BusyMamaMD

How many times have you heard that you can’t have fish if you are pregnant?  As an obstetrician, I am confronted with that misconception on a daily basis.  Even my own sister was terrified to eat a bite of fish during her Caribbean (pre-Zika) vacation.  With the amount of restrictions placed on a pregnant woman, this inaccurate and unnecessary war on fish is just one more thing.  The United Stated Food and Drug Administration (FDA) and Environmental Protection Agency (EPA) have once again updated their recommendations regarding seafood consumption.  Bottom line: Eat it!  (Just not too much).

Pregnant women not only CAN eat fish, but SHOULD eat fish.  It is important for brain and eye development and has many other potential health benefits for a growing fetus.  Eating fish in moderation has been the recommendation from the American College of Obstetricians and Gynecologists (ACOG), FDA, and EPA for years, however many people seemed to be under the impression that these organizations have told women not to eat fish.

So how did this rumor get started?  Well, after studies revealed that VERY HIGH levels of mercury could cause problems with the fetal brain, the FDA in 2001 recommended that pregnant women limit their fish consumption(1).  Never was it recommended to stop eating fish, but many women interpreted it that way.  Some received their information from the media, seeing headlines like “Warning Sounded on Safety of Seafood” and “Pregnant Women Warned not to East Shark, Swordfish, Mackerel” (2-3).  Others received bad advice from their physicians.  ACOG published a document titled “Do Your Pregnant Patients Know about the Danger of Eating Fish?” (4) which scared a lot of obstetricians. Concerned about lawsuits and the possibility of mercury-induced problems, some obstetricians told their patients to avoid all fish.

While it is true that you can’t get mercury toxicity if you don’t eat fish, there are dangers to avoiding seafood.  It is the primary source for two important fatty acids, DHA and EPA.  Both are needed for your baby’s brain development!  Animal studies have shown that being low in DHA and EPA can lead to problems with vision, behavior issues, and cognitive problems (5).  Numerous research has shown associations between higher fish consumption and improved outcomes in infants and children including improved infant memory (6), better test scores in children (7), higher IQ’s (8-9), improved memory in children (10), and less ADHD (11).

So can’t I just take a vitamin with DHA in it?  Why do I need to eat fish?  Unfortunately, studies examining DHA supplements have not shown benefit (12).  That is not to say that it definitely is not helpful, however.  This just means that research thus far has not shown a benefit.  If a woman does choose to supplement with DHA, that is fine, but she still needs her natural DHA and EPA from fish!

Here are the 2017 recommendations from the FDA and EPA and endorsed by ACOG (13)

1. Eat two to three serving a week, or a total of 8-12 ounces of the following fish: Anchovy, Atlantic croaker, Atlantic mackerel, black sea bass, butterfish, catfish clam, cod, crab, crawfish, flounder, haddock, hake, herring, lobster, mullet, oyster, pacific chub mackerel, pickerel, plaice, Pollock, salmon, sardine, scallop, shad, shrimp, skate, smelt, sole, squid, tilapia, trout (freshwater), tuna (canned, light), whitefish, whiting

2. For the following fish, you may eat only 1 serving per week or no more than 6 ounces: Bluefish, buffalo fish, carp, Chilean sea bass, Patagonian toothfish, grouper, halibut, Mahi Mahi/dolphinfish, monkfish, rockfish, sablefish, sheepshead, snapper, Spanish mackerel, striped bass (ocean), tilefish (Atlantic Ocean), albacore tuna, white tuna, yellowfin tuna, weakfish/seatrout, white croaker/Pacific croaker

3. Avoid the following fish, which have high mercury concentrations:  King mackerel, marlin, orange roughy, shark, swordfish, tilefish (Gulf of Mexico), bigeye tuna

It is also recommended to check local advisories for mercury content if you are eating fish caught by friends or family.  If no advisories exist, you should limit your fish to one serving that week.

Want to get the most bang for your buck?  Opt for fish with the highest DHA content and the lowest mercury content.   Salmon tops the list at 2300-2400mg of EPA and DHA per 4 ounces (14).  Other good sources include Atlantic mackerel, anchovies, herring, freshwater trout, and

Want to get the most bang for your buck?  Opt for fish with the highest DHA content and the lowest mercury content.   Salmon tops the list at 2300-2400mg of EPA and DHA per 4 ounces (14).  Other good sources include Atlantic mackerel, anchovies, herring, freshwater trout, and oysters.  For a complete list of common seafood and their EPA/DHA content, go to https://health.gov/dietaryguidelines/dga2010/dietaryguidelines2010.pdf.

Now go out and enjoy that salmon!  Have a shrimp cocktail or a calamari appetizer.  Your baby will thank you!

References

1-Oken E.  Decline in fish consumption among pregnant women after a national mercury advisory.  Obstetric Gynecol; 2003: Aug 102 (2): 346-351.

2-Braile R. Warning sounded on safety of seafood. Vol. 11. Boston Globe; 2001. Mar, p. 1.

3. Reuters. Pregnant women warned not to eat shark, sword-fish, mackerel. Washington Post. 2001 Jan;12:A12.
4. Do your pregnant patients know about the dangers of eating fish? ACOG Today. 2001;45(9):5.

5-Brenna JT. Animal studies of the functional consequences of suboptimal polyunsaturated fatty acid status during pregnancy, lactation and early post-natal life. Matern Child Nutr 2011; 7 Suppl 2:59

6-Oken E, Wright RO, Kleinman KP, et al. Maternal fish consumption, hair mercury, and infant cognition in a U.S. Cohort. Environ Health Perspect 2005; 113:1376.

7- Oken E, Radesky JS, Wright RO, et al. Maternal fish intake during pregnancy, blood mercury levels, and child cognition at age 3 years in a US cohort. Am J Epidemiol 2008; 167:1171.’

8-Hibbeln JR, Davis JM, Steer C, et al. Maternal seafood consumption in pregnancy and neurodevelopmental outcomes in childhood (ALSPAC study): an observational cohort study. Lancet 2007; 369:578.

9-Gale CR, Robinson SM, Godfrey KM, et al. Oily fish intake during pregnancy–association with lower hyperactivity but not with higher full-scale IQ in offspring. J Child Psychol Psychiatry 2008; 49:1061.

10-Boucher O, Burden MJ, Muckle G, et al. Neurophysiologic and neurobehavioral evidence of beneficial effects of prenatal omega-3 fatty acid intake on memory function at school age. Am J Clin Nutr 2011; 93:1025.

11- Sagiv SK, Thurston SW, Bellinger DC, et al. Prenatal exposure to mercury and fish consumption during pregnancy and attention-deficit/hyperactivity disorder-related behavior in children. Arch Pediatr Adolesc Med 2012; 166:1123

12- Meldrum S, Dunstan JA, Foster JK, et al. Maternal fish oil supplementation in pregnancy: a 12 year follow-up of a randomised controlled trial. Nutrients 2015; 7:2061.

13ACOG Practice Advisory: Update on Seafood Consumption During Pregnancy.  http://www.acog.org/About-ACOG/News-Room/Practice-Advisories/ACOG-Practice-Advisory-Seafood-Consumption-During-Pregnancy#Figure 1a.

14U.S. Department of Agricultrue and U.S Department of Health and Human Services.  Dietary Guidelines for Americans, 2010, 7th Edition, Washington, DC: U.S. Government Printing Office, December 2010.  Available at: http://health.gov/dietaryguidelines/dga2010/dietaryguidelines2010.pdf (Accessed January 31, 2017)