- Lees verder: http://loodinamsterdamnoord.nl/q4b5
TABLE OF CONTENTS
Preface………………………………………………………. .
i
Executive Summary
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iii
Summary of Public Health Actions Based on Maternal and Infant Blood Lead Levels
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vi
Members of the Work Group on Lead and Pregnancy
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vii
Acknowledgments .
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viii
Members of the Advisory Committee on Childhood Lead Poisoning Prevention ix
Glossary .
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xiii
Chapter 1. Introduction
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1
Chapter 2 Adverse Health Effects of Lead Exposure in Pregnancy
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5
Chapter 3 Biokinetics and Biomarkers of Lead in Pregnancy and Lactation
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27
Chapter 4 Distribution of BLLs, Risk Factors For and Sources of Lead Exposure in Pregnant
and Lactating Women
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35
Chapter 5 Blood Lead Testing in Pregnancy and Early Infancy
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51
Chapter 6 Management of Pregnant and Lactating Women Exposed to Lead
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63
Chapter 7 Nutrition and Lead in Pregnancy and Lactation
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77
Chapter 8 Chelation of Pregnant Women, Fetuses, and Newborn Infants
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89
Chapter 9 Breastfeeding
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97
Chapter 10 Research, Policy, and Health Education Recommendations
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107
Chapter 11 Resources and Referral Information
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113
List of References by Chapter
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116
APPENDICES
I
Existing State Legislation Related to Lead and Pregnant Women
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151
III Commonly Ingested Substances in Pregnancy-related Pica, Reasons for Use,
II
Charge Questions to the Lead and Pregnancy Work Group
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155
and Country/Race-Ethnicity of Origin
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159
IV
List of Occupations and Hobbies that Involve Lead Exposure
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163
V
Alternative Cosmetics, Food Additives, and Medicines That Contain Lead
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167
VI
Recommendations for Medical Management of Adult Lead Exposure
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171
VII
Medical Management Guidelines for Lead-Exposed Adults
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183
VIII
Pregnancy Risk Assessment Form, NYC DOH
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201
IX
Assessment Interview Form, Minnesota DOH
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219
X
Lead-Based Paint Risk Assessment Form, Minnesota DOH
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223
XI
Primary Prevention Information Form, NYC DOH
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233
XII
Child Risk Assessment Form, NYC DOH
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239
XIII
Nutritional Reference Information
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253
XIV Template for Letter to Construction Employer re: Occupational Exposure . . . . . . . . . . . . . . . . . 263
XV W orkplace Hazard Alert for Lead,
Occupational Lead Poisoning Prevention Program CA DOH. . . . . . . . . . . . . . . . . . . . . . . . . . 267
LIST OF FIGURES Chapter 1 Figure 1-1. Distribution of Blood Lead Levels in U.S. Women of Childbearing Age. . . . . . . . . . . . . . . . . . 3
Chapter 3 Figure 3-1. Major Lead Exposure Pathways from Mother to Infant. . . . . . . . . . . . . . . . . . . . . . . . . . . 33
Chapter 5 Figure 5-1. New York City Department of Health and Mental Hygiene: Recommended
Lead Risk Assessment Questions for Pregnant Women . . . . . . . . . . . . . . . . . . . . . . . . . . 61
Figure 5-2. M innesota Department of Health: Recommended Lead Risk Assessment
Questions for Pregnant Women . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 62
LIST OF TABLES Chapter 2 Table 2-1. Summar y of Studies Estimating Association of Prenatal Lead Exposure with
Neurodevelopmental Effects . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13
Chapter 4 Table 4-1. Risk Factors for Lead Exposure in Pregnant and Lactating Women. . . . . . . . . . . . . . . . . . . . 48
Table 4-2. Key R ecommendations to Prevent or Reduce Lead Exposure in Pregnant
and Lactating Women. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 49
Chapter 5 Table 5-1. Follow-up of Initial Blood Lead Testing of the Neonate (<1 month of age) . . . . . . . . . . . . . . . 58
Table 5-2. Schedule for Follow-up Blood Lead Testing in Infants (<6 months of age) . . . . . . . . . . . . . . . 59
Table 5-3. Frequency of Maternal Blood Lead Follow-up Testing During Pregnancy . . . . . . . . . . . . . . . 60
Chapter 6 Table 6-1. Recommended Actions by Blood Lead Level in Pregnancy . . . . . . . . . . . . . . . . . . . . . . . . 74
Table 6-2. Suggested Factors to Assess and Characterize Pica Behavior . . . . . . . . . . . . . . . . . . . . . . . 75
Chapter 8 Table 8-1. Chelating Agents Used to Treat Lead Poisoning . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 93
Table 8-2. Published Experience with Chelating Agents during Pregnancy in Humans. . . . . . . . . . . . . . 94
Table 8-3. Published Experience with Chelating Agents during Early Postpartum in Humans . . . . . . . . . 95
Chapter 9 Table 9-1. Frequency of Maternal Blood Lead Follow-up Testing during Lactation to Assess Risk of Infant Lead Exposure from Maternal Breast Milk . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 103
Table 9-2. Estimated Daily Intake of Lead from Breast Milk at Different Maternal Blood
Lead Concentrations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 104
Table 9-3. Estima ted Increase in Infant Blood Lead Concentration Associated with Different
Maternal Blood Lead Concentrations at 1 Month Postpartum. . . . . . . . . . . . . . . . . . . . . . 105
