Fish Consumption during Pregnancy in Relation to National Guidance in England in a Mixed-Methods Study: The PEAR Study

Abstract

Guidance on foods to limit or avoid in pregnancy is provided on the NHS website for England. Advice on fish consumption is related to exposure to mercury, dioxins and polychlorinated biphenyls, which may have adverse effects on fetal neurodevelopment. Our aim was to provide evidence on the effectiveness of the guidance in minimising exposure to toxins while maximising nutrient intake in a mixed-methods study. An online questionnaire on fish consumption before/during pregnancy was completed by postpartum women (≤12 months) in England (n = 598). A subsample of participants was invited to take part in an interview (n = 14). Women who ate fish before pregnancy reduced their intakes of both oily and white fish during pregnancy, with some avoiding it altogether. Women did not exceed the limit on tinned tuna, but there was evidence of mis-recall on the suggested limit. Overall intakes of fish were below that recommended during pregnancy (36% compliance for pre-pregnancy consumers). Barriers to fish consumption included risk aversion, confusion over specific details of the guidance, cost, availability, family preferences and smell/taste. Clarity and simplicity of the NHS guidance, with an overall message on the number of portions of fish a week advised prominently shown, would help pregnant women to benefit from the nutrients in fish while minimising exposure to toxins. The guidance on the number of cans of tuna advised per week is poorly recalled and needs to be disseminated accurately. The guidance on shark/marlin/swordfish could receive less prominence as it is rarely eaten by pregnant women in England.

Net effects explains the benefits to children from maternal fish consumption despite methylmercury in fish

“…Subsequent survey research by FDA also indicated that pregnant women were eating less fish than non-pregnant women of the same age (Lando et al, 2012). A similar reaction was reported in the United Kingdom in 2023 in response to precautionary consumption advice that emphasized types of fish to limit and avoid for safety (Beasant et al, 2023). Twentyseven percent of those surveyed ate fish less often during pregnancy and four percent stopped eating fish altogether.…”

Optimal omegas – barriers and novel methods to narrow omega-3 gaps. A narrative review

“…Amongst those consuming oily fish only 7.3% of children, 12.8% of teenagers, and 15.6% of young adults aged 20-29 years fell in line and met oily fish recommendations (30). A further analysis of survey data within this publication (data from 10 publications) found that EPA and DHA intakes were lower than guidelines, with children, teenagers, females, and pregnant women presenting some of the largest dietary gaps (30). The PEAR (31) study conducted with 598 women before/during pregnancy found that women who ate fish prior to pregnancy reduced their intakes of both oily and white fish during pregnancy, with some avoiding it altogether.…”

“…Given rising sustainability and toxicological concerns in the aquaculture sector research into possible alternative sources of O3LC-PUFAs has become a priority, to help plug the gap between supply and demand (42,88). Dietary intakes of O3LC-PUFAs largely remain to be insufficient in relation to the optimisation of health and cognitive outcomes (29,30,43). Historical evidence shows that fresh aquatic plants and seaweed were chewed such as red, green, and brown seaweeds and most likely consumed during Mesolithic and Neolithic time periods indicating that wild food resources were ingested before a switch to domesticated resources (93).…”

“…In the United Kingdom a secondary analysis of the National Diet and Nutrition Survey (NDNS), the country's largest cross-sectional dietary analysis, showed that only a quarter of the UK population were oily fish consumers -a predominant source of omega-3 fatty acids (30). Amongst those consuming oily fish only 7.3% of children, 12.8% of teenagers, and 15.6% of young adults aged 20-29 years fell in line and met oily fish recommendations (30).…”

“…In the United Kingdom a secondary analysis of the National Diet and Nutrition Survey (NDNS), the country's largest cross-sectional dietary analysis, showed that only a quarter of the UK population were oily fish consumers -a predominant source of omega-3 fatty acids (30). Amongst those consuming oily fish only 7.3% of children, 12.8% of teenagers, and 15.6% of young adults aged 20-29 years fell in line and met oily fish recommendations (30). A further analysis of survey data within this publication (data from 10 publications) found that EPA and DHA intakes were lower than guidelines, with children, teenagers, females, and pregnant women presenting some of the largest dietary gaps (30).…”