By Patricia Kendall, PhD, RD
Department of Food Science and Human Nutrition
Colorado State University
Fort Collins, Colo.

You are what you eat, and during pregnancy, what you eat can have a large impact on the healthy development of your unborn baby.  The best diet during pregnancy includes a balance of healthy meals and snacks, with special emphasis on vegetables and fruits, whole grains, low-fat dairy products and lean nutrient-dense sources of protein and long-chain omega-3 fatty acids. 

Fish and seafood are one of our most nutrient dense sources of protein and the best dietary source of long-chain omega-3 fatty acids.  The omega-3 fatty acid docosahexaenoic acid (DHA) is especially important for the healthy development of the unborn baby’s brain.  Unfortunately, it’s often consumed at lower than recommended levels by most Americans.  Research has shown that consuming optimum levels of DHA during pregnancy has a positive impact on the development of the newborn’s visual, motor, cognitive and behavioral skills, and that the impacts may last into childhood and beyond.  If this isn’t enough reason to include fish in the diet during pregnancy, higher DHA intakes during pregnancy also have been shown to reduce the risk of pre-term labor and help avoid postpartum depression.

Like all good things in the diet, too much is not a good thing.  Nor, is eating fish raw or under cooked.  Moderation, variety and cooking are the keys to enjoying the benefits fish has to offer you and your unborn baby. 

Moderation.  You only need to eat fish two to three times per week to get all the DHA needed to promote a healthy pregnancy.  This amount also fits well with the Food and Drug Administration’s recommendation to limit fish consumption to 12 ounces per week to minimize exposure to methyl mercury.  The most commonly eaten fish in the U.S., shrimp, canned tuna, salmon, pollock, catfish, tilapia, crab, cod, clams and flatfish, are all considered naturally low in mercury.  The only species that the FDA warns against eating because of possible higher mercury levels are swordfish, shark, king mackerel and tilefish.  Because white albacore tuna may contain moderate levels of mercury, it’s recommended that tuna lovers eat just six ounces of white albacore tuna per week.  Moderation also means paying attention to advisories about fish caught in local waters.

Variety.  Cold water, oily fish, such as salmon, tuna, herring, mackerel, sardines, anchovies and whitefish, are our best dietary sources of DHA.  Shellfish also provide some DHA.  If fresh fish seems too high priced, consider canned fish, such as tuna, pink salmon and sardines.  Choosing a variety of fish and fish recipes not only adds spice to your life, it also increases your cooking repertoire.

Cook and/or reheat.  When it comes to fish and pregnancy, the words to remember are cook and/or reheat.  Raw fish often harbor parasites, bacteria and viruses.  None of these belong in a pregnant woman’s body.  Not only can they make you sick, but they can also harm your unborn child, resulting in miscarriage or a baby born with complications.  Fish is “cooked” and safe to eat when it flakes with a fork, or reaches 145 degrees Fahrenheit.  Cook live oysters in boiling water for three to five minutes after the shells open.  Be careful not to put too many oysters in the cooking pot at once, as the ones in the middle may not get fully cooked.  Also, discard any oysters that don’t open during cooking. 

Finally, be sure to reheat to steaming hot or 165 degrees Fahrenheit any refrigerated, smoked seafood before eating.  This type of fish is often sold refrigerated in the deli section of the grocery store and may be labeled as lox, nova style, kippered or jerky.  The processing done during the cold smoking of fish is not sufficient to destroy the bacteria Listeria monocytogenes, which if eaten could be passed to the unborn child and cause miscarriage or other health problems.  Canned or shelf-stable forms of smoked seafood are safe to eat as are any smoked fish used as an ingredient in a meal that has been cooked, like a casserole.  Below are a couple of cooked recipes that call for smoked salmon.

Smoked Salmon Quiche

Pastry for a 9-inch pie plate

1 cup chopped broccoli

¼ cup chopped green onion

¼ chopped red pepper (optional)

¾ cup smoked salmon (slivered or shredded)

¾ cup shredded Swiss or Gruyere cheese

3 eggs

1 cup light cream or half & half

1 teaspoon dry mustard

¼ teaspoon pepper

Paprika

Preheat oven to 375ºF. Put broccoli, green onion and red pepper in glass bowl and steam on full power in microwave oven for 1 to 2 minutes or until softened.  Line pie shell with chopped vegetables, smoked salmon and shredded cheese.  Blend eggs, cream, dry mustard and pepper in separate bowl until smooth.  Pour egg mixture over salmon, vegetable, cheese mixture and sprinkle with paprika.  Bake for 35-40 minutes or until knife inserted into pie comes out clean.  If the pie is getting too brown around the edges before the center is done, cover edges with foil.  Makes 6 servings.

Smoked Salmon Fettucini

6 green onions or scallions, chopped

2 teaspoons butter or margarine

6 ounces smoked salmon, cut in ½-inch chunks

1 cup light cream or half and half

1 teaspoon thyme

¼ teaspoon celery salt

½ lb spinach fettucini (cooked as directed)

Saute green onions in butter for 2-3 minutes.  Lower heat and add salmon and cream, thyme and celery salt.  Stir and gently heat for 5 minutes.  Mixture should reach 165ºF, but not come to a boil.  Serve immediately over hot pasta.  Makes 3 to 4 servings.

The food we eat regulates our bodies on a cellular level that directly influences our growth and health.  Pregnancy is an amazing time of rapid cell division, differentiation and growth.  Emerging science repeatedly tells us that our maternal diet critically affects our pregnancy health and our child’s lifelong health.  Thus, eating a healthy diet during pregnancy is one of the most beneficial things you can do for yourself and your child. 
 
A few simple concepts can help you on your way: 1) eat lean protein sources (fish, eggs, poultry, low-fat beef and dairy products, dried legumes) with all meals to get your protein, iron, zinc, calcium, B and D vitamins, and regulate your blood sugar and insulin levels; 2) limit consumption of high-glycemic foods and beverages (added sugar and corn syrup, white flour and refined/instant grain products) and choose complex carbohydrates (fresh fruits, vegetables and whole grain products) for more fiber to decrease constipation, promote satiety, regulate your blood sugar and insulin levels, as well as get more B and C vitamins, including folic acid;  3) eat smaller meals every 3-4 hours while awake, and drink 8 cups of water between meals for gradual, healthy weight gain throughout pregnancy. 
 
Weight gain during pregnancy has become a ‘heavy’ issue.  To make matters difficult, more women are already overweight when they become pregnant.  Choosing calories carefully and eating dietary or healthy fats, like long chain omega-3 fatty acids eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA), help moms-to-be decrease their chances for preterm birth, postpartum depression and jump start your child’s lifelong health, mental capacity and adult learning potential.  Unfortunately, our bodies can’t make these fats, so it’s important to eat them, and we don’t have many food sources to choose from in our diet.  Fish, DHA and EPA fortified foods and supplements are our only sources of these essential healthy fats in our diets. 
 
The National Academy of Sciences Food and Nutrition Board recommend that pregnant and nursing women get 0.13 to 0.14 grams per day of EPA plus DHA.  This can safely be consumed by eating 12 ounces per week of fish like salmon, tuna, sardines, mackerel and herring, of which up to six ounces can be canned albacore tuna.  You should, however, avoid tilefish, shark, king mackerel and swordfish while pregnant.
 
Eating tastefully and healthfully during pregnancy and while nursing is easy to do with a balanced diet that includes whole foods.  It’s never too late to become a ‘wise gastronomer,’ knowing that you are what you eat and your child may very well become what you eat. 

Docosahexaenoic acid (DHA), an omega-3 fatty acid naturally found in fish, is an important nutrient for women during pregnancy and while breastfeeding because babies need DHA for brain and eye development. Several recent studies show that children whose mothers had high intakes of DHA during pregnancy have better vision and improved IQ test performance from infancy up to age four.  By consuming DHA during pregnancy, women may also decrease the risk of having a low birth-weight baby.  

DHA-Rich Foods
Salmon, sardines, tuna and other cold water fish are all rich in DHA and even shellfish provide DHA, although in smaller amounts.  While canned fish, such as tuna, pink salmon and sardines are usually not expensive, consumers should watch for store specials on other DHA-rich food options. 

Eggs are another great source of DHA. When grocery shopping, look for “omega-3 DHA” on egg carton labels.  Some store brands even offer omega-3 DHA-enriched eggs that may cost less than other brands, so be sure to compare DHA content and the price.  By eating one DHA-rich egg every day and one serving of fish two to three times per week, women are be able get the recommended amount of DHA during pregnancy and while breast feeding.

Season’s Eatings
Enjoy omega-3 rich foods during the holiday season. Here are some tips for increasing DHA intake while entertaining or attending holiday parties:

• Garnish omega-3 DHA deviled eggs with one small slice of anchovy and a pimento pepper.
• Load your plate with shrimp cocktail, which is low in fat and calories, high in protein and a good source of DHA.
• Make a nutritious salmon dip for your holiday buffet with the following delicious recipe:

Salmon Loaf
1 1lb can, pink salmon- drained and bones removed
8 oz, cream cheese at room temperature
2 tsp, prepared horseradish
1 tbsp, fresh lemon juice
1 tbsp, grated onion
1/4 tsp, liquid smoke
4 - 5 drops, Tabasco sauce
½ cup, chopped pecans¼ cup, chopped parsley
Combine cream cheese, horseradish, lemon juice, onion, liquid smoke and Tabasco. Add salmon, and mix thoroughly. Chill for several hours. In separate bowl, combine chopped pecans and parsley. Place the chilled salmon mixture on wax paper and shape into a log. Roll the log in the pecan and parsley mixture. Refrigerate until ready to use. Serve with crackers.

Easy Holiday Fare for Family Meals at Home
Use omega-3 DHA eggs in a breakfast burrito sprinkled with shredded cheddar cheese and smothered with fresh salsa (made with chopped tomatoes, onion, cilantro and lime for a low-sodium garnish packed with Vitamin C) and wrapped in a whole grain flour tortilla.

How about a crab and broccoli quiche made with omega-3 DHA eggs?  Buy premade pie shells in the refrigerated section of your grocery store – they are easy, delicious and always on special this time of year.  Fill with your favorite egg, milk and cheese mixture, but substitute crab meat (frozen or canned and drained) and broccoli for the bacon!

Baked stuffed potatoes are another family favorite this time of year – bake as usual, remove the inside and mash with low-fat half and half milk and margarine, chopped scallions,  and salt and pepper to taste.  Mix in one can of crabmeat.  Return the mixture to the reserves potato shell, sprinkle with shredded Swiss cheese and bake until melted.

With so many healthy and delicious options available all year long, it will be simple to make it an omega-3 DHA holiday!

Mary Harris, PhD,RD,BC0-ADM
Professor of Nutrition
Colorado State University

The March of Dimes reports that one out of eight babies is born prematurely in the United States. Doctors consider babies born before week 37 to be premature, and unfortunately the number of premature babies delivered has steadily increased during the past 20 years. Although an understanding of how mothers can prevent preterm labor remains incomplete, current research suggests that including long-chain omega-3 fatty acids from ocean fish in the diet during pregnancy may help reduce the likelihood of premature labor.

Inflammation in the uterus, which occurs when the body’s immune system responds to an adverse condition such as bacteria or a virus, is one of the main causes of premature birth. While inflammation is a normal and good response that helps prevent infection, too much inflammation may cause contractions and premature labor.

The degree of inflammation during pregnancy varies among women. Factors that determine inflammation include a previous history of preterm birth and genetic make up. Reducing inflammation in the uterus during pregnancy may help decrease the likelihood of preterm delivery. There is good news for women who are prone to uterine inflammation: you can incorporate foods rich with anti-inflammatory ingredients into your diet. For example, long-chain omega-3 fatty acids are a strong anti-inflammatory and can be found in fish such as salmon or tuna.

Researchers have evaluated whether consumption of long-chain omega-3 fatty acids from fish during pregnancy can reduce the rate of preterm birth. I know of at least eight trials on long-chain omega-3 fatty acid consumption during pregnancy and their effect on preterm labor. Four of the eight trials found a reduced rate of preterm birth for the women eating long-chain omega-3 fatty-acids from fish, while the other four trials found no impact on the length of the pregnancy. While the potential benefits of omega-3 fatty acids on preventing preterm birth were not definitively proven by these eight trials, further analysis did allow me to draw tentative conclusions.

One study showed no benefit from consuming long-chain omega-3 fatty acids, but it was performed on a population that ate large quantities of fish, so it already had a high omega-3 fatty acid intake. This trial suggested that eating more fish may not be beneficial for women with a diet already rich in fish. Another trial conducted – this one on a population with a diet very low in fish – showed benefits from consuming long-chain omega-3 fatty acids, and indicated even modest increases in long-chain omega-3 fatty acids may have a positive effect on reducing preterm labor for women.

While the trials did not find evidence that increased long-chain omega-3 fatty acid intake will reduce the rate of preterm birth in women carrying twins, they did show me that long-chain omega-3 fatty acid consumption may help to prevent the recurrence of a premature delivery in women with a prior history of preterm birth. Therefore, while more research should be conducted, current research indicates that including long-chain omega-3 fatty acids into the diet during pregnancy may reduce the likelihood of premature delivery.

Steven S Witkin, PhD
Professor of Immunology
Director, Division of Immunology and Infectious Diseases
Department of Obstetrics and Gynecology
Weill Medical College of Cornell University, New York

Every day we learn more about long-chain omega-3 fatty acids and how they are vital for fetal development—and that the most available and healthful choice for these fatty acids is seafood. While the Food and Drug Administration continues to recommend that women consume fish while pregnant or nursing, there is quite a bit of confusion for both women and physicians regarding the FDA’s guidance. My conversations with fellow physicians and health care practitioners led me to believe women are not receiving clear information about the benefits of eating seafood versus the alleged risks—and the media’s communication on fish is overly focused on the negative.

Many of us who care for pregnant women have had a continuing conversations on how best to inform women about the important benefits of seafood in pregnancy. Ocean fish consumption brings important benefits to mother and baby – its nutrients are important for pregnancy maintenance, nutritive improvement of breast milk, brain development, and long-term health risks like heart disease and diabetes. Eating fish in pregnancy has also been linked to lowering the risk of preterm birth and post-partum depression. In order to attempt to clear up confusion surrounding seafood consumption during pregnancy, a number of experts in prenatal care formed the Maternal Nutrition Group agreeing as our first activity to review current science on the benefits and risks of seafood consumption in pregnancy. Our goal was to provide guidance to women on how to evaluate the benefits and alleged risks of eating seafood during pregancy and to put the issue of mercury into perspective.

The Maternal Nutrition Group is composed of fourteen leaders in obstetrics and nutrition. We are faculty from Brown University, Cornell University, Stony Brook University, Medical University of South Carolina, New York University, University of North Carolina at Chapel Hill, University of Southern California, University of Miami, Colorado State University, Intermountain Healthcare and UCLA’s Cedars-Sinai Medical Center.

Our review included the science that formed the EPA’s reference dose for mercury and the 2004 FDA/EPA fish advisory (which was the foundation for our final recommendation), as well as more recent studies.

From our extensive review of the research, and as we realize that women are not eating enough fish, our recommendations are that women, who want to become pregnant, are pregnant or are breastfeeding, should eat a minimum of 12 ounces per week of fish like salmon, tuna, sardines or mackerel – women should also eat other seafood as well and they can do so safely without concern for the trace amount of methyl-mercury in fish. For fresh fish, that amount looks like four decks of cards; for canned fish, it is two cans. We, the Maternal Nutrition Group, believe seafood is not only safe to eat, but crucial during pregnancy and for the development of healthy, “brainy” babies.