Screening for Elevated Blood Lead Levels in Children and Pregnant Women

Abstract

The US Preventive Services Task Force (USPSTF) is redesigning its recommendation statement in response to feedback from primary care clinicians. The USPSTF plans to release, later in 2006, a new, updated recommendation statement that is easier to read and incorporates advances in USPSTF methods. The recommendation statement below is an interim version that combines existing language and elements with a new format. Although the definitions of grades remain the same, other elements have been revised. ### Children 1. The US Preventive Services Task Force (USPSTF) concludes that evidence is insufficient to recommend for or against routine screening for elevated blood lead levels (BLLs) in asymptomatic children aged 1 to 5 who are at increased risk (I recommendation) (see “Clinical Considerations” for a discussion of risk). 2. The USPSTF recommends against routine screening for elevated BLLs in asymptomatic children aged 1 to 5 years who are at average risk (D recommendation). ### Pregnant Women 1. The USPSTF recommends against routine screening for elevated BLLs in asymptomatic pregnant women (D recommendation). ### Importance BLLs in children have declined dramatically in the United States over the past 2 decades. However, segments of the population remain at increased risk for higher BLLs. Even relatively low BLLs are associated with neurotoxic effects in children. Severely elevated BLLs in symptomatic pregnant women are associated with poor health outcomes; however, BLLs in this range are rare in the US population. ### Detection There is good evidence that venous sampling accurately detects elevated BLLs and fair evidence that validated questionnaires are modestly useful in identifying children at increased risk for elevated BLLs. ### Benefits of Detection and Early Intervention The USPSTF found good-quality evidence that interventions do not result in sustained decreases in BLLs and found insufficient evidence (no studies) evaluating residential lead hazard-control efforts (ie, dust or paint removal, soil abatement, counseling, or education) or nutritional interventions for improving neurodevelopmental outcomes in children with mildly-to-moderately elevated … Address correspondence to Ned Calonge, MD, MPH, Chair, US Preventive Services Task Force, c/o Program Director, USPSTF, Agency for Healthcare Research and Quality, 540 Gaither Rd, Rockville, MD 20850. E-mail: uspstf{at}ahrq.gov