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TABLE OF CONTENTS
Preface. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
i
Executive Summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .iii
Summary of Public Health Actions Based on Maternal and Infant Blood Lead Levels . . . . . . . . . . . .vi
Members of the Work Group on Lead and Pregnancy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . vii
Acknowledgments. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .viii
Members of the Advisory Committee on Childhood Lead Poisoning Prevention ix
Glossary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .xiii
Chapter 1. Introduction. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .1
Chapter 2 Adverse Health Efects of Lead Exposure in Pregnancy. . . . . . . . . . . . . . . . . . . . . . . . . .5
Chapter 3 Biokinetics and Biomarkers of Lead in Pregnancy and Lactation . . . . . . . . . . . . . . . . . . . 27
Chapter 4 Distribution of BLLs, Risk Factors For and Sources of Lead Exposure in Pregnant
and Lactating Women . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .35
Chapter 5 Blood Lead Testing in Pregnancy and Early Infancy. . . . . . . . . . . . . . . . . . . . . . . . . . .51
Chapter 6 Management of Pregnant and Lactating Women Exposed to Lead . . . . . . . . . . . . . . . . . 63
Chapter 7 Nutrition and Lead in Pregnancy and Lactation . . . . . . . . . . . . . . . . . . . . . . . . . . . . .77
Chapter 8 Chelation of Pregnant Women, Fetuses, and Newborn Infants . . . . . . . . . . . . . . . . . . . . 89
Chapter 9 Breastfeeding. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .97
Chapter 10 Research, Policy, and Health Education Recommendations . . . . . . . . . . . . . . . . . . . . . 107
Chapter 11 Resources and Referral Information. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 113
List of References by Chapter . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 116
APPENDICES
I Existing State Legislation Related to Lead and Pregnant Women. . . . . . . . . . . . . . . . . . . . . . . 151
II Charge Questions to the Lead and Pregnancy Work Group . . . . . . . . . . . . . . . . . . . . . . . . . . 155
III Commonly Ingested Substances in Pregnancy-related Pica, Reasons for Use,
and Country/Race-Ethnicity of Origin. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 159
IV List of Occupations and Hobbies that Involve Lead Exposure . . . . . . . . . . . . . . . . . . . . . . . . . 163
V Alternative Cosmetics, Food Additives, and Medicines That Contain Lead . . . . . . . . . . . . . . . . . 167
VI Recommendations for Medical Management of Adult Lead Exposure . . . . . . . . . . . . . . . . . . . 171
VII Medical Management Guidelines for Lead-Exposed Adults . . . . . . . . . . . . . . . . . . . . . . . . . . 183
VIII Pregnancy Risk Assessment Form, NYC DOH. . . . . . . . . . . . . . . . . . . . . . . . . . . . . ……. 201
IX Assessment Interview Form, Minnesota DOH. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 219
X Lead-Based Paint Risk Assessment Form, Minnesota DOH . . . . . . . . . . . . . . . . . . . . . . . . . . . 223
XI Primary Prevention Information Form, NYC DOH. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 233
XII Child Risk Assessment Form, NYC DOH. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 239
XIII Nutritional Reference Information. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 253
