Door ophoping van lood in de botten kan chronische loodvergiftiging leiden tot acute loodvergiftiging.

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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