Avoiding lead is not always that easy. Even if you don’t have a job in construction or plumbing, you may still come across lead in the paint and dust in older homes, and in everyday items such as candy and make-up, as well as soil and tap water. If you’re trying to conceive or already pregnant, it helps to know if lead is an issue of concern.
Dreaming of Baby speaks with Dr. Lina Akopians from the Southern California Reproductive Center (SCRC) on the effects of lead on pregnancy and how to keep yourself safe.
Daniela: Good afternoon, Dr. Akopians, and welcome to Dreaming of Baby. It’s a pleasure to have you with us today and we look forward to our discussion on the effects of lead on fertility and pregnancy. Before we start with our questions on the subject, it would be great if you could introduce yourself to our readers as well as provide an overview of your experience working in this field.
Dr. Lina Akopians: My name is Dr. Lina Akopians and I am a Reproductive Endocrinology and Infertility specialist at Southern California Reproductive Center (SCRC) located in Beverly Hills, California. Our team of physicians at SCRC specialize in helping couples achieve their family planning goals through IVF technology.
The effect of lead on fertility
Daniela: Thank you for that introduction Dr. Akopians. To start with today’s focus subject, how does lead affect fertility?
Dr. Lina Akopians: Lead as a heavy metal may affect fertility in a number of ways. Specifically, it may affect the male reproductive system, and increase the risk of miscarriage and premature birth. Lead can cross the placental barrier and affect the development of the baby’s nervous system.
Lead exposure and pregnancy
Daniela: That is very insightful. Indeed, we’ve had some readers express concern as to whether lead exposure affects pregnancy, and I would like to focus on this if I may. Can you please explain further as to how lead can increase the risk of miscarriage?
Dr. Lina Akopians: The exact mechanism of how lead may affect the miscarriage rate is not well understood. But one possibility is that lead increases reactive oxygen species (ROS). ROS inhibits DNA repair, damages nucleic acids, inhibits enzyme function and these all may contribute to implantation failure or miscarriage.
Daniela: In terms of the possibility of lead affecting the development of the baby’s nervous system, can this lead to birth defects?
Dr. Lina Akopians: Most of the nervous system effects in literature indicate a possible effect on behavior and intelligence. There is a higher risk of miscarriage, preterm delivery, and low birth weight infants. However, available data is inadequate to establish a clear association between maternal lead exposure and major congenital anomalies in the fetus.
Daniela: How can a mom-to-be know if she has been or is being exposed to lead? Is specific testing done?
Dr. Lina Akopians: If there is a suspicion for lead toxicity, a blood lead level can be obtained.
Daniela: In terms of lead’s effect on fertility, in the case of patients struggling to conceive, is testing for lead levels a routine exercise?
Dr. Lina Akopians: Testing for lead is not a part of a routine exercise. During evaluation, if a patient or partner exhibits risk factors or symptoms for lead exposure, then checking for lead levels may be considered as part of the workup.
What can I do to limit exposure to lead?
Daniela: Thank you. Are there any tips to note as to how parents-to-be can create an optimal environment prior to conception and during pregnancy to ensure that they are not being exposed to lead?
Dr. Lina Akopians: Washing hands prevents hand-to-mouth contamination of dust and soil. Keep surfaces free of dust. Remove shoes before entering the house as this will keep lead-based soil outside. Run cold water at least 1 minute before using if you have older plumbing which may contain lead. Eat a healthy diet rich in iron, calcium and vitamin C which will help reduce absorption of lead.
Dr. Lina Akopians: “Eat a healthy diet rich in iron, calcium and vitamin C which will help reduce absorption of lead.”
Daniela: That’s very informative. If it transpires that a male patient struggling to conceive has high lead levels, what kind of treatment would be pursued?
Dr. Lina Akopians: Studies have indicated that high lead levels may affect semen analysis parameters. Sperm regenerates approximately every 72 days so the first recommendation would be to avoid further exposure to lead.
Treating lead poisoning
Daniela: In the case of a woman with high lead levels and who is also trying to conceive, what kind of treatment plan would be followed?
Dr. Lina Akopians: The first step in treating lead poisoning is to remove the source of lead from the environment. Your local health department can recommend ways to identify and reduce lead in your home or community. For adults with relatively low lead levels, avoiding exposure to lead might be the only necessary step to reduce blood lead levels. At toxic lead levels (>45 mcg/dL), your doctor may recommend the following treatments: chelation therapy or EDTA chelation therapy.
Daniela: Let’s say that a mom-to-be has received a test result for high lead levels when pregnant, what is the care plan to be followed?
Dr. Lina Akopians: The first step in the treatment will be to remove the source of lead from the environment. The patient should then be referred to a Maternal-Fetal-Medicine specialist to discuss the risk of exposure to the fetus and possible treatment options.
Should I be concerned about lead exposure?
Daniela: Based on your experience, how much of a concern would you say that lead exposure is when it comes to general reproductive health and fertility? Should the general public be worried and why?
Dr. Lina Akopians: Most women with blood lead levels typical in the United States are unlikely to have a substantial negative effect to their fertility. Studies looking at the effect of blood lead level and time to pregnancy have been mostly inconclusive with some studies indicating longer time to pregnancy and with some studies indicating no effect. Fetal exposure to lead through maternal bone lead mobilization during pregnancy is possible for women with significant prior lead exposure; however, given typical lead levels in the United States, this is unlikely to contribute substantial burden to their infants.
Daniela: As a final question, what would be that one piece of advice that you would give a patient worried about the effects of lead?
Dr. Lina Akopians: If a patient is worried about effects of lead I would highly recommend the patient to discuss his/her concerns with their physician.
Daniela: Thank you for time today, Dr. Akopians!
Dr. Lina Akopians is a Reproductive Endocrinology and Infertility specialist at Southern California Reproductive Center (SCRC).