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However, there is evidence that there are subtle effects even at lower levelsSymptoms include weight loss, anemia, stomach cramps (lead colic), a bluish black line at the edge of the gums, and constipation. Other symptoms may be mental depression and, in children, irritability and convulsions. In addition to the poisoning, the anemia and weight loss must also be treated, usually by providing an adequate diet.

The domains of interest addressed in the survey questionnaire included: seeking prenatal care (barriers and facilitators, including women’s experience with the newly implemented Medicaid managed care eligibility process), receiving prenatal care (experience and perceptions), acculturation, social support, health behaviors during pregnancy (including substance use and abuse),slimming nursing tank, border market purchasing practices, domestic violence, family planning practices and intentions, future health care intentions (for mother and infant), and crossing the border for health care services (present pregnancy and future intentions).The full details of the process used in the translation, linguistic adaptation, and assurance of cultural relevance, appropriateness, and psychometric properties of this tool are published elsewhere.35 Briefly, content validity of the instrument was confirmed by linking to the published literature and by receiving affirmation of the relevance of all survey items from a panel of perinatal experts. A certified translator crafted the English to Spanish form. Another individual who was also an expert in obstetrical terminology amended the Spanish form as necessary, and then backtranslated to the English language.