New Recommendations for Fish Consumption During Pregnancy

Health Professional, Medical Reviewer

In January 2017, the Food and Drug Administration (FDA) and the Environmental Protection Agency (EPA) published revised guidelines for fish consumption during pregnancy. These new recommendations, revised from their previous recommendations from 2014, go into deeper detail about what fish to avoid and which are better for consumption.

Why the change in guidelines? The FDA and EPA wanted to issue more specific recommendations after information became available that suggested that seafood low in mercury can be beneficial during pregnancy, including improved neurodevelopmental outcomes in infants. Fish consumption during pregnancy was found to be far below their 2014 recommendations for fish consumption of 8-12 ounces per week. This is most likely due to an increasing number of pregnant women avoiding fish altogether since it may contain contaminants such as mercury, which can harm an unborn baby’s developing brain and nervous system. The new FDA/EPA guidelines are broken down into three major categories:

Best Choices (eat two to three times per week): These include salmon, herring, trout, tilapia, catfish, canned light tuna, and seafood such as lobster, oysters, crab, and squid.

Good Choices (eat one time per week): These include tuna (yellowfin, white/albacore, canned, fresh, and frozen), mahi mahi, grouper, halibut, snapper, and tilefish (from the Atlantic Ocean).

Choices to Avoid (those highest in mercury): These include bigeye tuna, shark, swordfish, king mackerel, orange roughy, marlin, and tilefish (from the Gulf of Mexico).

The American College of Obstetricians and Gynecologists (ACOG) concurs with this advice and encourages pregnant women, women who may become pregnant, and breastfeeding mothers and mothers of young children to follow this advice. Specifically, women in this group should consume 8-12 ounces each week from the Best Choices group, eat no more than 6 ounces each week from the Good Choices group, and avoid fish altogether from the Choices to Avoid group. Although not mentioned in the FDA/EPA guidelines, ACOG advises that all pregnant women continue to avoid raw and undercooked seafood. Women who follow these guidelines may gain the health benefits from seafood consumption without increasing their risk of mercury exposure.

Judith Scott, D.O., F.A.C.O.G., a board-certified obstetrician at Methodist Physicians Clinic Women’s Center in Omaha, Nebraska, notes that these new guidelines can be confusing to her patients.

“I usually tell my patients that it is OK to have a tuna sandwich, just not every day,” Dr. Scott says.

She also advises her patients to avoid raw seafood (such as sushi) altogether, to avoid exposure to potentially harmful parasites and pathogens.

“Many patients, particularly in the Midwest, do not like fish in general,” Dr. Scott says. “If they don’t like fish, I try to encourage them to take a fish oil supplement with omega-3s, since most [patients] are deficient.”

The bottom line

While seafood consumption may have health benefits for pregnant and nursing mothers, it still may pose some health risks. ACOG recommends that women discuss the potential risks and benefits of the FDA/EPA’s recommendations with their obstetric provider. For patients who don’t like fish but want to reap the health benefits, it is important to note that omega-3s are not limited to fish but are also found in some vegetable oils, nuts, seeds, and soy foods. Talk with your physician or a registered dietitian if you have questions about how to eat a safe, balanced, and healthful diet during pregnancy and lactation.

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