Periconceptional Seafood Intake and Fetal Growth

Fish consumption benefits and PFAS risks: Epidemiology and public health recommendations

Finfish and shellfish intake (collectively referred to as fish) has been associated with health benefits, although fish often have chemical contaminants that are separately associated with health risks. The presence of chemical contaminants, however, does not inherently pose a health risk and optimizing the benefits is desirable for individual and population health. Reference doses (RfDs) and other comparison values that estimate contaminant or pollutant safety thresholds typically do not account for the benefits of the foods that carry them (e.g., fish, eggs, fruit, vegetables). Rather, these numbers are typically applied uniformly for various media such as food, soil, and water. This paper summarizes principal epidemiology studies on per- and polyfluoroalkyl substances (PFAS)-associated noncancer health indicators used by the United States Environmental Protection Agency (EPA) to develop RfDs for PFAS and compares these with the same health outcomes associated with seafood intake. Moreover, it frames these findings in relation to varying human PFAS exposures, fish intake amount, and fish type when the information is available. Further, it presents brief overviews of both general population temporal PFAS exposure trends and PFAS fish contaminant data in the United States. Finally, it discusses approaches that risk assessors and policy makers can consider in developing their fish consumption recommendations in relation to PFAS. In brief, epidemiology studies show that the benefits of fish intake generally counter the risks of PFAS exposure based on four noncancer health endpoints that EPA identified as having the greatest strength of evidence for PFAS health effects.

Mollusc and crustacean consumption in the first 1000 days: a scoping review

Mollusc and crustacean consumption in the first 1000 d may improve maternal and child health by providing essential nutrients. However, in some contexts, molluscs and crustaceans have been associated with allergies and environmental contamination, potentially leading to adverse health and development outcomes. It is unclear whether the health benefits of consuming molluscs and crustaceans, collectively classified as shellfish in nutrition, are outweighed by the potential risks to pregnant women and children. We conducted a scoping review (PROSPERO: CRD42022320454) in PubMed, Scopus and EBSCO Global Health of articles published between January 2000 and March 2022 that assessed shellfish consumption during pregnancy, lactation or childhood (0-2 years) in relation to maternal health, child health or child development. A total of forty-six articles were included in this review. Overall, shellfish consumption was associated with higher biomarkers of environmental contaminants, with mercury being the most studied and having the strongest evidence base. The limited research on nutritional biomarker status shows an association between shellfish consumption and iodine status. Preterm birth was not associated with shellfish consumption, but newborn anthropometry showed mixed results, with several studies reporting lower birth weight with higher shellfish consumption. The few studies that examined child development and maternal health outcomes reported no significant associations. This review revealed trade-off health risks and benefits with inclusion of molluscs and crustaceans in the dietary patterns of mothers and young children. More research is needed to understand how these aquatic animal-source foods may be safely consumed and leveraged for improving human nutrition.

Maternal seafood consumption and fetal growth: a birth cohort study in urban China

BACKGROUND

Seafood is a good source of essential fatty acids which has a presumably beneficial effect on developing embryos and fetuses, although it is also a source of contaminants. In this context, pregnant women are faced with conflicting reports on the risk and benefits of seafood consumption. This study aims to assess whether the consumption of seafood during pregnancy was associated with fetal growth in an inland city in China.

METHODS

This study included 10,179 women who delivered a singleton live birth in Lanzhou, China. Seafood consumption was assessed using a Food Frequency Questionnaire. Maternal data including birth outcomes and maternal complications information is extracted from the medical records. Associations between seafood consumption and fetal growth indicators were analyzed using multiple linear regression and multiple logistic regression.

RESULTS

There was a positive association between total seafood consumption and birth weight (β = 0.027, 95%CI:0.030-0.111) but no association concerning birth length or head circumference. Seafood consumption was associated with decreased risk of low birth weight (OR = 0.575, 95% CI: 0.480, 0.689). The frequency of seafood consumption during pregnancy showed a trend toward a positive association with low birth weight. Significantly reduced rates of low birth weight were found in women who consumed more than 75 g of seafood/week during pregnancy as compared to women with no or very low intakes (P for trend 0.021). A significant interaction was observed between pre-pregnancy BMI and seafood consumption on birth weight among underweight women, but not among overweight women. Gestational weight gain partially mediated the association between seafood consumption and birth weight.

CONCLUSIONS

Maternal seafood consumption was associated with decreased risk of low birth weight and increased birth weight. This association was mainly driven by freshwater fish and shellfish. These results further corroborate the present dietary recommendation to the Chinese Nutrition Society for pregnant women, especially those with underweight pre-pregnancy BMI and inadequate GWG. In addition, our findings provide implications for future interventions to improve seafood consumption among pregnant women to prevent low birth weight babies in the inland city in China.

Periconceptional Mediterranean diet during pregnancy on children's health

During pregnancy, rapid and subtle physiological changes are observed from conception to birth. Nutrition and other lifestyle factors before and during pregnancy have been shown in the literature to influence the health of both mother and child. A healthy and varied diet during pregnancy can provide adequate energy and nutrients for both the mother and the growing fetus. Current research focuses on the periconceptional phase, which includes the early processes of gametogenesis, embryogenesis and placentation. A variety of abnormalities and pregnancy-related problems occur during this period, including congenital defects, fetal loss, miscarriage and preterm birth. A varied and balanced diet during periconception is important to maintain fetal development and growth. To date, numerous studies have been conducted to investigate the effects of consuming different nutrients, foods or food groups during pregnancy on the health of mother and child. For example, the Mediterranean diet is considered as a balanced, nutrient-rich diet due to the low consumption of meat products and fatty foods and the high consumption of vegetables, cheese, olive oil, fish, shellfish and little meat. While many studies have been conducted in the literature to investigate the effects of a Mediterranean diet during pregnancy on fetal health, the results have been inconclusive. The aim of this article is to review the current literature on the Mediterranean diet during pregnancy.

Maternal periconceptional nutrition matters. A scoping review of the current literature

BACKGROUND

The importance of nutrition in reproductive health is widely acknowledged with special emphasis given to periconceptional maternal diet and its implications on embryo-fetal development, pregnancy complications, and the health of the offspring.

METHODS

Following the PRISMA guidelines, we searched for literature in PubMed, CINAHL, and WoS to gather newer information on how diet composition influences the concepts from the very early stages of pregnancy and how maternal health may be affected as well. Fifty-six studies published up to June 2020 met the inclusion criteria.

RESULTS

With its proportioned and diversified macronutrient composition, the Mediterranean Diet prevents congenital anomalies, preterm birth, hypertensive disorders, and gestational diabetes. Similar dietary patterns rich in vegetables, nuts, fish, and cereals increase the likelihood of conception and have a protective action, mediated by their antioxidant properties, against orofacial clefts, congenital heart and limb defects in the progeny. Conversely, the pro-inflammatory features of western diets, rich in processed foods and low in fruit content, diminish fertility, increase miscarriage rates, and enhance the risk of neural tube defects regardless of folate supplementation.

CONCLUSIONS

It may be concluded that within the multiple dietary options, some of them are soundly associated with beneficial effects for the mother and the newborn.Implications for practiceAn appropriate counseling must be offered to the woman of fertile age to make her aware of how periconceptional nutrition may help fulfill her reproductive expectations.

Dietary Fat and Fatty Acid Intake in Nulliparous Women: Associations with Preterm Birth and Distinctions by Maternal BMI

BACKGROUND

Evidence documenting whether diet quality, particularly dietary fatty acids, is associated with preterm birth (PTB) is limited.

OBJECTIVE

The aim was to measure associations between dietary fatty acid intake prior to pregnancy, specifically n-3 (ɷ-3) PUFAs and odds of PTB in US women and determine if associations differed by prepregnancy BMI.

METHODS

We designed a secondary analysis of dietary intake in nulliparous women enrolled in a longitudinal cohort (NCT01322529). Participants completed an FFQ, modified to assess detailed PUFA intake, during the 3 mo preceding pregnancy. Inclusion in this analytic cohort required total energy intake within 2 SDs of the group mean. Prepregnancy BMI was categorized as underweight, normal, overweight, or obese. The primary exposure was estimated intake of EPA and DHA (combined EPA+DHA), in the context of a recommended intake of 250 mg. The primary outcome was PTB (<37 wk). Adjusted regression models controlled for maternal factors relevant to PTB and evaluated associations with PUFAs. Interaction terms estimated effect modification of BMI. A false discovery rate (FDR) correction accounted for multiple comparisons.

RESULTS

Median daily intake of combined EPA+DHA in 7365 women was 70 mg (IQR: 32, 145 mg). A significant interaction term indicated the effects of EPA+DHA on odds of PTB were different for different BMI categories (P < 0.01). Specifically, higher intake of combined EPA+DHA was nominally associated with reduced odds of PTB in women with underweight (OR: 0.67; 95% CI: 0.46-0.98) and normal BMI (OR: 0.87; 95% CI: 0.78-0.96), yet was associated with increased odds of overweight BMI (OR: 1.21; 95% CI: 1.02-1.44). Associations remained significant after FDR correction.

CONCLUSIONS

Based on a cohort of US women designed to identify predictors of adverse pregnancy outcomes, dietary intake of combined EPA+DHA was considerably lower than recommended. Associations between intake of these recommended n-3 fatty acids and risk of PTB differ by maternal BMI.

Maternal Long-Chain Polyunsaturated Fatty Acid Status, Methylmercury Exposure, and Birth Outcomes in a High-Fish-Eating Mother-Child Cohort

BACKGROUND

Maternal status of long-chain PUFAs (LC-PUFAs) may be related to fetal growth. Maternal fish consumption exposes the mother to the neurotoxicant methylmercury (MeHg), which, in contrast, may restrict fetal growth.

OBJECTIVE

Our aim was to examine relations between maternal LC-PUFA status at 28 wk and birth outcomes (birth weight, length, and head circumference), controlling for MeHg exposure throughout pregnancy, in the Seychelles Child Development Study Nutrition Cohort 2. Our secondary aim was to examine the influence of maternal variation in genes regulating the desaturation of LC-PUFAs [fatty acid desaturase (FADS)] on birth outcomes.

METHODS

From nonfasting blood samples collected at 28 wk of gestation, we measured serum total LC-PUFA concentrations and FADS1 (rs174537, rs174561), FADS1-FADS2rs3834458, and FADS2rs174575 genotypes, with hair total mercury concentrations assessed at delivery. Data were available for n = 1236 mother-child pairs. Associations of maternal LC-PUFAs, MeHg, and FADS genotype with birth outcomes were assessed by multiple linear regression models, adjusting for child sex, gestational age, maternal age, BMI, alcohol use, socioeconomic status, and parity.

RESULTS

In our cohort of healthy mothers, neither maternal LC-PUFA status nor MeHg exposure were significant determinants of birth outcomes. However, when compared with major allele homozygotes, mothers who were heterozygous for the minor allele of FADS1 (rs174537 and rs174561, GT compared with TT, β = 0.205, P = 0.03; TC compared with CC, β = 0.203, P = 0.04) and FADS1-FADS2 (rs3834458, Tdel compared with DelDel, β = 0.197, P = 0.04) had infants with a greater head circumference (all P < 0.05). Homozygosity for the minor allele of FADS2 (rs174575) was associated with a greater birth weight (GG compared with CC, β = 0.109, P = 0.04).

CONCLUSIONS

In our mother-child cohort, neither maternal LC-PUFA status nor MeHg exposure was associated with birth outcomes. The observed associations of variation in maternal FADS genotype with birth outcomes should be confirmed in other populations.

Maternal Fatty Fish Intake Prior to and during Pregnancy and Risks of Adverse Birth Outcomes: Findings from a British Cohort

Fish is an important source of the essential fatty acids contributing to foetal growth and development, but the evidence linking maternal fatty fish consumption with birth outcomes is inconsistent. In the UK, pregnant women are recommended to consume no more than two 140 g portions of fatty fish per week. This study aimed to investigate the association between fatty fish consumption before and during pregnancy with preterm birth and size at birth in a prospective birth cohort. Dietary intake data were acquired from a cohort of 1208 pregnant women in Leeds, UK (CARE Study) to assess preconception and trimester-specific fatty fish consumption using questionnaires. Multiple 24-h recalls during pregnancy were used to estimate an average fatty fish portion size. Intake was classified as ≤2, >2 portions/week and no fish categories. Following the exclusion of women taking cod liver oil and/or omega-3 supplements, the associations between fatty fish intake with size at birth and preterm delivery (<37 weeks gestation) were examined in multivariable regression models adjusting for confounders including salivary cotinine as a biomarker of smoking status.. The proportion of women reporting any fatty fish intake decreased throughout pregnancy, with the lowest proportion observed in trimester 3 (43%). Mean intakes amongst consumers were considerably lower than that recommended, with the lowest intake amongst consumers observed in the 1st trimester (106 g/week, 95% CI: 99, 113). This was partly due to small portion sizes when consumed, with the mean portion size of fatty fish being 101 g. After adjusting for confounders, no association was observed between fatty fish intake before or during pregnancy with size at birth and preterm delivery.

Fish consumption prior to pregnancy and pregnancy outcomes in the National Birth Defects Prevention Study, 1997-2011

OBJECTIVE

To evaluate the relationships between maternal fish consumption and pregnancy outcomes in a large, population-based sample of women in the USA.

DESIGN

We collected average fish consumption prior to pregnancy using a modified version of the semi-quantitative Willett FFQ. We estimated adjusted OR (aOR) and 95 % CI for associations between different levels of fish consumption and preterm birth (&lt;37 weeks), early preterm birth (&lt;32 and &lt;35 weeks) and small-for-gestational-age infants (SGA; &lt;10th percentile).

SETTING

The National Birth Defects Prevention Study (NBDPS).

SUBJECTS

Control mother-infant pairs with estimated delivery dates between 1997 and 2011 (n 10 919).

RESULTS

No significant associations were observed between fish consumption and preterm birth or early preterm birth (aOR = 0·7-1·0 and 0·7-0·9, respectively). The odds of having an SGA infant were elevated (aOR = 2·1; 95 % CI 1·2, 3·4) among women with daily fish consumption compared with women consuming fish less than once per month. No associations were observed between other levels of fish consumption and SGA (aOR = 0·8-1·0).

CONCLUSIONS

High intake of fish was associated with twofold higher odds of having an SGA infant, while moderate fish consumption prior to pregnancy was not associated with preterm or SGA. Our study, like many other studies in this area, lacked information regarding preparation methods and the specific types of fish consumed. Future studies should incorporate information on nutrient and contaminant contents, preparation methods and biomarkers to assess these relationships.

Maternal seafood intake and the risk of small for gestational age newborns: a case-control study in Spanish women

OBJECTIVE

To investigate the relationship between seafood consumption during pregnancy and the risk of delivering a small for gestational age (SGA) newborn.

DESIGN

This case-control study included women with SGA newborns and controls matched 1:1 for maternal age (±2 years) and hospital.

SETTING

Five hospitals in Eastern Andalusia, Spain.

PARTICIPANTS

518 pairs of pregnant Spanish women. The SGA group included women who delivered SGA newborns: SGA was defined as a birth weight below the 10th percentile of infants at a given gestational age. Controls were women who delivered newborns with adequate birth weights.

INTERVENTIONS

We collected data on demographic characteristics, socioeconomic status, toxic habits and diet. Midwives administered a 137-item Food Frequency Questionnaire.

OUTCOME MEASURES

We calculated quintiles of seafood intake and applied conditional logistic regression to estimate ORs and 95% CIs.

RESULTS

Shellfish intake more than once/week yielded a significant protective effect against an SGA newborn (OR 0.25, 95% CI 0.08 to 0.76, after adjusting for energy, educational level, smoking, prepregnancy body mass index, weight and a history of preterm or low birthweight newborn). The risk of an SGA newborn was lower among women who consumed >121 g/day fish compared with women who consumed ≤56 g (adjusted OR 0.63, 95% CI 0.41 to 0.98; p=0.025 for a trend). Similarly, the risk of an SGA newborn was lower among women who consumed >1 g/day of marine n-3 polyunsaturated fatty acids compared with those who consumed ≤0.4 g/day (adjusted OR 0.58, 95% CI 0.38 to 0.90; p=0.025 for a trend).

CONCLUSION

An average seafood intake of at least 121 g/day during pregnancy, equivalent to 3-4 servings/week, reduced the risk of an SGA newborn, compared with an average seafood intake of less than 56 g/day.

Dietary intake and urinary metals among pregnant women in the Pacific Northwest

Pregnancy is a period when the mother and her offspring are susceptible to the toxic effects of metals. We investigated associations of intake of frequently consumed foods with urinary metals concentrations among pregnant women in the Pacific Northwest. We measured urinary cadmium (U-Cd), arsenic (U-As) and molybdenum (U-Mo) concentrations from spot urine samples in early pregnancy (15 weeks of gestation, on average) among 558 women from Seattle and Tacoma, Washington. We assessed periconceptional dietary intake using a semi-quantitative food frequency questionnaire (FFQ). We also determined early pregnancy zinc concentrations in serum. Statistical analyses involved multivariable linear regression models, adjusted for smoking status, age, race/ethnicity, multivitamin and supplement use, education, estimated total energy intake, and gravidity. The geometric mean and range in μg/g creatinine for U-Cd, U-As and U-Mo were 0.29 (0.1-8.2), 18.95 (3-550), and 72.1 (15-467), respectively. U-Cd was positively associated with dietary zinc intake (P-value = 0.004) and serum zinc (P-value<0.001) while it was negatively associated with coffee intake (P-value = 0.03). U-As was positively associated with dietary fish [(Lean fish, fatty fish, shellfish and non-fried fish) (P-values<0.01)], selenium (P-value = 0.004), zinc (P-value = 0.017), vegetables (P-value = 0.004), and low-fat yogurt (P-value = 0.03). Women who reported higher intake of dietary magnesium (Mg)(P-value = 0.04), insoluble fiber (P-value = 0.03), and low-fat yogurt (P-value = 0.04) had higher U-Mo concentrations. Our study suggests that vegetables, fish, fiber and yogurt might be significant dietary sources of metals. Future studies aimed at investigating the risk of exposure to metals from other various food sources among reproductive-age and pregnant women are needed.

Healthy Lifestyle During Early Pregnancy and Risk of Gestational Diabetes Mellitus

Previous studies have found associations between individual healthy behaviors and reduced risk of gestational diabetes mellitus (GDM); however, the association of composite healthy lifestyle during pregnancy with GDM has not been examined. Participants in the Omega Study (n = 3,005), a pregnancy cohort study conducted in Washington State (1996-2008), reported information on diet, physical activity, smoking, and stress during early pregnancy. Lifestyle components were dichotomized into healthy/unhealthy and then combined into a total lifestyle score (range, 0-4). Regression models were used to determine relative risk of GDM (n = 140 cases) in relation to healthy lifestyle. Twenty percent of participants had a healthy diet, 66% were physically active, 95% were nonsmokers, and 55% had low stress. Each 1-point increase in lifestyle score was associated with a 21% lower risk of GDM (95% confidence interval: 0.65, 0.96) after adjustment for age, race, and nulliparity. Adjustment for prepregnancy body mass index, prepregnancy physical activity, and prepregnancy smoking attenuated the associations slightly. Associations were similar in normal-weight and overweight/obese women. In this study, a composite measure of healthy lifestyle during early pregnancy was associated with substantially lower GDM risk. Public health messaging and interventions promoting multiple aspects of a healthy lifestyle during early pregnancy should be considered for GDM prevention.