Tobacco Smoke and Lead Exposure During Pregnancy

Overview

This study will test whether a short interview session about lead and secondhand tobacco smoke can help pregnant women reduce their exposure to lead and secondhand smoke. Both lead and secondhand tobacco smoke can cause problems with a pregnancy. The best way to prevent exposure to lead and secondhand tobacco smoke is to recognize the sources and avoid them. Non-smoking African-American and Hispanic pregnant women between 18 and 49 years of age who live in Washington, D.C. may be eligible for this study. Participants are randomly assigned to one of two study groups. Both groups have a 30-minute one-on-one session with a member of the study staff. The content of the session differs between groups. In addition, all women undergo the following tests and procedures: * Answer questions about themselves, their pregnancies, diet, home and smokers in the home. * Requested to provide permission to obtain medical records of children older than 12 months of age who have ever been seen at Children's National Medical Center. * Blood draws at least four times during the study: at the time of enrollment, during the second trimester of the pregnancy, during the third trimester, and at the time of delivery. Up to three optional blood samples may also be requested, one during each trimester of the pregnancy. Blood samples are used to measure lead, cotinine (a chemical the body makes out of nicotine) and hematocrit (a test for anemia). * Collection of umbilical cord blood at the time of delivery. * Answer questions after the delivery about the patient's health, the delivery and the baby.

Prenatal exposure to lead and tobacco has been shown to cause long-term adverse effects to the fetus and child, including decreased birthweight and premature delivery. These effects have been shown even at very low exposure levels. Since both exposures can be modified, many experts recommend screening for and counseling to prevent or reduce these exposures as part of routine prenatal care. The high infant mortality in the District of Columbia (DC) (10.2 deaths per 1,000 live births, versus 6.2 deaths per 1,000 births nationally) is incompletely understood, but disparities in health and healthcare access for minority populations, premature delivery, and low birthweight are likely contributors. Several studies and prevention programs have addressed smoking by and secondhand tobacco smoke (SHS) exposure of pregnant women living in DC in an effort to reduce the infant mortality rate, but none have addressed elevated blood lead levels (BLL) or the effects of exposure to both elevated BLL and SHS. Since DC children have high rates of both elevated BLL and SHS exposure, compared to the US population, we hypothesize that pregnant women in DC have similar high rates of elevated BLL and SHS exposure, AND that these exposures contribute to the high rates of low birthweight and decreased gestational age, and therefore to the rate of infant mortality in DC. The primary aim of this study is to determine the effectiveness of a screening and secondary prevention intervention for elevated blood lead and SHS exposure of low income, pregnant women living in Washington, DC.