New Jersey Department of Health Expands Program for Lead and Mercury Screening in Pregnant People and Newborns

TRENTON, NJ - The New Jersey Department of Health (NJDOH) announces the expansion of its universal prenatal and newborn screening for lead and mercury program into Saint Peter's University Hospital in New Brunswick, NJ, with the goal of increasing access and improving health outcomes for pregnant people and newborns.

Universal prenatal screening provides an opportunity for mothers and health care providers to identify emergency cases of exposure that would otherwise go undiagnosed or untreated. This empowers mothers to be proactive in limiting lead and mercury exposure during pregnancy and facilitates interventions by health care providers to address disparities and improve health outcomes for women and newborns. It is important for mothers to limit exposure to these toxic metals, as it can lead to an array of health complications such as preeclampsia, kidney damage, endocrine disruption, and impaired motor function. In newborns, exposure can cause neurological damage, organ malformation, preterm birth, learning disabilities, lower IQ, behavioral disorders, and death.

Led by NJDOH's Public Health and Environmental Laboratories' New Jersey Biomonitoring Program, this expansion follows six years of successfully piloting the program at University Hospital in Newark. The program is being implemented at Saint Peter's University Hospital as part of its Quality Improvement Process. First, Saint Peter's and NJDOH will screen 1,000 patients for lead and mercury. The screening data will be used by NJDOH to assess the prevalence of heavy metal exposure in the prenatal population. Following the screening and data assessment period, the goal is for prenatal and newborn lead and mercury screening to become a standard of care at the hospital.

The screening program is a proactive addition to the current best practices for prenatal and newborn testing. University Hospital data show that there is a higher prevalence of lead (13%) and mercury (60%) in pregnancies at potentially harmful levels to newborns than gestational diabetes (8% nationally), preeclampsia (3% nationally), sexually transmitted diseases, and other conditions for which pregnancies and babies are currently screened (1:1,200 to 1:200,000). The need for increased access to universal heavy metal screening is especially critical for foreign-born mothers as their babies are at an increased risk of environmental exposure to potentially hazardous levels of lead and mercury.

"We are determined to improve health outcomes for New Jersey's moms and babies, and expanding access to prenatal and newborn screenings will help us lower the risk of lead or mercury poisoning through quick intervention," said First Lady Tammy Murphy. "This is a simple, but effective method to ensure New Jersey families are connected with timely support and treatment."

As part of Nurture NJ, the Murphy Administration included funding in the Fiscal Year 2024 budget for technology that supports the program's processes. The standard of care includes screening at a mother's first prenatal visit, follow-up screening for the mother and newborn at delivery, and providing patients with access to educational resourcesabout lead and mercury poisoning. The screening process entails drawing an additional teaspoon of blood used for testing. If screening results determine high lead or mercury levels, the patient will receive intervention and support from the hospital, the local departments of health, NJDOH's Childhood Lead program, NJDOH's Division of Consumer, Environmental and Occupational Health Services, NJ Department of Community Affairs, and the NJ Poison Control Center, as appropriate for the situation.

"It's more than just identifying the risks and dangers; it's about improving outcomes," said Acting Health Commissioner Jeff Brown. "Testing mothers during pregnancy and babies when they're born allows for the opportunity to provide guidance and treatment when it matters most. By taking actions to mitigate mothers' and newborns' risk of lead or mercury poisoning, health outcomes are changing for the better."

"We are very excited at the opportunity to participate in this extremely successful public health initiative and to help promote universal heavy metal screening for New Jersey mothers and infants in the near future," said Debra-Lynn Day-Salvatore, MD, PhD, FAAP, FACMGG, chair of the Department of Medical Genetics and Genomic Medicine at Saint Peter's University Hospital. "I am personally grateful for the enthusiastic support of our hospital administration and the departments of Pediatrics, Obstetrics and Gynecology, and Pathology for this project."

Since the program's inception at University Hospital in 2019, over 27,000 tests, including follow ups, have been conducted to identify the exposure level of lead and mercury in mothers and newborns. Data at University Hospital show that potentially harmful levels of lead and mercury are present in 13% and 60% of babies, respectively. It also supports that babies exposed to dangerous levels of lead or mercury are 75% more likely to be admitted to intensive care and six times more likely to have an abnormal newborn screening result. In one case from the pilot program, a baby was born with up to 90% less mercury than expected based on the mother's levels due to screening and early intervention.

"The program has a compliance rate of over 90% in both our ambulatory practice and intrapartum care at delivery," said Dr. Onajovwe Fofah, Medical Director of the Neonatal Intensive Care Unit and Newborn Services at University Hospital. "The multidisciplinary and multispecialty approach to care has led to early detection of exposed mothers, maternal education in multiple languages with reduction in the levels of the heavy metals, and treatment of exposed babies and developmental follow up of exposed newborn infants."

"We look forward to working with the Department of Health to expand the lead and mercury screening to New Brunswick and surrounding communities," said William J. Lowe III, MD, FACOG, vice chair, Department of Obstetrics and Gynecology, and medical director of the Mary V. O'Shea Birth Center and of Outpatient Quality and Informatics at Saint Peter's University Hospital. "It will be interesting to compare the data from the Newark and New Brunswick communities. This new information will increase our knowledge of the extent of the exposure as well as the response to education and treatment."

The program has been recognized at regional and national pediatric conferences, most recently at the 2025 American Academy of Pediatrics National conference in Denver, Colorado as a Top 10 Section on Neonatal-Perinatal Medicine abstract award. NJDOH is undertaking the expansion of this program to increase equity and access and improve pregnancy-related health outcomes to New Jerseyans. In the future, NJDOH is looking to expand this program to other hospitals and mobile care units.

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The New Jersey Department of Health is a nationally accredited health department working to ensure that all New Jerseyans live long, healthy lives and reach their fullest potential. With more than 5,500 employees, the Department serves to protect the public's health, promote healthy communities, and continue to improve the quality of health care in New Jersey.

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