O2105: Perinatal Heavy Metal screening to improve health outcomes in infants.

Background: Maternal and infant health outcomes are interlinked, making a dyadic approach essential to improve perinatal health. Fetal development may be impacted by in-utero exposure to high levels of lead and mercury, yet prenatal screening is not mandatory, leaving vulnerable groups at risk. In-utero exposure may contribute to cardiometabolic diseases and obesity in childhood. In Newark, health disparities and environmental exposure heighten these risks. Hence, in 2019, we implemented lead and mercury screenings for pregnant mothers and newborns as a standard of care at University Hospital, in collaboration with NJ DOH, and Poison Control aiming to improve perinatal health outcomes through this dyadic approach.

Project Description: All pregnant mothers had blood lead and mercury testing at first prenatal visit and at delivery. Educational pamphlets were provided. Elevated levels (lead > 5 µg/dL and mercury ≥5 µg/L) triggered source identification via questionnaire. Cord bloods were collected from all newborns. DOH analyzed the specimens for lead and mercury using triple quadrupole ICP-MS, and TSID-SPME-GC-ICP-MS for mercury speciation. Newborns with elevated levels were retested and treated per AAP guidelines. Results were securely stored for analysis. Remediation plans and support were provided from NJ Poison Control and DOH. Newborns with high levels were referred to a high-risk clinic and early intervention services where evaluation was done using Battelle Developmental Inventory with two-person team.

Discussion: Total of 6,555 mothers and 5,938 newborns were screened. Elevated mercury was found in 4.55% of mothers and 8.69% of newborns, while elevated lead levels was detected in 1.08% of mothers and 0.74% of newborns.
Within the study group ,74.7% of the mothers who had elevated levels were immigrants (N=79), compared to 20.2% of mothers in reference group (N=102), statistically significant difference.
Early detection, source identification, and education at first prenatal visit helped reduce maternal mercury levels and in-utero exposure by over 90%(Table 1).
Identification of elevated lead levels at birth allowed for prompt chelation therapy and follow-up (Tables 2). Newborn who was chelated soon after birth for elevated lead level showed delays in adaptive behavior, communication, fine and gross motor development, and cognition at 4 months, with improvement in these parameters at 16- month evaluation after early intervention

Conclusion: 1. Elevated mercury level was four times more prevalent in mothers and eight times more prevalent in babies than lead in our population
2. Immigrant mothers showed statistically significant higher levels of lead and mercury compared to non-immigrant population.
3. Asymptomatic toxic levels highlight the importance of prenatal screening in high-risk groups for early detection, source identification, and exposure reduction through counseling.
4. Early detection of lead, chelation and follow up with early intervention improved neurodevelopmental outcome in newborn.
5. Continued follow-up is essential to assess the long-term health effects of lead and mercury exposure.