规则和准则似乎有效地查明了本来可能不会曝光的病例；(2)迅速启动了病例管理和环境干预措施；(3)病例平均而言，随着时间的推移，潜在寿命大幅减少；(4)需要对城市多文化中心的孕妇采取更多的公共卫生干预措施。虽然数据表明，普遍筛查可能会增加高危移民人口中的病例发现率，但还需要进一步的研究和监测，以系统地确定最有效的方法。
This article presents information on pregnant women with incident blood lead levels (BLLs) of 20 mug per deciliter or greater as reported to the New York City Department of Health between September 1996 and June 1999 (n = 33). Almost half of the women were diagnosed during their third trimester of pregnancy, often at their first Prenatal visit. The median BLLs at incidence and at last report among women who were retested were 25 and 15 gamma/dL, respectively, a 40% decline. The median incident BLL among newborns (n = 25) was 12 mug/dL. The BLLs were inversely associated with maternal age and length of time in the United States and directly associated with gestational age and pica behavior. Cases were more than twice as likely to be foreign-born women than all women who gave birth in New York City. Prenatal care facilities employing a policy of universal blood lead testing of all pregnant women at the time of their first visit reported disproportionate numbers of cases, accounting for 77% of cases yet only 11% of all births citywide. The findings suggest that (1) the promulgation of recent rules and guidelines for lead risk assessment and screening among pregnant women appears to have been effective in identifying cases that might not have otherwise come to light, (2) case management and environmental interventions were initiated promptly; (3) cases experienced, on average, significant BLL reductions over time; and (4) there is a need for additional public health interventions for pregnant women in urban, multicultural centers. While the data suggest that universal screening may increase case finding among high-risk, immigrant populations, further studies and surveillance are needed to determine systematically the most effective approach.