A qualitative study of fish consumption during pregnancy

Department of Population Medicine, Harvard Medical School and the Harvard Pilgrim Health Care Institute, Boston, MA 02215, USA.
American Journal of Clinical Nutrition (Impact Factor: 6.77). 11/2010; 92(5):1234-40. DOI: 10.3945/ajcn.2010.30070
Source: PubMed


Many pregnant women in the United States do not consume enough docosahexaenoic acid (DHA)--an essential nutrient found in fish. Apparently conflicting findings that fish consumption is beneficial for the developing fetus, yet potentially toxic because of mercury contamination, have created uncertainty about the appropriate fish-consumption advice to provide to pregnant women.
Our objective was to determine knowledge, behaviors, and received advice regarding fish consumption among pregnant women who are infrequent consumers of fish.
In 2009-2010 we conducted 5 focus groups with 22 pregnant women from the Boston area who ate <2 fish servings/wk. We analyzed transcripts by using immersion-crystallization.
Many women knew that fish might contain mercury, a neurotoxin, and had received advice to limit fish intake. Fewer women knew that fish contains DHA or what the function of DHA is. None of the women had received advice to eat fish, and most had not received information about which fish types contain more DHA or less mercury. Because of advice to limit fish intake, as well as a lack of information about which fish types they should be eating, many of the women said that they would rather avoid fish than possibly harm themselves or their infants. The participants thought that a physician's advice to eat fish and a readily available reference regarding which fish are safe to consume during pregnancy would likely have encouraged them to eat more fish.
Pregnant women might be willing to eat more fish if this were advised by their obstetricians or if they had an accessible reference regarding which types are safe.

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    • "We encouraged women to give the second copy to a partner or other family member who purchased food. We prepared these materials based on our preliminary qualitative research [28], targeted at a 5th grade reading level, and pilot tested them prior to use with Boston-area pregnant women not enrolled in the trial. "
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    ABSTRACT: Nutritionists advise pregnant women to eat fish to obtain adequate docosahexaenoic acid (DHA), an essential nutrient important for optimal brain development. However, concern exists that this advice will lead to excess intake of methylmercury, a developmental neurotoxicant. Conduct a pilot intervention to increase consumption of high-DHA, low-mercury fish in pregnancy. In April-October 2010 we recruited 61 women in the greater Boston, MA area at 12–22 weeks gestation who consumed <=2 fish servings/month, and obtained outcome data from 55. We randomized participants to 3 arms: Advice to consume low-mercury/high-DHA fish (n=18); Advice + grocery store gift cards (GC) to purchase fish (n=17); or Control messages (n=20). At baseline and 12-week follow-up we estimated intake of fish, DHA and mercury using a 1-month fish intake food frequency questionnaire, and measured plasma DHA and blood and hair total mercury. Baseline characteristics and mean (range) intakes of fish [21 (0–125) g/day] and DHA from fish [91 (0–554) mg/d] were similar in all 3 arms. From baseline to follow-up, intake of fish [Advice: 12 g/day (95% CI: -5, 29), Advice+GC: 22 g/day (5, 39)] and DHA [Advice: 70 mg/d (3, 137), Advice+GC: 161 mg/d (93, 229)] increased in both intervention groups, compared with controls. At follow-up, no control women consumed >= 200mg/d of DHA from fish, compared with 33% in the Advice arm (p=0.005) and 53% in the Advice+GC arm (p=0.0002). We did not detect any differences in mercury intake or in biomarker levels of mercury and DHA between groups. An educational intervention increased consumption of fish and DHA but not mercury. Future studies are needed to determine intervention effects on pregnancy and childhood health outcomes. Trial registration Registered on as NCT01126762
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    • "). These changes were welcome because many consumers may have been more aware of the content and effect of harmful substances in fish than of the nutrients (Bloomingdale et al. 2010; Verbeke et al. 2005). "
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