Role of Omega-3 Fatty Acids in Maternal, Fetal, Infant and Child Wellbeing

Ellen Mozurkewich; Deborah R Berman; Julie Chilimigras

Disclosures

Expert Rev of Obstet Gynecol. 2010;5(1):125-138. 

In This Article

Advice to Pregnant Women

Although per capita fish consumption in the USA falls in the mid-range on cross-national studies, pregnant women may consume less seafood than the general population because of fear of environmental contaminants.[25,26] Despite the potential benefits of dietary sources of EPA and DHA, dietary fish consumption exposes pregnant mothers to industrial contaminants, namely methyl mercury and polychlorinated biphenyls. In the late 1960s, following widespread inorganic mercury contamination of the Shiranui Sea in Japan, maternal exposure to very high mercury levels in fish was recognized to be the cause of Minamata disease, resulting in mental retardation in exposed offspring.[27,28] Subsequent epidemiologic studies of populations, such as Seychelle and Faroe islanders, with high dietary intake of fish from waters with more moderate mercury contamination have yielded mixed results. Some, but not all, studies of children born to mothers with high fish consumption have suggested that lower levels of mercury may be associated with subtle adverse developmental consequences.[29,30] Prenatal exposures to polychlorinated biphenyls through fish has also been found to be associated with adverse developmental effects.[31] The DHA and EPA content of dietary fish and shellfish, as well as levels of industrial contaminants, are listed in Table 1.

The risk–benefit analysis of dietary fish consumption during pregnancy is consequently a matter of some controversy. Pregnant women receive conflicting advice regarding the desirability of dietary fish consumption from the US FDA, who advises limiting prenatal fish intake to a maximum of two fish meals per week from species low in mercury, including shrimp, canned light tuna, salmon, pollock and catfish,[201] and from advocacy groups, such as the Healthy Mothers Healthy Babies Coalition, who recommend greater prenatal fish consumption.[202] Owing to the uncertain trade-offs of the benefits of fish consumption versus industrial contaminants, some authorities have advised supplementation with highly purified fish oil during pregnancy.[32] However, some benefits of dietary fish may not be replicated by supplements.[33] This review aims to identify the best evidence on the benefits and risks of eating fish and the possible role of omega-3 fatty acid supplementation during pregnancy and lactation in maternal and child health and development.

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