Elsevier

The Lancet

Volume 369, Issue 9561, 17–23 February 2007, Pages 578-585
The Lancet

Articles
Maternal seafood consumption in pregnancy and neurodevelopmental outcomes in childhood (ALSPAC study): an observational cohort study

https://doi.org/10.1016/S0140-6736(07)60277-3 Get rights and content

Summary

Background

Seafood is the predominant source of omega-3 fatty acids, which are essential for optimum neural development. However, in the USA, women are advised to limit their seafood intake during pregnancy to 340 g per week. We used the Avon Longitudinal Study of Parents and Children (ALSPAC) to assess the possible benefits and hazards to a child's development of different levels of maternal seafood intake during pregnancy.

Methods

11 875 pregnant women completed a food frequency questionnaire assessing seafood consumption at 32 weeks' gestation. Multivariable logistic regression models including 28 potential confounders assessing social disadvantage, perinatal, and dietary items were used to compare developmental, behavioural, and cognitive outcomes of the children from age 6 months to 8 years in women consuming none, some (1–340 g per week), and >340 g per week.

Findings

After adjustment, maternal seafood intake during pregnancy of less than 340 g per week was associated with increased risk of their children being in the lowest quartile for verbal intelligence quotient (IQ) (no seafood consumption, odds ratio [OR] 1·48, 95% CI 1·16–1·90; some, 1·09, 0·92–1·29; overall trend, p=0·004), compared with mothers who consumed more than 340 g per week. Low maternal seafood intake was also associated with increased risk of suboptimum outcomes for prosocial behaviour, fine motor, communication, and social development scores. For each outcome measure, the lower the intake of seafood during pregnancy, the higher the risk of suboptimum developmental outcome.

Interpretation

Maternal seafood consumption of less than 340 g per week in pregnancy did not protect children from adverse outcomes; rather, we recorded beneficial effects on child development with maternal seafood intakes of more than 340 g per week, suggesting that advice to limit seafood consumption could actually be detrimental. These results show that risks from the loss of nutrients were greater than the risks of harm from exposure to trace contaminants in 340 g seafood eaten weekly.

Introduction

Optimum fetal neurodevelopment is dependent on specific nutrients derived solely from dietary sources, including docosahexaenoic acid (DHA), an omega-3 essential fatty acid, of which seafood is a major source.1 Low seafood intake during pregnancy could lead to fetal deficiency in essential long-chain omega-3 fatty acids such as DHA and eicosapentaenoic acid, (EPA) resulting in adverse effects on neurodevelopment.2 DHA deficiency leads to reduced dendritic arborisation3 and impaired gene expression for regulation of neurogenesis, neurotransmission, and connectivity.4 In severe conditions of DHA deprivation, such as Zellweger disease and peroxisomal disorders, mental retardation is common, yet restoration of dietary DHA intake improves clinical outcomes and neuronal myelination.5, 6, 7

In 2004, advice8 was issued jointly by two US Federal Government agencies for pregnant women or women likely to become pregnant to restrict their overall consumption of seafood to 340 g per week,8 to avoid fetal exposure to trace amounts of neurotoxins. However, such control of seafood consumption could cause intake of long-chain omega-3 fatty acids to fall below quantities adequate for best fetal neurodevelopment.9, 10 We analysed an observational cohort study, the Avon Longitudinal Study of Parents and Children (ALSPAC), to assess whether the advice is successful in providing protection from adverse neurodevelopmental outcomes.

Section snippets

Methods

ALSPAC was designed to assess environmental factors (including diet) during and after pregnancy that might affect the development, health, or wellbeing of the child. All pregnant women living in Bristol, UK, and surrounding areas, with an expected delivery date between April 1, 1991 and Dec 31, 1992 were eligible for inclusion.11 Of 14 541 pregnancies, 13 988 children survived for at least 12 months. About 85% of eligible expectant mothers participated; recruitment, dropout, and other

Results

Maternal seafood consumption ranged from 0 to 3268 g per week (mean 235 g per week, SD 202), resulting in estimated intakes of omega-3 fatty acids from seafood ranging from 0 to 15·6 g per week, (mean 1·06 g per week, SD 1·05). In total 12% of women were eating no fish during pregnancy, 65% 1–340 g per week, and 23% more than 340 g per week.

As shown in table 1, low seafood consumption by mothers was more likely in homes with evidence of social disadvantage (high level of family adversity,

Discussion

The information obtained in ALSPAC shows no evidence that consumption of more than three portions of seafood a week during pregnancy has an adverse effect on the behaviour or development of the child. By contrast, maternal consumption of more than 340 g seafood a week was beneficial for the child's neurodevelopment. These results were unexpected since the 2004 advisory8 was formulated on the basis of an assessment of development in the verbal domain, the Boston naming test.29 The relevant

References (42)

  • F Calderon et al.

    Docosahexaenoic acid promotes neurite growth in hippocampal neurons

    J Neurochem

    (2004)
  • CV Rojas et al.

    Gene expression analysis in human fetal retinal explants treated with docosahexaenoic acid

    Invest Ophthalmol Vis Sci

    (2003)
  • NV Eldho et al.

    Polyunsaturated docosahexaenoic vs docosapentaenoic acid-differences in lipid matrix properties from the loss of one double bond

    J Am Chem Soc

    (2003)
  • M Martinez

    Restoring the DHA levels in the brains of Zellweger patients

    J Mol Neurosci

    (2001)
  • What you need to know about mercury in fish and shellfish 2004 EPA and FDA advice for: women who might become pregnant women who are pregnant nursing mothers young children. Washington, DC, 2004. Report number EPA-823-R-04-005

  • Fats and oils in human nutrition. Report of a joint expert consultation. Food and Agriculture Organization of the United Nations and the World Health Organization

    FAO Food Nutr Pap

    (1994)
  • AP Simopoulos et al.

    Workshop on the essentiality of and recommended dietary intakes for omega-6 and omega-3 fatty acids

    J Am Coll Nutr

    (1999)
  • J Golding et al.

    ALSPAC: the Avon Longitudinal Study of Parents and Children. I. Study methodology

    Paediatr Perinat Epidemiol

    (2001)
  • I Rogers et al.

    Diet during pregnancy in a population of pregnant women in South West England. ALSPAC Study Team. Avon Longitudinal Study of Pregnancy and Childhood

    Eur J Clin Nutr

    (1998)
  • Fatty acids supplement to McCance and Widdowson's the composition of foods

    (1998)
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