Public Health

To Protect Children From Lead, Fix Pregnant Women's Homes

Old windows can be a big source of lead contamination.

Old windows can be a big source of lead contamination. iStockphoto.com hide caption

itoggle caption iStockphoto.com

Children are diagnosed with lead exposure only when their health is already endangered. Wouldn't it be better to prevent that danger instead? That's the goal of a project in the city of St. Louis that tests the homes of pregnant women and removes dangerous lead before babies were born.

That SWAT-team approach can reduce children's exposure to toxic lead, according to a new study.

About 250,000 children are poisoned by lead each year, according to current standards, and experts say twice as many are affected. Lead permanently damages a child's brain, lowering IQ and causing lifelong behavior problems and learning disabilities.

Decades of effort to remove lead paint from substandard housing haven't ended the problem – about 24 million houses and apartments in the United States are still thought to have lead paint, according to the federal Centers for Disease Control and Prevention. Prospective parents have no way of knowing if their housing is contaminated without having it tested, an expensive prospect.

So researchers in St. Louis and city officials decided they would make a preemptive strike. In the Heavy Metal Project, low-income pregnant women were offered a free home inspection. If lead was found, it was cleaned up. That included cleaning, covering over old paint, and replacing windows.

The babies whose homes were cleaned up before they were born had less lead in their blood than children whose housing wasn't cleaned. The average blood lead level among the 60 participants was 2.70 micrograms per deciliter, compared to 3.63 for controls. Blood lead levels greater than 5 micrograms per decileter were found in 13.3 percent of study participants, compared to 22.5 percent of controls.

Those last numbers are important, because in January, a federal panel said the standard for dangerous lead exposure in children should be cut in half to 5 micrograms, compared to the current standard of 10 micrograms. That's based on lots of research in the past decade showing that even a small amount of lead exposure messes up a brain.

So what's not to like about this project?

The home cleanups are expensive, costing about $6,500 in homes where windows needed to be replaced, and a little less than $1,000 where they didn't. Half of the homes got replacement windows, for an average of about $3,500.

But many of those homes would have had to have been remediated after children were poisoned, according to Daniel Berg, the study's lead author. He's a physician at Family Care Health Centers in St. Louis. "You're gonig to be doing the work a few years later on a lot of these properties anyway," he told Shots. "We're shifting it to find the hazards before the kids are poisoned. The idea is to prevent it up front."

St. Louis used funds from the federal Department of Housing and Urban Development, which is given to cities with substandard housing for lead remediation.

Berg and his colleagues say they'd like a woman's obstetrician to refer their patients for home lead screening if the doctor thinks there's a risk. The research was published in the American Journal of Obstetrics and Gynecology.

One in 27 children in St. Louis are at risk of being exposed to lead, the authors note. That's a lot more kids than the 1 in 800 who are affected by treated diseases detected by newborn screening, which is commonplace.

A similar project in Philadelphia, the Lead Safe Homes Study, didn't show the improvements found in St. Louis. That may be because the St. Louis project fixed the homes before the children were born, while the other project started work after the children were born.

Screening of homes is the only way to prevent damage to children's health, Jerome Paulson, a pediatrician at Childrens National Medical Center in Washington, D.C., told Shots in January. "We really need to screen houses, not kids."

The present system, says Paulson, uses "children as a means to identify substandard housing. To me, that's immoral."

But even that imperfect system may be imperiled. Congress has cut funding for lead testing of children from $30 million to $2 million. The money is given to local health departments to pay for children's blood tests. The health deparmtments are now scrambling to figure out how to keep providing the tests.

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