Prenatal Screening in NJ
The risk of mercury and lead for expecting mothers and their babies.
When Maria Lala Bonilla’s daughter was born in 2020 with heart disease and anemia, she was surprised to learn that both her and her baby had dangerously high levels of lead in their blood.
The CDC recently reported on this finding by the NJ Prenatal Screening Program for Lead and Mercury, a project started by the NJDOH’s Biomonitoring Program (NJB) in collaboration with University Hospital (UH) in Newark.1 The goal of the program is to not only offer free prenatal screening for lead and mercury to all expecting and birthing mothers and their babies, but also engage mothers in education to bring down high levels, using medical intervention only when critical.
In an interview for the same CDC report, Dr. Onajovwe Fofah, a neonatal specialist at UH, identifies education as the most important part of the screening program: “No mother wants to harm a baby. Once they understand through education, they tend to respond, and you see the mercury and lead levels come down.”
Unlike most children who may not be screened for lead for the first time until they are two years old (and not screened for mercury at all), Bonilla’s daughter was tested at birth, and she received the urgent news within days.
In another case, a 30-year-old expecting mother was screened for lead and mercury during her first prenatal visit at 10 weeks at UH. The levels of mercury in her blood were much higher than the state limit.
From the lab results and questionnaire information, the medical team determined that most of the mercury was coming from eating large fish and suggested the mom-to-be switch to smaller fish. Importantly, the medical team did not force their patient to stop eating all fish, but educated her on the risk and what safer options would be.
The team saw a steady decline in her blood mercury levels and 7 months later, her baby was born with 90-95% less mercury than would have been expected without the intervention (see Figure 1).
Screening for Lead and Mercury
Screening for lead and mercury is as easy as a blood test! For the mothers participating in the NJ Prenatal Screening Program, an extra tube of blood is taken at each prenatal visit and at birth. Blood is typically collected from the umbilical cord to test the babies, a non-invasive approach that is much more effective than a traditional heel stick.
Lead Quick Facts
What is it?
- Lead is a toxic metal that is especially dangerous for young children due to its effects on the brain and other body systems
Where does it come from?
- In older homes (built before 1978), lead may be in the pipes and the paint, which can be inhaled or consumed
- Soil or dirt can be brought into the home and accidentally ingested
- Imported products such as ceramics, spices, and makeup
- Cultural practices such as ayurvedic medicine and eating “earth”
Lead has been known to cause:
- Abdominal pain
- Fatigue
- Mood disorders
- Difficulty sleeping
- Memory loss
- Constipation
- Anemia
- Joint pain
- Increased blood pressure
- Preeclampsia
Mercury Quick Facts
What is it?
- Mercury is a toxic metal that comes from a variety of sources, some more toxic than others
- Methylmercury is the most toxic type and is present in larger fish due to contamination of water sources like oceans and lakes
- Inorganic mercury is less common but is still used in skin lightening creams and red tattoo dye
- Elemental mercury is known as a silver, liquid metal. It is commonly found in old thermometers and used in religious practices and ayurveda
- Ethylmercury has been used as a preservative and is rarely found in people
Where does it come from?
- Eating fish (especially larger fish like tuna, swordfish, and shark)
- Using skin lightening creams or cosmetics with mercury
- Breathing in liquid mercury
Mercury has been known to cause:
- Anxiety
- Muscle weakness
- Impaired motor skills
- Hair loss
- Mood disorders
- Nausea and vomiting
- Depression
- Memory loss
- Coma
Lead and mercury can be passed from mother to baby during pregnancy. Developing fetuses are very vulnerable to these toxic metals. The more babies and children are exposed to lead and mercury and the longer they go without being treated, the worse the effects can be.
Lead’s effect on babies
- Damage to brain, nervous system, and kidneys
- Learning disabilities, lower IQ, decreased attention span
- Behavior problems (e.g. antisocial or aggressive behavior)
- Lower educational and career attainment
Mercury’s effect on babies
- Slow brain, bone, and nervous system growth
- Learning disabilities, lower IQ, decreased attention span
- Behavioral disorders
- Kidney failure, blindness, deafness
- Preterm birth or miscarriage
- Lower education and career attainment
Who is at risk?
Children are the most vulnerable to lead and mercury poisoning. Children living in older homes may be mouthing or teething and ingest lead-contaminated paint, dirt, and dust.
Mothers who are foreign-born, engage in certain cultural practices, and/or use imported products are also at higher risk of exposure to lead and mercury.
Diet and water source are another source of exposure. Food such as rice, fish, and seaweed are staples in many cultures diets, but it is rarely communicated the high amounts of toxic metals in these products. Water can also be contaminated by old pipes and faucets and filters that remove lead can be expensive.
What the NJ Prenatal Screening Program for Lead and Mercury is Finding
Since 2019, NJPSP has performed >17K screenings at UH, identifying more than 1,000 expectant mothers and babies above the health limit and >13K exposures to lead and/or mercury. The 1,000+ patients with levels above the health limits received support from their medical providers, NJDOH Child Lead Program, NJDOH CEOHS, local health departments, and others, as appropriate to address these dangerous exposures.
Figures 3a and 3b show the average levels of blood mercury and blood lead in NJ (data from NJHANES study in progress, in green) are higher than the levels recorded by the CDC’s nationally representative survey NHANES (in blue). Looking specifically at mercury, our UH population of mothers and babies are consistently higher than the national sample, while lead among mothers and babies is slightly lower, possibly owing to the amount of remediation efforts focused in Newark.
What is the Impact?
University Hospital has potentially saved up to 51 million dollars when accounting for the effects of lead and mercury on IQ and cardiovascular disease. This analysis did not include the potential economic burden of reduced liver functions, kidney disease, cost of neonatal intensive care unit (NICU) care, and other conditions that have been linked to chronic lead and mercury exposure.
Coming to a Hospital Near You!
There is a need for prenatal screening for toxic metals such as lead and mercury and the information resulting from this program will allow advocates for the program to lobby for coverage of screening as standard of care, so it can be offered to all mothers and babies. Currently, NJB is working to expand the program beyond UH to additional hospital systems around the state, which will allow the reach of the program to be felt by mothers and babies around NJ.
Additional Resources
First Lady Tammy Murphy’s NurtureNJ Iniative
Click to learn more about lead
Click to learn more about mercury.
“Keeping Babies Safe from Lead and Mercury” - CDC Feature
References
Gao, Z., Wu, N., Du, X., Li, H., Mei, X., & Song, Y. (2022). Toxic nephropathy secondary to chronic mercury poisoning: Clinical characteristics and outcomes. Kidney International Reports, 7(6), 1189–1197. https://doi.org/10.1016/j.ekir.2022.03.009
Zhou, X., Feng, Y., & Gong, Z. (2022). Associations between lead, Cadmium, Mercury, and arsenic exposure and alanine aminotransferase elevation in the general adult population: An exposure–response analysis. Environmental Science and Pollution Research, 29(35), 53633–53641. https://doi.org/10.1007/s11356-022-19698-7