Scientific foundations of fish-consumption advice for pregnant women: Epidemiological evidence, benefit-risk modeling, and an integrated approach

PurposeThe Caribbean Consortium for Research in Environmental and Occupational Health prospective environmental epidemiologic cohort study addresses the impact of chemical and non-chemical environmental exposures on mother/child dyads in Suriname. The study determines associations between levels of environmental elements and toxicants in pregnant women, and birth outcomes and neurodevelopment in their children.ParticipantsPregnant women (N=1143) were enrolled from December 2016 to July 2019 from three regions of Suriname: Paramaribo (N=738), Nickerie (N=204) and the tropical rainforest interior (N=201). Infants (N=992) were enrolled at birth. Follow-up will take place until children are 48 months old.Findings to dateBiospecimens and questionnaire data on physiological and psychosocial health in pregnant women have been analysed. 39.1% had hair mercury (Hg) levels exceeding values considered safe by international standards. Median hair Hg concentrations in women from Paramaribo (N=522) were 0.64 µg/g hair (IQRs 0.36–1.09; range 0.00–7.12), from Nickerie (N=176) 0.73 µg/g (IQR 0.45–1.05; range 0.00–5.79) and the interior (N=178) 3.48 µg/g (IQR 1.92–7.39; range 0.38–18.20). 96.1% of women ate fish, respective consumption of the three most consumed carnivorous species, Hoplias aimara, Serrasalmus rhombeus and Cichla ocellaris, known to have high Hg levels, was 44.4%, 19.3% and 26.3%, respectively, and was greater among the interior subcohort. 89% frequently consumed the vegetable tannia, samples of which showed presence of worldwide banned pesticides. 24.9% of pregnant women had Edinburgh Depression Scale scores indicative of probable depression.Future plansFish consumption advisories are in development, especially relevant to interior women for whom fish consumption is likely to be the primary source of Hg exposure. Effects of potentially beneficial neuroprotective factors in fish that may counter neurotoxic effects of Hg are being examined. A pesticide literacy assessment in pregnant women is in progress. Neurodevelopmental assessments and telomere length measurements of the children to evaluate long-term effects of prenatal exposures to toxicant mixtures are ongoing.

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Mercury interactions with selenium and sulfur and the relevance of the Se:Hg molar ratio to fish consumption advice

Environmental Science and Pollution Research ◽

10.1007/s11356-021-12361-7 ◽

2021 ◽

Author(s):

Michael Gochfeld ◽

Joanna Burger

Keyword(s):

Fish Consumption ◽

Molar Ratio ◽

Se:Hg Molar Ratio ◽

Consumption Advice

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Relationship between methylmercury and DHA in pregnant women and fetuses: The risks and benefits of fish consumption

Toxicology Letters ◽

10.1016/j.toxlet.2010.03.165 ◽

2010 ◽

Vol 196 ◽

pp. S38

Author(s):

M. Sakamoto ◽

K. Murata ◽

S. Kawakami ◽

J. Domingo ◽

K. Nakai ◽

...

Keyword(s):

Pregnant Women ◽

Fish Consumption ◽

Risks And Benefits

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A review of guidance on fish consumption in pregnancy: is it fit for purpose?

Public Health Nutrition ◽

10.1017/s1368980018000599 ◽

2018 ◽

Vol 21 (11) ◽

pp. 2149-2159 ◽

Cited By ~ 11

Author(s):

Caroline M Taylor ◽

Pauline M Emmett ◽

Alan M Emond ◽

Jean Golding

Keyword(s):

Pregnant Women ◽

Fish Consumption ◽

Evidence Base ◽

Positive Contribution ◽

National Guidelines ◽

International Guidelines ◽

Beneficial Effects ◽

Use Of Technology ◽

The Impact ◽

In Pregnancy

AbstractObjectivePublic health messages to reduce Hg exposure for pregnant women have focused exclusively on advice on fish consumption to limit Hg exposure, with little account being taken of the positive contribution of fish to nutritional quality. The aim of the present review was to compare and contrast the content and presentation of national guidelines on fish consumption in pregnancy, and comment on their evidence base and impact on consumption.DesignWe searched for national and international guidelines on fish consumption in pregnancy using Internet search strategies. The detailed content and style of presentation of the guidelines were compared. The evidence base for the guidelines, and evidence for the impact of the guidelines on fish consumption levels, were assessed.ResultsWe identified nineteen national guidelines and three international guidelines. There was great variation in the content, complexity and presentation style. The guidelines were based largely on the Hg content of fish with far less consideration being given to the positive beneficial effects of nutrients provided by fish. The complexity of the guidelines may lead to pregnant women reducing their fish intake, or not eating fish at all.ConclusionsGuidelines on fish consumption in pregnancy should take the beneficial effects of fish into account. Guidelines need to be clear and memorable, and appropriately disseminated, to achieve impact. Guidelines could include visual rather than narrative content. Use of technology, for example apps, could enable women to record their fish consumption in real time and log compliance with guidance over a week or other time period.

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Contribution of fish to intakes of micronutrients important for fetal development: a dietary survey of pregnant women in the Republic of Seychelles

Public Health Nutrition ◽

10.1017/s136898000800387x ◽

2009 ◽

Vol 12 (9) ◽

pp. 1312-1320 ◽

Cited By ~ 24

Author(s):

Maxine P Bonham ◽

Emeir M Duffy ◽

Paula J Robson ◽

Julie M Wallace ◽

Gary J Myers ◽

...

Keyword(s):

Pregnant Women ◽

Fish Consumption ◽

Fetal Development ◽

Antenatal Clinic ◽

Dietary Analysis ◽

Public Health Policies ◽

Micronutrient Status ◽

Diet Diary ◽

The Republic ◽

Child Development Centre

AbstractObjectivesTo characterise the diets of pregnant women in the Republic of Seychelles and to determine the contribution of fish to intakes of nutrients important for fetal and neonatal development.DesignObservational, prospective study.SettingSeychelles Child Development Centre, Mahé, Republic of Seychelles.Subjects and methodsPregnant women (n 300) were recruited at their first visit to an antenatal clinic. At 28 weeks’ gestation subjects completed a 4 d diet diary (n 273) and intakes were analysed using dietary analysis software.ResultsMean (sd) energy intake was 9·0 (2·5) MJ/d and fat intakes were higher than UK recommendations for almost two-thirds of the cohort. Fish consumption was lower than in previous surveys, suggesting a move towards a more Westernised diet. Low intakes of a number of nutrients important during pregnancy for fetal development (Fe, Zn, Se and iodine) were observed. However, women who met the current recommendations for these nutrients consumed significantly more fish than those who did not (97 v. 73 g/d).ConclusionsThe present study highlights the importance of fish in the diet of pregnant Seychellois women for ensuring adequate intakes of micronutrients important in fetal development. Dietary patterns in Seychelles, however, are in a state of transition, with a move towards a Western-style diet as evidenced by higher fat and lower fish intakes. If these dietary trends continue and fish consumption declines further, micronutrient status may be compromised. These findings suggest caution in establishing public health policies that promote limitation of fish intake during pregnancy.

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