The Yugoslavia Prospective Study of environmental lead exposure

The Yugoslavia Prospective Study of environmental lead exposure has studied the associations between exposure to lead and pregnancy outcomes; childhoo d neuropsychological, behavioral, and physical development; and hematologic , renal, and cardiovascular function. The cohort comprises 577 children bor n to women recruited at midpregnancy in two towns in Kosovo, Yugoslavia; on e town is the site of a lead smelter, refinery, and battery plant and the o ther is 25 miles away and relatively unexposed. A sample of these children has been followed at 6-month intervals through 7.5 years of age. Blood lead concentrations ranged from 1 to 70 mu g/dl. Exposure to lead was not assoc iated with adverse pregnancy outcomes. Exposure was associated with modest decrements in intelligence, small increases in blood pressure, higher risks of proteinuria, small increases in behavior problems, and perturbed hemato poiesis. Only at low level exposures (i.e., <16 mu g/dl) were small associa tions with decreased height found. We discuss methodological problems that may hinder causal interpretation of these data, namely, use of blood lead c oncentration as an exposure measure, confounding, and town-specific associa tions. We conclude that while reported associations are small, collectively they lend support to the notion that lead is a toxicant with numerous adve rse health effects.