A coalition that advocates for healthy pregnancies came under criticism after issuing an advisory urging pregnant women to eat more fish, based on an evidence review that received financial support from the fisheries industry.
In a statement issued Oct. 4, the National Healthy Mothers, Healthy Babies (HMHB) Coalition recommended that “women who want to become pregnant, are pregnant or are breast-feeding should eat a minimum of 12 ounces per week of fish like salmon, tuna, sardines, and mackerel, and can do so safely.”
According to the HMHB Coalition, this strategy of eating ocean fish rich in omega-3 fatty acids will ensure optimal neurologic development in children, as well as reduce the risk of preterm labor and postpartum depression in mothers.
That advice is at odds with the recommendation of the Food and Drug Administration and the Environmental Protection Agency, which in 2004 advised pregnant women and breast-feeding mothers to eat no more than 12 ounces of fish a week because of concerns about mercury exposure.
Within days after the HMHB Coalition issued its report, at least two organizations that had been listed on its Web site (www.hmhb.org
The AAP “was not pleased” to be associated with the advisory, said Dr. Frank R. Greer, chair of the AAP's nutrition committee. The academy was part of the coalition at its inception, but has not been actively involved in the organization in recent years. It “knew nothing about this statement until it was released,” said Dr. Greer, a professor of pediatrics at the University of Wisconsin, Madison.
The AAP continues to support the position that pregnant or lactating women should eat no more than 12 ounces of fish per week, he added.
The American College of Obstetricians and Gynecologists (ACOG) is a founding member of the Healthy Mothers, Healthy Babies Coalition. “However, ACOG was not involved in the development of the new recommendations. At this time, ACOG follows the FDA's recommendations on fish consumption for pregnant women,” said a spokesperson for the college.
At press time, the HMHB Coalition included more than 60 organizations, including ACOG, the Centers for Disease Control and Prevention, and the March of Dimes. The advisory and supporting documents were posted online at www.brainybabieshealthykids.org
Initial news reports about the advisory failed to mention that the coalition received funding from the National Fisheries Institute, including $14,000 for travel expenses for the Maternal Nutrition Group—a group of experts convened by the coalition—to meet and review evidence, and $60,000 to publicize the findings.
After the funding issue came to light, the coalition responded to criticism by placing a disclaimer on its Web site saying that “any statement that is supported by the HMHB Board in no way implies that it has been endorsed by our member organizations.”
The coalition maintains that the funding source did not influence the opinion of its expert group, which was led by Dr. James A. McGregor, a visiting professor of clinical obstetrics and gynecology at the University of Southern California, Los Angeles.
“If you read the articles [that the Maternal Nutrition Group reviewed], you would come to the same conclusion,” Dr. McGregor said in an interview. None of the supporting research studies were sponsored by the fisheries industry, he added.
Even before the potential conflict of interest came to light, some obstetricians said they weren't putting great stock in the suggestion.
“I would not use this recommendation to make any radical change in diet,” said Dr. E. Albert Reece, a specialist in maternal-fetal medicine who is Vice President for Medical Affairs at the University of Maryland, Distinguished Professor, and dean of the school of medicine in Baltimore.
The HMHB Coalition said that it made the recommendation because studies show that women in the United States do not consume enough fish, and that the FDA advisory warning women about mercury contamination has further discouraged consumption.
Data from the National Health and Nutrition Examination Survey show that 90% of women are eating less than the amount of fish recommended as an upper limit by the FDA, the group noted.
Further, a study by Dr. William Goodnight of the Medical University of South Carolina, Charleston, found that of the pregnant women who were aware of the FDA's advisory to limit fish intake during pregnancy, 56% reduced their fish intake well below beneficial amounts.
A survey conducted by the HMHB Coalition found that 53% of women pregnant for the first time ate less fish during pregnancy because of the warnings about mercury.
Oily ocean fish are the major source of long-chain omega-3 fatty acids, such as eicosapentaenoic acid and docosahexa- enoic acid, nutrients that are essential for fetal nervous system development. In rapid fetal growth, these fats are not synthesized by the human body in adequate amounts.