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Can women safely eat fish while pregnant?

The American College of Obstetricians and Gynecologists (ACOG) issued a warning regarding eating fish in response to the US FDA's consumer advisory about the dangers of eating fish for nursing mothers and women who are or who may become pregnant. The fish themselves are not harmful, but extensive fish consumption increases exposure to the naturally occurring compound methylmercury, levels of which have been increasing in the waters because of industrial pollution. Mercury is very toxic and can cause danger to the fetus and to the newborn nursing infant. Mercury exposure can actually occur via inhalation and/or skin absorption, and all fish contain trace amounts. However, longer-lived and larger fish, such as shark, swordfish, king mackerel, and tilefish, have increased mercury levels and cause the most concern for consumption by pregnant women.

The FDA, as of March of 2004, therefore advises that pregnant or nursing women should not eat shark, swordfish, king mackerel, or tilefish. However, these women can safely eat 12 ounces per week of varieties of fish thought to be low in mercury if they eat a variety of cooked, smaller fish. The safest fish that are low in mercury are shrimp, canned light tuna, salmon, Pollock, and catfish. Specifically, the FDA states that albacore (white) tuna has more mercury than light tuna. So, pregnant women should eat only up to 6 ounces (one average meal) of albacore tuna per week. In addition, the Environmental Protection Agency (EPA) also recommends that pregnant women and young children limit their consumption of freshwater fish caught by family and friends to no more than one meal per week and to follow all local advisories as to fish safety. The EPA specifies no more than 8 ounces of uncooked fish per week for adults.

Fish is loaded with healthy omega 3 fatty acids which have been shown to be beneficial to the body in many ways, including cardiovascular health, mental health, brain growth and function (supplies DHA). For this reason we don't advise against eating fish - the benefits are tremendous. But limiting the large fish (King Mackerel, Swordfish, Shark, Tilefish) can help you avoid the mercury problem. Some good choices include trout, salmon, chunk light tuna, sardines and halibut.

Click post title to read about other pregnancy questions.

Vitamins and DHA

You may have heard that there is a wide variety of prenatal vitamins, both by prescription and over-the-counter. It can be overwhelming. The best prenatal vitamin for you will depend on several factors, such as any special health needs or how much you want to spend.

Is there a difference between various prenatal vitamins?

Click on the post title for a discussion on this topic. Of particular interest now is DHA which is an omega-3 fatty acid that appears to be important for brain, eye, and heart health. Some of the prenatal vitamins are adding this, sometimes in the form of a separate pill. This substance is sometimes lacking in the American diet so supplementing is a good idea.

Pregnancy-info.net says:

In the past decade or so, the importance of Omega 3 during pregnancy has been acknowledged. It is now known that Omega 3 actually plays a large role in the development and growth of your baby when it is in your uterus. Omega 3 helps to:

• build the brain
• form the retinas
• develop the nervous system

Omega 3 is also necessary for your own pregnancy health and well-being. Omega 3 helps to:

• reduce your chances of developing preeclampsia
• reduce your risk for postpartum depression
• minimize the chance of preterm labor

How can I get DHA (omega-3)?

You can add extra omega-3 rich foods to your diet (olive oil, avocados, walnuts, beans are good sources). Fish is an excellent source, but concerns about mercury in fish make women reluctant to eat much of this. It is recommended that you avoid Tile Fish, King Mackerel, Swordfish and Shark (large fish more likely to have mercury contamination from the ocean). Other fish such as salmon, tuna, shellfish, pollock, etc. can be eaten with recommendations of up to 12 ounces/week for pregnant moms. Locally caught fish and albacore tuna should be limited to 6 ounces/week. Click here for more information on food sources.

• You can take a fish oil softgel available in bulk at Costco, pharmacies, etc. If you add this to your regular, generic prenatal vitamin you are getting the same benefit as a designer vitamin costing many times what it is worth. Marine algae (what fish eat) is often used for making the DHA supplements. This is the reason the fish is rich in the nutrient. So, your supplement may be made from this algae. Nursing mothers should continue to take fish oil or other DHA if not eating enough omega-3 rich foods. The baby will benefit through the breast milk.
• You can pay extra for a prenatal vitamin that includes this, but if you have PEHP insurance, brand names are not covered due to high costs. A generic vitamin is sufficient and there should be a generic equivalent.
  
• You can buy a private-label brand which includes DHA at Walmart or other mass marketers.

We have been told that Coscto carries a generic chewable which must be written as Prenatal 19 chewable. This is an adult version of a chewable by prescription so you can get the benefit whereas the children's version (taking two) is OTC and you can't get these without a copay.
More information is available here. For fish consumption guidelines, click here.

Foods to Avoid

Are you confused by food warnings in pregnancy? It's not as restrictive as you may think but there are a few things that have potential for harm so it's good to avoid them. Here is a good overview of cautions and foods to avoid altogether in pregnancy. Some things that cause minimal problems for adults can be more dangerous for children and developing babies so it's good to be careful. (You can also click the post title)

Included is information on meat, fish, cheese, hotdogs, liver, artificial sweeteners, sprouts, and more. Of course alcohol should be avoided and caffeine limited. Common sense prevails here - and besides, it's only nine months! Breastfeeding is even less restrictive than pregnancy when it comes to foods.

Also notice our nutrition links on the right side bar - scroll down for lots of resources.