Background.Pregnancy and breastfeeding mobilize lead stored in bone, which may be a hazard for the fetus and infant. We tested the hypothesis that in lactating women a dietary calcium supplement will lower blood lead levels.Methods.Between 1994 and 1995 we conducted a randomized trial among women in Mexico City. Lactating women (N = 617; mean age = 24 years; mean blood lead level = 8.5 ug/dL) were randomly assigned to receive either calcium carbonate (1200 mg of elemental calcium daily) or placebo in a double-blind trial. Blood samples were obtained at baseline, and 3 and 6 months after the trial began. Blood lead was determined by graphite furnace atomic absorption spectroscopy. Bone lead was measured at baseline with a 109cd K x-ray fluorescence instrument. The primary endpoint was change in maternal blood lead level, which was analyzed in relation to supplement use and other covariates by multivariate generalized linear models for longitudinal observations.Results.An intention-to-treat analysis showed that women randomized to the calcium supplements experienced a small decline in blood lead levels (overall reduction of 0.29 ug/dL; 95% confidence interval = −0.85 to 0.26). The effect was more apparent among women who were compliant with supplement use and had high bone lead levels (patella bone lead ≥5 &mgr;g/gm bone). Among this subgroup, supplement use was associated with an estimated reduction in mean blood lead of 1.16 ug/dL (95% confidence interval = −2.08 to −0.23), an overall reduction of 16.4%.Conclusions.Among lactating women with relatively high lead burden, calcium supplementation was associated with a modest reduction in blood lead levels.