Is lead in tap water still a public health problem? An observational study in Glasgow

Analyzing and Optimizing the Distribution of Blood Lead Level Testing for Children in New York City: A Data-Driven Approach

This study investigates blood lead level (BLL) rates and testing among children under 6 years of age across the 42 neighborhoods in New York City from 2005 to 2021. Despite a citywide general decline in BLL rates, disparities at the neighborhood level persist and are not addressed in the official reports, highlighting the need for this comprehensive analysis. In this paper, we analyze the current BLL testing distribution and cluster the neighborhoods using a k-medoids clustering algorithm. We propose an optimized approach that improves resource allocation efficiency by accounting for case incidences and neighborhood risk profiles using a grid search algorithm. Our findings demonstrate statistically significant improvements in case detection and enhanced fairness by focusing on under-served and high-risk groups. Additionally, we propose actionable recommendations to raise awareness among parents, including outreach at local daycare centers and kindergartens, among other venues.

Did a Nocebo Effect Contribute to the Rise in Special Education Enrollment Following the Flint, Michigan Water Crisis?

Background

Exposure to waterborne lead during the Flint Water Crisis during April 2014-October 2015 is believed to have caused increased special education enrollment in Flint children.

Method

This retrospective population-based cohort study utilized de-identified data for children under six years of age who had their blood lead tested during 2011 to 2019, and special education outcomes data for children enrolled in public schools for corresponding academic years (2011-12 to 2019-20) in Flint, Detroit (control city) and the State of Michigan. Trends in the following crisis-related covariates were also evaluated: waterborne contaminants, poverty, nutrition, city governance, school district policies, negative community expectations, media coverage and social media interactions.

Results

Between 2011 and 2019, including the 2014-15 crisis period, the incidence of elevated blood lead in Flint children (≥ 5µg/dL) was always at least 47% lower than in the control city of Detroit (p < .0001) and was also never significantly higher than that for all children tested in Michigan (p = 0.33). Nonetheless, special education enrollment in Flint spiked relative to Detroit and Michigan (p < .0001). There is actually an inverse relationship between childhood blood lead and special education enrollment in Flint.

Conclusion

This study failed to confirm any positive association between actual childhood blood lead levels and special education enrollment in Flint. Negative psychological effects associated with media predictions of brain damage could have created a self-fulfilling prophecy via a nocebo effect. The findings demonstrate a need for improved media coverage of complex events like the Flint Water Crisis.

Drinking natural water unchangeably is associated with reduced all-cause mortality in elderly people: A longitudinal prospective study from China

Objective

Because of rapid economic growth and followed urban expansion in China, many people drinking natural water had to change their water sources to tap water. We aimed to test the unknown association that whether continued use of natural water for drinking is different from switching to tap water in all-cause mortality risks in elderly people.

Methods

In total, based on Chinese Longitudinal Healthy Longevity Survey, 26,688 elderly participants drinking natural water from childhood to young-old were included in the final analyses. Associations between whether changing drinking water sources or not and all-cause mortality risk were then estimated by Cox regression models with the use of multiple propensity score methods, and the primary analysis used propensity score matching, with other propensity score methods confirming the robustness of the results.

Results

Baseline characteristics were fairly well balanced by the three post-randomization methods. During a median follow-up period of 3.00 (IQR: 1.52, 5.73) years, 21,379 deaths were recorded. The primary analysis showed people using natural water unchangeably was associated with a lower risk of all-cause mortality than those switching to tap water in later life (HR: 0.94, 95% CI: 0.91-0.97, p < 0.001). Other propensity score methods, as well as Cox regression analysis without using propensity score methods, showed similar results.

Conclusions

Among elderly people depending on natural water for drinking from their childhood to young-old in China, continued use of natural water was associated with a lower all-cause mortality risk than conversion to tap water later. Further studies in different countries and populations are needed to verify our conclusions.

Levels of Lead in Residential Drinking Water and Iron Deficiency among Patients with End Stage Kidney Disease

Background

Although those with kidney disease may have heightened susceptibility to heavy metal toxicity, whether low levels of drinking water lead contamination have clinical consequence is unknown.

Methods

Given that lead toxicity is known to associate with iron deficiency, we merged data from the Environmental Protection Agency (EPA) Safe Drinking Water Information and United States Renal Data Systems to examine whether municipal 90th percentile drinking water lead levels associate with iron deficiency among incident dialysis patients. Iron deficiency was defined across thresholds of transferrin saturation (<10% and 20%) and ferritin (<100 and <200 ng/ml), and simultaneous transferrin saturation <20% and ferritin <200 ng/ml, all obtained within 30 days of dialysis initiation. The average 90th percentile of drinking water lead samples per patient city of residence over a 5-year period before dialysis initiation was examined at the <1 μg/L level of detection, and at the 25th, 50th, and 100th percentile of the EPA's actionable level (15 μg/L).

Results

Among 143,754 incident ESKD patients, those in cities with drinking water lead contamination had 1.06 (95% CI, 1.03 to 1.09), 1.06 (95% CI, 1.02 to 1.10), and 1.07 (95% CI, 1.03 to 1.11) higher adjusted odds of a transferrin saturation <20%, ferritin <200 ng/ml, and simultaneous transferrin saturation <20% and ferritin <200 ng/ml, respectively. These associations were apparent across the range of lead levels found commonly in the United States and were significantly greater among Black patients (multiplicative interaction P values between lead and race <0.05).

Conclusions

Even exposure to low levels of lead contamination, as commonly found in US drinking water, may have adverse hematologic consequence in patients with advanced kidney disease. These associations are particularly evident among Black people and, although consistent with other environmental injustices facing minorities in the United States, might reflect a greater susceptibility to lead intoxication.

Controlling lead release due to uniform and galvanic corrosion - An evaluation of silicate-based inhibitors

Silicates have been added to drinking water for decades, both to sequester iron/manganese and as a corrosion control treatment for lead. But the mechanisms by which they might act to limit lead release are not well understood. We evaluated the effects of two silicate formulations on lead release due to uniform and galvanic corrosion over a wide range of pH and dissolved inorganic carbon concentrations. We compared these results to better-characterized systems, with added ortho- or polyphosphate and in an inhibitor-free control. Independent of pH, silicates did not consistently mitigate lead release due to either uniform or galvanic corrosion. Furthermore, lead carbonates appeared to determine lead solubility in the presence of sodium silicate. While silicate treatment did promote the formation of a nanometer-thick silicon layer on lead and a decrease in crystallite size at the scale surface, these changes did not inhibit lead release. But unlike polyphosphate-which is known to form soluble complexes with lead and disperse particulate metals-high ratio silicate did not exacerbate lead release. Metasilicate did exacerbate lead release, especially at pH 7 and 5 mg DIC/L; this suggests that silicate formulation may have an important effect on the dispersion of lead-rich particles.

Variability and sampling of lead (Pb) in drinking water: Assessing potential human exposure depends on the sampling protocol

Lead (Pb) in drinking water has re-emerged as a modern public health threat which can vary widely in space and in time (i.e., between homes, within homes and even at the same tap over time). Spatial and temporal water Pb variability in buildings is the combined result of water chemistry, hydraulics, Pb plumbing materials and water use patterns. This makes it challenging to obtain meaningful water Pb data with which to estimate potential exposure to residents. The objectives of this review paper are to describe the root causes of intrinsic Pb variability in drinking water, which in turn impacts the numerous existing water sampling protocols for Pb. Such knowledge can assist the public health community, the drinking water industry, and other interested groups to interpret/compare existing drinking water Pb data, develop appropriate sampling protocols to answer specific questions relating to Pb in water, and understand potential exposure to Pb-contaminated water. Overall, review of the literature indicated that drinking water sampling for Pb assessment can serve many purposes. Regulatory compliance sampling protocols are useful in assessing community-wide compliance with a water Pb regulatory standard by typically employing practical single samples. More complex multi-sample protocols are useful for comprehensive Pb plumbing source determination (e.g., Pb service line, Pb brass faucet, Pb solder joint) or Pb form identification (i.e., particulate Pb release) in buildings. Exposure assessment sampling can employ cumulative water samples that directly capture an approximate average water Pb concentration over a prolonged period of normal household water use. Exposure assessment may conceivably also employ frequent random single samples, but this approach warrants further investigation. Each protocol has a specific use answering one or more questions relevant to Pb in water. In order to establish statistical correlations to blood Pb measurements or to predict blood Pb levels from existing datasets, the suitability of available drinking water Pb datasets in representing water Pb exposure needs to be understood and the uncertainties need to be characterized.

Evaluating the Effects of Full and Partial Lead Service Line Replacement on Lead Levels in Drinking Water

Lead service line replacement (LSLR) is an important strategy for reducing lead exposure via drinking water, but jurisdictional issues can sometimes interfere with full replacement of the lead line. The effects of full and partial LSLR on lead levels were assessed using 5 × 1-L sample profiles collected at more than 100 single-unit residences. Profiles comprised four sequential standing samples (L1-L4) and a free-flowing sample (L5) drawn after a 5 min flush of the outlet. At 45 sites with full lead service lines, 90th percentile lead levels in standing samples ranged from 16.4 to 44.5 μg L(-1) (L1 and L4, respectively). In the free-flowing sample (L5), 90th percentile lead was 9.8 μg L(-1). Within 3 days, full LSLR had reduced L3-L5 lead levels by more than 50%, and within 1 month, lead levels were significantly lower in every liter of the sample profile. Conversely, partial LSLR more than doubled premises plumbing (L1, L2) lead release in the short term and did not reduce L1, L2 lead release in the long term. Even 6 months after partial LSLR, 27% of first-draw lead levels were greater than 15 μg L(-1) (the U.S. EPA action level), compared with 13% pre-replacement.

Effectiveness of interventions to reduce exposure to lead through consumer products and drinking water: A systematic review

OBJECTIVES

The objective of this systematic review is to assess the effectiveness of regulatory, environmental and educational interventions for reducing blood lead levels (BLLs) and associated health outcomes in children, pregnant women and the general population.

METHODS

Searches were run in MEDLINE, EMBASE and the Global Health Library up until August 2015. Studies were eligible for inclusion if they assessed the impact of regulatory, environmental or educational interventions, stand-alone or in combination, on BLLs among children, pregnant women or the general population through randomized controlled trials (RCT), controlled before-after (CBA), interrupted time series (ITS), uncontrolled before-after (UBA) or repeated cross-sectional studies. Studies assessing the impact of interventions to reduce exposure to lead in paint or household dust as well as studies concerned exclusively with environmental concentrations of lead were not included. As documented in a detailed protocol, screening, data extraction and quality appraisal were largely undertaken according to Cochrane standards. Harvest plots were used to graphically summarize evidence of effectiveness.

RESULTS

The searches yielded 6466 unique records, of which five met our eligibility criteria; two additional eligible studies were identified by experts. We did not find any studies regarding the effectiveness of regulatory, educational or environmental interventions targeting exposure to lead in consumer products. Evidence regarding the effectiveness of interventions in reducing BLLs from exposures through drinking water is limited in both quantity and quality. Stand-alone targeted educational interventions showed no statistically significant reductions in children's BLL (two RCT) when compared to general educational interventions. Likewise, instructing women to reduce or eliminate lead-contaminated drinking water showed no effect on BLL (one RCT). Stand-alone environmental interventions appeared more promising in reducing BLL (three UBA). Combining educational and environmental interventions and targeting multiple settings may be effective in reducing BLL, as suggested by one uncontrolled before-after study. No studies examining the effectiveness of regulatory interventions were found.

CONCLUSIONS

The limited quantity and quality of the evidence measuring BLL and associated health outcomes points to an urgent need for more robust research into the effectiveness of interventions to reduce lead exposure from consumer products and drinking water, especially for regulatory interventions.

The Identification and Synthesis of Lead Apatite Minerals Formed in Lead Water Pipes

Phosphate is added to drinking water in the UK to minimise the release of lead from lead water pipes. The phosphate encourages the formation of insoluble lead apatites on the walls of the pipe. Hydroxylpyromorphite Pb5(PO4)3OH is the lead apatite that is most often used to model lead levels in tap water; however, its presence has not been confirmed. Our aims were to identify the lead pipe apatite and synthesise it. The synthetic mineral would then be used in future solubility studies to produce better predictions of lead levels in tap water. XRD and FTIR were used to characterise the minerals on a range of lead pipes. Pyromorphite and hydroxylpyromorphite were absent and instead a range of mixed calcium lead apatites were present. For every five lead ions in the general formula Pb5(PO4)3X between one and two ions were replaced with calcium and there was evidence of substitution ofPO43-by eitherCO32-orHPO42-. Calcium lead apatites with similar unit cell dimensions to those found on lead water pipes were then synthesised. The calcium : lead ratio in these reaction mixtures was in excess of 500 : 1 and the resulting crystals were shown by TEM to be nanosized rods and flakes. The synthetic apatites that most closely resembled the unit cell dimensions of the apatites on lead water pipes were shown to be Pb3.4Ca1.3(PO4)3Cl0.03OH0.97, Pb3.6Ca1.2(PO4)3Cl0.07OH0.93, and Pb3.6Ca1.2(PO4)3Cl0.27OH0.73.

Identification of the sources of metal (lead) contamination in drinking waters in north-eastern Tasmania using lead isotopic compositions

This study utilises a range of scientific approaches, including lead isotopic compositions, to differentiate unknown sources of ongoing lead contamination of a drinking water supply in north-eastern Tasmania, Australia. Drinking water lead concentrations are elevated above the Australian Drinking Water Guideline (10 μg/L), reaching 540 μg/L in the supply network. Water lead isotopic compositions from the town of Pioneer ((208)Pb/(207)Pb 2.406, (206)Pb/(207)Pb 1.144 to (208)Pb/(207)Pb 2.360, (206)Pb/(207)Pb 1.094) and Ringarooma ((208)Pb/(207)Pb 2.398, (206)Pb/(207)Pb 1.117) are markedly different from the local bedrock ((208)Pb/(207)Pb 2.496, (206)Pb/(207)Pb 1.237). The data show that the lead in the local waters is sourced from a combination of dilapidated drinking water infrastructure, including lead jointed pipelines, end-of-life polyvinyl chloride pipes and household plumbing. Drinking water is being inadvertently contaminated by aging infrastructure, and it is an issue that warrants investigation to limit the burden of disease from lead exposure.

Lead, cadmium and mercury levels in pregnancy: the need for international consensus on levels of concern

For heavy metals that have any degree of transfer though the placenta to the fetus, it is unlikely that there are safe limits for maternal blood levels. The only means of reducing fetal exposure is to minimise maternal exposure. There are few recommendations for levels of concern. With the exception of US recommendations for maternal Pb levels, but there are no international levels of concern or cut-off levels specifically for pregnancy for heavy metals, so that comparisons can generally only be made with national reference values relating to similar physiological statuses or age groups. These include recommendations for Cd levels by Germany (reference value for non-smoking adults aged 18–69 years, 1 µg/l) and for Hg by Germany (reference value for adults age 18–60 years with fish intake ⩽3 times per month, 2.0 µg/l) and the USA (cut-off level for women, 5.8 µg/dl). To illustrate the lack of cohesion, we present data on blood Pb, Cd and Hg levels from pregnant women enroled in the UK Avon Longitudinal Study of Parents and Children study and compare the values with present levels of concern and recommended cut-off values. We also compare the levels with those found in other groups of pregnant women worldwide to strengthen the database for the development of levels of concern in pregnancy. The need for clarity of terminology in describing levels of concern is discussed. There is a pressing need for international consensus on levels of concern for all age groups and physiological statuses, particularly for pregnancy.

Environmental factors predicting blood lead levels in pregnant women in the UK: the ALSPAC study

Background

Lead is a widespread environmental toxin. The behaviour and academic performance of children can be adversely affected even at low blood lead levels (BLL) of 5–10 µg/dl. An important contribution to the infant's lead load is provided by maternal transfer during pregnancy.

Objectives

Our aim was to determine BLL in a large cohort of pregnant women in the UK and to identify the factors that contribute to BLL in pregnant women.

Methods

Pregnant women resident in the Avon area of the UK were enrolled in the Avon Longitudinal Study of Parents and Children (ALSPAC) in 1991–1992. Whole blood samples were collected at median gestational age of 11 weeks and analysed by inductively coupled plasma dynamic reaction cell mass spectrometry (n = 4285). Self-completion postal questionnaires were used to collect data during pregnancy on lifestyle, diet and other environmental exposures. Statistical analysis was carried out with SPSS v19.

Results

The mean±SD BLL was 3.67±1.47 (median 3.41, range 0.41–19.14) µg/dl. Higher educational qualification was found to be one of the strongest independent predictor of BLL in an adjusted backwards stepwise logistic regression to predict maternal BLL <5 or ≥5 µg/dl (odds ratio 1.26, 95% confidence interval 1.12–1.42; p<0.001). Other predictive factors included cigarette smoking, alcohol and coffee drinking, and heating the home with a coal fire, with some evidence for iron and calcium intake having protective effects.

Conclusion

The mean BLL in this group of pregnant women is higher than has been found in similar populations in developed countries. The finding that high education attainment was independently associated with higher BLL was unexpected and currently unexplained. Reduction in maternal lead levels can best be undertaken by reducing intake of the social drugs cigarettes, alcohol and caffeine, although further investigation of the effect of calcium on lead levels is needed.

A systematic review on status of lead pollution and toxicity in Iran; Guidance for preventive measures

Lead is an old environmental metal which is presented everywhere and lead poisoning is an important health issue in many countries in the world including Iran. It is known as a silent environmental disease which can have life-long adverse health effects. In children, the most vulnerable population, mental development of children health effects is of the greatest influence. Low level lead exposure can significantly induce motor dysfunctions and cognitive impairment in children. The sources of lead exposure vary among countries. Occupational lead exposure is an important health issue in Iran and mine workers, employees of paint factories, workers of copying centers, drivers, and tile making factories are in higher risk of lead toxicity. Moreover lead processing industry has always been a major of concern which affects surface water, drinking waters, and ground waters, even water of Caspian Sea, Persian Gulf and rivers due to increasing the number of industries in vicinity of rivers that release their waste discharges into river or sea. In addition, lead contamination of soil and air especially in vicinity of polluted and industrialized cities is another health problem in Iran. Even foods such as rice and fishes, raw milk, and vegetables which are the most common food of Iranian population are polluted to lead in some area of Iran. Adding lead to the opium is a recently health hazard in Iran that has been observed among opium addicts. There are few studies evaluated current status of lead exposure and toxicity in the Iranian children and pregnant women which should be taken into account of authorities. We recommend to identify sources, eliminate or control sources, and monitor environmental exposures and hazards to prevent lead poisoning.

Assessment and management of tap water lead contamination in Lower Saxony, Germany

Lead is known to have numerous adverse effects especially to infants and children. The intake of lead through drinking water is commonly due to metal corrosion in the peripheral water distribution system, especially the user's plumbing. The aim of this project was to assess the present state of drinking water contamination with lead in Lower Saxony and to promote replacement of lead pipes. For this purpose a project was initiated comprising three parts. First, a free examination of drinking water was offered in cooperation with local public health departments for private households with young women and families with children living in buildings constructed before 1974. Participants were asked to collect a cold tap water sample in their household after nocturnal stagnation and to complete a questionnaire. The collected samples were analysed by atomic absorption spectrometry for their lead concentration. Second, data from local public health departments on results of lead measurements, especially in buildings for the public, were collected and analysed. Finally a working group 'lead replacement' was initiated. In the project in total 2436 tap water samples from households were collected. Of these, 6.49% had lead concentrations exceeding 10 microg/l (recommended limit of the World Health Organization) and 2.79% had concentrations above the limit of the German drinking water ordinance (25 microg/l). There were remarkable regional differences in the frequency of tap water contamination. Multi-family houses were more frequently affected than single- and double-family houses.

Lead exposure by drinking water: an epidemiologial study in Hamburg, Germany

Study objective was to investigate the extent of lead exposure via tap water in Hamburg and the relevance of preventive strategies. Two hundred and forty-eight non-smoking young women participated in the cross-sectional study program and 52 women completed the intervention program. In the cross-sectional study program most women (N = 178) didn't know anything about the material of the plumbing system at their homes. Participants with lead in the tap water above the detection limit of 5 microg/l (N = 142) showed significantly higher blood lead levels (median 31 microg/l) compared to those with no detectable lead in the tap water (N = 106; median blood lead 24 microg/l, p < = 0.001). There is a close correlation between the average lead concentration in the tap water and blood lead concentrations (N = 142 value pairs, Spearman's rho 0.43, p < = 0.0001). In the intervention program, the women were asked to minimize exposure by flushing water or to exclude it by consuming bottled water. Intervention lowered blood lead-level significantly (median decrease of 11 microg/l, p < = 0.001). "Minimizers" could lower their blood lead levels by about 21% of the initial value, "excluders" by about 37% (ns, p < = 0.17). The majority judged neither minimizing nor excluding tap water as practicable health preventive behaviour pattern in the long run. Lead in tap water stands for an avoidable surplus exposure. These results underline the relevance of health care preventive measures for the most sensitive groups.

Prevention of lead toxicity in US children

During the past 2 decades, the proportion of US children who have blood lead concentrations of 10 microg/dL or higher declined by over 80% after the elimination of leaded gasoline and lead solder from canned foods, and a ban on leaded paint used in housing and other consumer products. Fatalities and symptomatic lead poisoning are now rare. Residential lead hazards, which are exceedingly difficult to control, are currently the major source of lead intake for children. Undue lead exposure has retreated into 2 major risk groups; impoverished children who live in older, poorly maintained rental housing and more affluent children who live in older housing undergoing renovation. Despite the dramatic decline in children's blood lead levels, lead toxicity remains epidemic among impoverished children who live in older rental housing, especially those who live in the northeastern and midwestern regions of the United States. There are increasing data linking lead exposure with other systemic effects including delinquency, dental caries, and learning problems. Moreover, there is evidence indicating that there is no discernible threshold for lead-associated cognitive deficits. Thus, it is increasingly important to shift our efforts toward the primary prevention of childhood lead exposure from residential hazards. This article reviews the epidemiology and control of childhood lead exposure, focusing especially on steps necessary to shift toward primary prevention.

Lead contamination in tap water of households with children in Lower Saxony, Germany

Lead has numerous acute and chronic adverse effects on human beings. This is especially true for infants and children. The main path of lead ingestion in children can be different according to housing and living situation. The intake of lead through drinking water is commonly due to metal corrosion. The users plumbing can be an important factor. In recent years, many lead pipes in Germany have been replaced by pipes made of an alternative material. The aim of this study is to assess the present state of drinking water contamination and the resulting exposure of infants to lead. For this purpose mothers of new-born babies were offered a free examination of their drinking water. After a written declaration of consent had been obtained and after the infant in question had reached an age of 3 months, a stagnation sample of cold tap-water after overnight stagnation together with a random daytime sample was obtained from the family. The collected samples were analysed by atomic absorption spectrometry for their lead concentration. In total, 1485 samples from households were collected. Of the 1434 stagnation samples, 3.1% had lead concentrations greater than 0.01 mg/l (recommended limit of the WHO) and 0.6% had concentrations above the limit of the German drinking water regulation (0.04 mg/l). The values for the 1474 random daytime samples were 2.1% above 0.01 mg/l and 0.2% greater than 0.04 mg/l, respectively. By region, the areas Bovenden, Friedland, Duderstadt, Northeim and Rosdorf were particularly affected. The highest measured concentrations of lead in the stagnation samples were 0.11 mg/l and 0.15 mg/l in the random daytime samples, respectively.

Public health implications of new guidelines for lead in drinking water: a case study in an area with historically high water lead levels

Concern about the neurotoxicity of lead, particularly in infants and young children, has led to a revision of blood lead levels which are considered to involve an acceptable level of human exposure. Drinking water guidelines have also been reviewed in order to reduce this source of population exposure to lead. In the last 20 years, guidelines have been reduced from 100 to 50 to 10 microg/litre. Lead in tap water used to be a major public health problem in Glasgow because of the high prevalence of houses with lead service pipes, the low pH of the public water supply and the resulting high levels of lead in water used for public consumption. Following two separate programmes of water treatment, involving the addition of lime and, a decade later, lime supplemented with orthophosphate, it is considered that maximal measures have been taken to reduce lead exposure by chemical treatment of the water supply. Any residual problem of public exposure would require large scale replacement of lead service pipes. In anticipation of the more stringent limits for lead in drinking water, we set out to measure current lead exposure from tap water in the population of Glasgow served by the Loch Katrine water supply, to compare the current situation with 12 years previously and to assess the public health implications of different limits. The study was based on mothers of young children since maternal blood lead concentrations and the domestic water that mothers use to prepare bottle feeds are the principal sources of foetal and infant lead exposure. An estimated 17% of mothers lived in households with tap water lead concentrations of 10 microg/litre (the [WHO,] guideline) or above in 1993 compared with 49% in 1981. Mean maternal blood lead concentrations fell by 69% in 12 years. For a given water lead concentration, maternal blood lead concentrations were 67% lower. The mean maternal blood lead concentration was 3.7 microg/litre in the population at large, compared with 3.3 microg/litre in households with negligible or absent tap water lead. Nevertheless, between 63% and 76% of cases of mothers with blood lead concentrations of 10 microg/dl or above were attributable to tap water lead. The study found that maternal blood lead concentrations were well within limits currently considered safe for human health. About 15% of infants may be exposed via bottle feeds to tap water lead concentrations that exceed the WHO guideline of 10 microg/litre. In the context of the health and social problems which affect the well-being and development of infants and children in Glasgow, however, current levels of lead exposure are considered to present a relatively minor health problem.

Lead levels in domestic water supplies and neural tube defects in Glasgow

OBJECTIVE

To study the association between "pregnancy" prevalence (affected births and terminations) of neural tube defects in postcode districts of Glasgow and lead concentrations in domestic water.

SETTING

Postcode districts of Glasgow supplied by water from the Loch Katrine reservoir.

DESIGN

An ecological study. Lead concentrations from 1911 randomly selected domestic water samples were obtained from the Glasgow 93 lead study. Neural tube defects (affected births and terminations) were identified from the Glasgow register of congenital anomalies for the period 1983-95 for each postcode district in the study population. Correlations were sought between lead concentrations and pregnancy prevalence of neural tube defects/1000 live births in postcode districts.

RESULTS

No correlation was found between domestic water lead concentrations > 10 microg/litre and pregnancy prevalence of neural tube defects within postcode districts. Areas of Glasgow previously with high domestic water lead concentrations did not have a higher prevalence of neural tube defects. Houses with the lowest domestic water lead concentrations were in Carstairs deprivation categories 1 (least deprived), 6, and 7 (most deprived). The highest pregnancy prevalence of neural tube defects was found in the most deprived areas.

CONCLUSION

Deprivation is a risk factor for neural tube defects and might have been a confounding factor in previous studies looking at the association between such defects and domestic water lead concentrations. This study does not support the hypothesis that levels of lead > 10 microg/litre in domestic water supplies are associated with a higher pregnancy prevalence of neural tube defects. The reasons behind the decline in pregnancy prevalence of neural tube defects seen in the past two decades remain unexplained.