Lead Information for OB/GYNs or Midwives

When someone is pregnant, lead can pass from them to the unborn baby, so exposure during pregnancy has the potential to impact fetal growth and neurodevelopment.

Too much lead in a pregnant person’s body can:

  • Increase risk of miscarriage
  • Cause the baby to be born early or underweight
  • Hurt the baby’s brain, nervous system, or kidneys
  • Cause the child to have learning or behavioral issues

While a healthy diet is always important, especially while pregnant or nursing, foods that are high in calcium, iron, and vitamin C can provide additional protection against lead. See the Lead and Nutrition page for more information.

The CDC provides a fact-sheet in English and Spanish that can be provided to pregnant patients with tips on how to reduce and avoid exposure to lead.

Risk Factors and Testing

The CDC recommends that only those who are most at risk get tested. Here are a series of questions to ask anyone who is pregnant or breastfeeding:

  1. Do you live in or regularly visit an older house (built before 1978)?
    1. Does this house have peeling, dusty, or chalking paint?
    2. At any point since becoming pregnant, has this house been undergoing renovations that cause dust (sanding, scraping, etc.)?
  2. Sometimes pregnant people have an urge to eat things that are not food, such as clay, soil, plaster, or paint chips. Do you ever eat or chew non-food items?
  3. Are there any children in the house with elevated blood lead levels?
  4. Do you have a history of elevated blood lead levels?
  5. Are there any lead pipes or fixtures in the home?
  6. Has the home been tested for lead in the water? If so, was the the level high?
  7. Do you use handmade, antique, or imported pottery or leaded crystal?
  8. Do you use any traditional folk remedies, makeup, or skincare products that are not sold in a regular drugstore or supermarket? (This includes any that are homemade or imported from another country.)
  9. Do you or anyone else in the household have a job or hobby that involves exposure to lead? (This can include things like home renovation, auto repair, metal work, electronics repair, hunting, jewelry making, or stained glass crafting.)
  10. Have you recently moved to the United States from another country?
  11. Do you live near a possible source of lead, such as a mine, smelter, or battery recycling plant (even if it’s no longer being used)?

If they answer yes to any of these questions, they may be at risk for lead exposure, so a blood lead test should be considered.

For more detailed information about possible sources of lead exposure, see the Lead Sources page. This can be used to help guide follow-up questions, such as specific folk remedies or products that are known be made of or frequently contain lead. Also see the page on Preventing Exposure for Lead.

The American College of Gynecology and Obstetrics (ACOG) also provides recommendation on Lead Screening During Pregnancy and Lactation, which includes a recommended timeline for follow-up testing based on blood lead levels.

Breastfeeding and Lactation

The CDC provides guidance on Lead and Breastfeeding. As of 2024, the recommended breastfeeding guidelines based on maternal blood lead levels are:

  • < 5 µg/dL: Breastfeeding should be encouraged
  • 5-39 µg/dL: Infant blood lead levels should be monitored
    • If infant BLLs are below 5 µg/dL, breastfeeding should be encouraged
    • If infant BLLs are rising or fail to decline by 5 µg/dL, the health department should be contacted for environmental evaluation
    • If no external source is identified, maternal BLLs are > 20 µg/dL, AND infant BLLs are >= 5 µg/dL, breast milk should be pumped and discarded until BLLs are lower
  • > 40 µg/dL: Breast milk should be pumped and discarded until BLLs drop below 40 µg/dL

ACOG’s recommendations on Lead Screening During Pregnancy and Lactation also note that “Calcium supplementation (1,200 mg daily) has been associated with a 5–10% decrease in breast milk lead levels among women over the course of lactation” and “increased intakes of vitamin C also have been associated with decreased levels of lead in breast milk.” There is no formal recommendation of supplementation, but it may be appropriate for some patients.

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