What to Expect When You’re Expecting (Lead): Unmasking the Science and the New Policy Protecting Black Maternal Health

By: Deandrah Cameron, MPH, Backbone staff; Elyse Pivnick, MCP, Lead-Free NJ Health Committee Co-Chair; and Sheila Caldwell, RN, Lead-Free NJ Health Committee Co-Chair

As we observe Black Maternal Health Week and acknowledge the urgent need for maternal health equity, we must spread awareness of how lead impacts the pregnant body and a landmark policy update, P.L.2025, c.193, that improves lead screening for pregnant people in New Jersey.

Lead exposure remains a threat that lingers in the very bones of expecting parents. Lead is a neurotoxin and remains a “hidden danger” that disproportionately impacts Black pregnant and lactating persons. We often discuss lead as a challenge of the past or a risk confined to early childhood, but the biological reality of pregnancy can “unmask” old exposures, turning a person’s own system into a source of toxicity for their developing child.

The Biological Imposter: How Lead Mimics Calcium

To understand why lead poses such a persistent threat, we must examine its role as a “biological imposter”. Lead is an electropositive heavy metal that mimics essential minerals, most notably calcium. Because the body cannot easily distinguish between the two, it absorbs lead and stores it in mineralized tissue, such as bones. In fact, over 95% of a person’s total lead load is stored in the skeleton, where it can remain for several decades (Riess & Halm, 2007).

During development, the fetus requires calcium to build its skeletal system. To meet this high demand, the pregnant person’s body undergoes bone resorption. The process of breaking down mineralized tissue to release calcium into the bloodstream. If lead has been stored in those bones from exposures years or even decades prior, it is mobilized and redistributed back into the blood along with the calcium.

When lead enters the bloodstream, lead crosses the placenta as early as 12 weeks of gestation. At this stage, the lead levels in the parent and the baby can become virtually identical or even higher. Lead exposure during pregnancy is linked to miscarriage, stillbirth, preterm delivery, and low birth weight. Additionally, the developing fetal brain lacks a sufficient barrier to protect against neurotoxins, meaning even low levels of lead can cause permanent neurodevelopmental issues, behavioral problems, and learning challenges later in life. One alarming case report highlights the severity: a woman with no new lead exposure in seven years saw her blood lead levels nearly triple during her pregnancy because of this internal skeletal mobilization (Riess & Halm, 2007).

A Crisis of Equity

This lead crisis is not just a medical issue; it is a crisis of equity. In 2023, Black/African American infants had a mortality rate 95% higher than that of infants nationwide, and were approximately 2.5 times more likely to die from complications related to being born too early or low birth weight. These outcomes are a haunting mirror to the known risks of lead exposure, which include low birth weight and preterm delivery. Furthermore, Black/African American mothers were 49% more likely than mothers nationwide to receive late or no prenatal care (U.S. Department of Health and Human Services, 2026). This lack of consistent healthcare access, compounded by systemic environmental burdens, means that lead exposure, which is often asymptomatic, frequently goes undetected until permanent damage has occurred. Black pregnant and lactating persons are disproportionately affected by lead poisoning as they are more likely to live in older housing with deteriorating lead-based paint, increasing the risk of exposure to contaminated dust and soil. Recognizing lead as a critical, yet overlooked, factor in these maternal health disparities is the first step toward unmasking and dismantling the inequities that continue to claim the lives of Black mothers and babies.

New Jersey Law  P.L.2025, c.193

Until recently, pregnant people in New Jersey were not typically tested for lead. However, a major policy update has arrived to change that. New Jersey Assembly Bill No. 4848, recently advanced in the legislature, improves lead screening for pregnant people, which should increase testing.

This legislation mandates that licensed healthcare professionals, including physicians, certified nurse-midwives, and physician assistants, assess every pregnant person for risk factors for lead exposure. If risk factors are identified in accordance with the latest Centers for Disease Control and Prevention (CDC) and American College of Obstetricians and Gynecologists (ACOG) guidelines, testing is required.

This bill is a critical victory for public health and maternal equity because it ensures that:

• Patients are Informed: If an elevated lead level is found, providers must notify the patient in writing and provide a plain-language explanation of the dangers.
• Households are Protected: The law requires providers to ensure that any other children or household members under age six are screened, 
• Care is Coordinated: Laboratory results must be reported to the Department of Health and local health departments within five business days to ensure a rapid public health response.

Suggested Action and Advocacy: What You Can Do

While this policy is a landmark achievement, the work to protect our communities is ongoing. We must move from awareness to active prevention.

For Pregnant and Expecting Individuals:

• Prioritize Screening: Do not assume you are being tested. Ask your doctor or midwife to assess your risk factors for lead exposure under the new guidelines. The docket app allows you to view and access medical records like your test results 
• Prioritize Calcium: Adequate calcium intake (approximately 1,200 mg per day) is essential. Sufficient calcium can help limit the mobilization of lead from your bones, protecting both you and your baby.
• Assess Your Home: Be vigilant about deteriorating paint, lead in drinking water, and contaminated soil.

For Advocates and Policymakers: Continue to advocate for universal lead screening during pregnancy so that no parent is left behind. We must also advocate for increased funding for holistic lead remediation in housing, water, and soil, the only way to truly break the cycle of exposure.

Organizations like Lead-Free NJ are already doing this work by amplifying community voices and driving collective action. New Jersey Future, Clean Water Action, Waterspirit, Housing Community Development Network of New Jersey, Isles, Green & Healthy Homes Initiative, and Trenton Health Team, along with their staff, facilitate the collaborative’s work. The collective impact of community organizers, stakeholders, and industry experts drives efforts to address lead contamination through equitable policy change, holistic remediation, and community empowerment. 

By utilizing grassroots community hubs in Paterson, Orange, and Trenton, the network ensures its policy solutions are grounded in the lived experiences of those most impacted. The collaborative seeks to ensure all residents can thrive by advocating for increased state funding, stronger housing safety regulations, and the provision of accessible multilingual resources for lead education, testing, and treatment.

Blog Authors: Pictured left to right: Deandrah Cameron, MPH., Elyse Pivnick, MCP., and Sheila Caldwell, RN.References:

Riess, M. L., & Halm, J. K. (2007). Lead poisoning in an adult: lead mobilization by pregnancy?. Journal of general internal medicine, 22(8), 1212–1215. https://doi.org/10.1007/s11606-007-0253-x

Get involved: Join Lead-Free NJ today. Become a member, sign up for our newsletter, our contact [email protected]

Lead-Free NJ is a statewide collaborative dedicated to lead poisoning prevention in New Jersey through holistic lead remediation, equitable policy change, and empowered communities. The collaborative centers community hubs, which are local grassroots organizations that advance and define the collaborative’s goals while organizing for solutions in their local communities. Lead-Free NJ also has policy-focused committees working on housing, water, and health.