Department of Epidemiology, Brown University, Providence, Rhode Island.
Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.
JAMA Pediatr. 2018 Oct 1;172(10):934-942. doi: 10.1001/jamapediatrics.2018.2382.
Childhood lead exposure is associated with neurobehavioral deficits. The effect of a residential lead hazard intervention on blood lead concentrations and neurobehavioral development remains unknown.
To determine whether a comprehensive residential lead-exposure reduction intervention completed during pregnancy could decrease residential dust lead loadings, prevent elevated blood lead concentrations, and improve childhood neurobehavioral outcomes.
DESIGN, SETTING, AND PARTICIPANTS: This longitudinal, community-based randomized clinical trial of pregnant women and their children, the Health Outcomes and Measures of the Environment (HOME) Study, was conducted between March 1, 2003, and January 31, 2006. Pregnant women attending 1 of 9 prenatal care clinics affiliated with 3 hospitals in the Cincinnati, Ohio, metropolitan area were recruited. Of the 1263 eligible women, 468 (37.0%) agreed to participate and 355 women (75.8%) were randomized in this intention-to-treat analysis. Participants were randomly assigned to receive 1 of 2 interventions designed to reduce residential lead or injury hazards. Follow-up on children took place at 1, 2, 3, 4, 5, and 8 years of age. Data analysis was performed from September 2, 2017, to May 6, 2018.
Residential dust lead loadings were measured at baseline and when children were 1 and 2 years of age. At 1, 2, 3, 4, 5, and 8 years of age, the children's blood lead concentrations as well as behavior, cognition, and executive functions were assessed.
Of the 355 women randomized, 174 (49.0%) were assigned to the intervention group (mean [SD] age at delivery, 30.1 (5.5) years; 119 [68.3%] self-identified as non-Hispanic white) and 181 (50.9%) to the control group (mean [SD] age at delivery, 29.2 [5.7] years; 123 [67.9%] self-identified as non-Hispanic white). The intervention reduced the dust lead loadings for the floor (24%; 95% CI, -43% to 1%), windowsill (40%; 95% CI, -60% to -11%), and window trough (47%; 95% CI, -68% to -10%) surfaces. The intervention did not statistically significantly reduce childhood blood lead concentrations (-6%; 95% CI, -17% to 6%; P = .29). Neurobehavioral test scores were not statistically different between children in the intervention group than those in the control group except for a reduction in anxiety scores in the intervention group (β = -1.6; 95% CI, -3.2 to -0.1; P = .04).
Residential lead exposures, as well as blood lead concentrations in non-Hispanic black children, were reduced through a comprehensive lead-hazard intervention without elevating the lead body burden. However, this decrease did not result in substantive neurobehavioral improvements in children.
ClinicalTrials.gov identifier: NCT00129324.
儿童铅暴露与神经行为缺陷有关。住宅铅危害干预对血铅浓度和神经行为发育的影响仍不清楚。
确定在怀孕期间进行全面的住宅铅暴露减少干预是否可以降低住宅灰尘铅负荷，防止血铅浓度升高，并改善儿童神经行为结果。
设计、地点和参与者：这是一项纵向、基于社区的随机临床试验，研究对象为孕妇及其子女，即健康结果和环境测量（HOME）研究，于 2003 年 3 月 1 日至 2006 年 1 月 31 日进行。招募了参加辛辛那提俄亥俄州大都市区 3 家医院的 9 家产前诊所之一的 1263 名符合条件的孕妇。在 1263 名合格的女性中，有 468 名（37.0%）同意参加，其中 355 名女性（75.8%）按照意向治疗原则进行了随机分组。参与者被随机分配接受旨在减少住宅铅或伤害危害的 2 种干预措施之一。对儿童的随访在 1、2、3、4、5 和 8 岁时进行。数据分析于 2017 年 9 月 2 日至 2018 年 5 月 6 日进行。
在基线和儿童 1 岁和 2 岁时测量住宅灰尘铅负荷。在 1、2、3、4、5 和 8 岁时，评估儿童的血铅浓度以及行为、认知和执行功能。
在随机分组的 355 名女性中，174 名（49.0%）被分配到干预组（分娩时的平均[标准差]年龄为 30.1[5.5]岁；119 名[68.3%]自我认定为非西班牙裔白人），181 名（50.9%）被分配到对照组（分娩时的平均[标准差]年龄为 29.2[5.7]岁；123 名[67.9%]自我认定为非西班牙裔白人）。干预措施降低了地板（24%；95%CI，-43%至 1%）、窗台（40%；95%CI，-60%至-11%）和窗槽（47%；95%CI，-68%至-10%）表面的灰尘铅负荷。干预措施并未显著降低儿童的血铅浓度（-6%；95%CI，-17%至 6%；P=0.29）。干预组儿童的神经行为测试评分与对照组儿童相比没有统计学差异，但干预组儿童的焦虑评分降低（β=-1.6；95%CI，-3.2 至-0.1；P=0.04）。
通过全面的铅危害干预，非西班牙裔黑儿童的住宅铅暴露以及血铅浓度都有所降低，而体内铅负荷并没有升高。然而，这一降低并没有导致儿童的神经行为有实质性的改善。
ClinicalTrials.gov 标识符：NCT00129324。
