An updated US Preventive Services Task Force (USPSTF) recommendation states that the current evidence is insufficient to assess the benefits and harms of screening for elevated blood lead levels in asymptomatic children age ≤5 years, both at average and increased risk, as well as in pregnant women. The guidelines were published in JAMA.1

Researchers sought to update the 2006 USPSTF screening recommendations, as elevated blood lead levels may be associated with neurologic effects in children and organ failure and preeclampsia in pregnant women. 

Capillary blood testing was confirmed as the method to accurately identify children with elevated blood lead levels compared with venous blood testing. Questionnaires and other clinical predication tools were found to be inaccurate in identifying elevated blood lead levels in asymptomatic children or communities at highest risk, while no determination could be made regarding the accuracy of these tools in identifying elevated blood lead levels in asymptomatic pregnant women. 

The USPSTF found inadequate evidence on the effectiveness of screening for or treatment of elevated blood lead levels in asymptomatic children age ≤5 years or pregnant women. Inadequate evidence was found as to whether the effectiveness of screening pregnant women varies by gestational age.

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In an accompanying editorial published in JAMA Pediatrics,2 author Michael Weitzman, MD, concludes, “The inconclusive findings of the new USPSTF recommendation does not mean that screening children for elevated lead levels is not necessary, nor does it shed light on whether screening should be targeted to children at high risk or whether it should be universally done. Only more rigorously conducted research will provide evidence-based answers to these questions.”

References

  1. US Preventive Services Task Force. Screening for elevated blood lead levels in children and pregnant women: US Preventive Services Task Force recommendation statement. JAMA. 2019;321(15):1502-1509.
  1. Weitzman M. Blood lead screening and the ongoing challenge of preventing children’s exposure to lead [published online April 16, 2019]. JAMA Pediatr. doi:10.1001/jamapediatrics.2019.0855