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Fish consumption and omega-3 long-chain polyunsaturated fatty acid supplementation during pregnancy

Author
Emily Oken, MD, MPH
Section Editor
Susan M Ramin, MD
Deputy Editor
Vanessa A Barss, MD, FACOG

INTRODUCTION

Fish, including finfish and other seafood, is a healthful food that is low in saturated fat and high in protein. It is the primary dietary source for two n-3 (also called omega-3) long chain polyunsaturated fatty acids (n-3 LCPUFA): docosahexaenoic acid (DHA) and eicosapentaenoic acid (EPA), which are also available in fish oil supplements. DHA is of particular interest to obstetrical and pediatric providers because of its role in early brain development (see "n-3 long-chain polyunsaturated fatty acids (LCPUFA) for preterm and term infants", section on 'Metabolism and function'). Fish and fish oil consumption likely confers modest protection against preterm birth and, in turn, delivery of low birth weight newborns [1-4]. In addition, both DHA and EPA modulate several biologic pathways, and thus may reduce the risk of gestational diabetes, preeclampsia, and development of atopic disease in offspring [5]; however, these potential benefits remain unproven.

However, fish also may be contaminated by environmental pollutants, such as methylmercury, which have adverse fetal effects [6]. In the United States, any seafood consumption in the last 30 days is the most significant predictor of higher blood mercury concentrations in pregnant and nonpregnant women [7]. Because of the health risks associated with methylmercury, the US Food and Drug Administration (FDA) and the United States Environmental Protection Agency (EPA) have recommended that women of childbearing age, pregnant women, and breastfeeding mothers limit their intake of fish, and avoid all consumption of some types of fish (table 1) [8,9]. The United Kingdom has proposed similar guidelines [10,11].

This topic will discuss potential obstetrical and fetal/infant benefits and risks of maternal fish consumption during pregnancy. Issues related to the health effects of fish and fish oil consumption in the general population, as well as fish oil dosing and preparations, are reviewed separately. (See "Fish oil and marine omega-3 fatty acids".) Dietary n-3 LCPUFA supplementation for breast- and formula-fed infants is also reviewed separately. (See "n-3 long-chain polyunsaturated fatty acids (LCPUFA) for preterm and term infants".)

POTENTIAL OUTCOMES

Pregnant and breastfeeding women are encouraged to consume fish because it is a healthful food and a major source of docosahexaenoic acid (DHA), which is important for normal development of the retina and brain and, in turn, normal fetal and infant visual and cognitive function. DHA is preferentially incorporated into the rapidly developing brain during the third trimester of pregnancy and the first two years of infancy, concentrating in brain gray-matter and retinal membranes [12-14]. Fish is an excellent source of DHA, but it is also available in fish oil supplements and fortified foods. Infants can convert the shorter-chain n-3 fatty acids found in nuts and seeds to DHA to a greater extent than adults, but it is not known whether such conversion is adequate for the developing brain in the absence of maternal DHA intake [15-17].

Although there is evidence that fish and/or fish oil intake is associated with modest reductions in risk of preterm delivery, potential benefits with respect to reduction in other adverse outcomes, such as gestational diabetes, preeclampsia, and development of atopic disease in offspring, are more controversial. (See 'Other outcomes' below.)  

               

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