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Health Equity/Community Health

Poster Session 1

(283) A Prenatal Lead Screening and Intervention Program in a High Risk Obstetrical Population

Tuesday, February 13, 2024

10:30 AM – 12:00 PM

Location: Prince George's Exhibit Hall CDE, Lower Atrium Level

Primary & Presenting Author(s)

Maria Phillis, MD

The MetroHealth System/Case Western Reserve University Program
Cleveland, OH, United States

Coauthor(s)

NH

Natalie Harper, BA, MA

Community Health Advocacy Initiative Manager
The MetroHealth System, Institute for HOPE
Cleveland, OH, United States
JC

Jennifer Conti, RN

Manager of Population Health
The MetroHealth System
Cleveland, OH, United States
Kelly S. Gibson, MD (she/her/hers)

Division Director, Maternal Fetal Medicine
The MetroHealth System
Cleveland, OH, United States

Objective: Prenatal lead exposure in pregnancy has known adverse effects on maternal health and infant outcomes. We aimed to assess the efficacy of a prenatal screening and intervention program for lead exposure. We hypothesized that in a city with high rates of lead exposure, blood lead levels drawn in pregnancy would identify additional patients with elevated levels, beyond those discovered via survey screening.

Study Design: A prospective quality intervention study of lead exposure in pregnant patients at a tertiary urban center with high lead rates in the city. We screened patients at their first prenatal visit with a survey of their exposure and a blood lead level. “Yes” to any question or a blood lead level >5mg/dL were considered screening positive. Patients with positive screens were referred to the Community Health Worker for intervention, a detailed interview, in depth education on the risks of lead exposure, nutrition education and referrals to a dietician and a lead cleaning kit for use at home. Patients deemed appropriate by the Community Health Worker were also offered a home lead inspection and assessment.

Results: In 2022-2023, the intervention clinic had 1717 new pregnancy encounters. 1229 completed surveys (71.6%) and 72 partially completed a survey (4.2%). Of those surveys, 155 patients (11.9%) screened positive for possible lead exposure. A total of 976 blood lead levels were drawn and resulted in 9 (0.9%) elevated lead levels, all of whom also screened positive for possible exposure on the survey. Of the 155 patients who screened positive, 70 kits were offered for lead intervention. 55 total kits were distributed. Of the patients with the home kits, 18 (33.3%) were referred for inspections. A third of the inspections required intervention.

Conclusion: The rate of elevated lead levels in pregnant patients living in areas with high lead exposure is low. It is feasible to conduct a screening protocol for lead exposure using a survey at the obstetric intake visit. The addition of serum lead screening did not increase the identification of high risk patients.