Maternal Nutrition Group Recommendations for Fish Consumption During Pregnancy

Dear Visitor:

Thank you for your interest in nutrition and the health of mothers, babies and families.

Unfortunately, misinformation has once again obscured a critical health issue, this time regarding seafood consumption recommendations for pregnant and nursing women shared by the National Healthy Mothers, Healthy Babies Coalition on October 4, 2007.

These recommendations were made by the Maternal Nutrition Group, an independent group of respected physicians, researchers and nutritionists from prestigious academic institutions across the country. These colleagues have dedicated their careers to improving women’s chances for having healthy pregnancies and affording babies the best possible start in life. It is absurd to suggest that these individuals would risk their reputation by releasing information on any health issue without first reviewing substantial, reliable, evidence-based science. It should be clarified that there was no study released by the Maternal Nutrition Group. Rather, the recommendations they made were derived from an assessment of a significant body of research from reputable sources around the world.

The decision of the National Healthy Mothers, Healthy Babies Coalition’s Board of Directors to share the recommendations of the Maternal Nutrition Group is consistent with our mission, history and track record. We have taken on similar projects for 26 years because our role is to serve as a conduit for health information and foster a dialogue about issues that have potential to have an impact on maternal and child health. As research continues on this topic and new science is made available, we will continue to share it along with the opinions of experts on the subject matter.

Those who are familiar with our work recognize that we are, and always have been, proactive in sharing what is known about maternal and child health issues. These issues are sometimes surrounded by controversy, for various reasons. However, it is only through a review of the facts and a healthy debate about them that progress has been made on issues such as immunization, jaundice management and newborn screening. Recommendations, guidelines and position statements can require years of deliberation in some organizations. During these times, we stand behind the need to share the science, along with the committed partners who take on the complex issues.

The Board of the National Healthy Mothers, Healthy Babies Coalition regrets that our membership was misrepresented over the past several weeks with respect to the Board’s support recommendations made by the Maternal Nutrition Group. We in no way meant to imply that our decision to share the information reflected endorsement from the organizations that make up our membership. We apologize for the inconvenience this has caused to influential partners and longtime friends working at the community, state and national level.

Thank you,

Judy Meehan
Executive Director
National Healthy Mothers Healthy Babies Coalition

Myth vs. Reality

Myth: The Maternal Nutrition Group was funded by the seafood industry.

Reality: The Maternal Nutrition Group is a group of obstetricians, nutritionists and researchers who are independent of any industry affiliation. Many within the Group have been meeting for more than five years in a Nutritional Special Interest Group within the Society for Maternal Fetal Medicine. As the importance of seafood in pregnancy became clear to the Group, NFI was approached to pay for the costs of a meeting, which NFI did.

Dr. McGregor also requested honoraria for the members and NFI agreed to provide $1,000 to each of the 14 participants. In addition, four members acted as an Executive Committee to develop an agenda and list of scientific studies to review. The Executive Committee was provided an additional $500 for the time spent in planning the meeting. The cost of travel, hotel and food was also covered.

Myth: The Maternal Nutrition Group used "industry-funded studies" to form its recommendations.

Reality: The research that served as a basis for the recommendations has been published in multiple, peer-reviewed articles in prestigious scientific publications including the Journal of the American Medical Association and The Lancet. This research has been funded by U.S. and international governments, NIH and EPA and from various academic institutions. To view abstracts of the science click here: http://www.brainybabieshealthykids.org/ocean-fish-science/.

Myth: The Maternal Nutrition Group’s purpose was to take on the FDA/EPA advisory.

Reality: Even though the FDA/EPA advisory is intended to guide women on safely consuming fish and seafood during pregnancy, it has been interpreted as some kind of warning and has created a negative effect, driving pregnant women away from eating fish. This has been confirmed by researchers from the Medical University of South Carolina. He conducted a survey and found that 56 percent of pregnant women who were familiar with the FDA advisory decreased their seafood consumption. As a consequence, they weren’t eating enough seafood each week to meet the nutritional needs of their bodies or their babies’.

Concerned by this trend of pregnant women avoiding seafood and the misinformation around the advisory, the Group came together to review recent relevant science and weigh the risks and benefits of consuming fish during pregnancy.

Myth: The effects of mercury were not properly evaluated by the Maternal Nutrition Group.

Reality: Mercury was evaluated by the Maternal Nutrition Group because all fish contain trace amounts of mercury. Mercury is a naturally occurring substance that comes from volcanic activity and ocean thermal vents. Some mercury is manmade, but data shows that over time the amount of mercury in fish in the ocean has remained the same over the past 30 years. In conclusion, the data on fish and mercury shows that the risk of mercury harm to children is exceedingly rare whereas the likelihood of a nutritional deficiency from a lack of fish in the diet is actually quite common.

Among others, there were two studies that were critically important in the final recommendation:

• “Separation of Risks and Benefits of Seafood Intake” by Esben Budtz-Jørgensen, Philippe Grandjean, and Pal Weihe, which was published in Environmental Health Perspectives (March 2007)
• “Maternal Seafood Consumption In Pregnancy And Neurodevelopmental Outcomes In Childhood” (ALSPAC study), an observational cohort study by Joseph R. Hibbeln, John M. Davis, Colin Steer, Pauline Emmett, Imogen Rogers, Cathy Williams, and Jean Golding

Esben Budtz-Jørgensen et al. found a confounding benefit of fish consumption stating, “These results support the notion that confounding may be of importance when exposures to a toxicant [methymercury] occurs from a food source [fish] that is also associated with essential or otherwise beneficial nutrients. Such confounding does not assume that toxicants and nutrients affect the same molecular target, only that they affect the same epidemiologic outcomes. The Faroe Islands would seem to be particularly suited for such considerations because of the correlation between fish intake and methylmercury exposure is relatively low due to the fact that whale meat rather than fish is the main source of methylmercury exposure.” The further discussion showed statistical benefit for children of women who ate fish in pregnancy.

In the ALSPAC Study, published in the Lancet in July 2007, a twenty-ninth variable looked at mercury intake from local seafood consumed by pregnant women. . When women exceeded the limit of 340 gm of fish, (12 ounces or 2-3 meals per week) they had the best fetal outcomes in terms of vision, problem solving, motor and behavioral skills. The fact is, the women with the most mercury from fish showed the best outcomes. This was incorporated into the Group’s thinking, as was the Lancet, February, 2007 article

Myth: The Maternal Nutrition Group is recommending that women eat any fish, including tilefish, shark, king mackerel and swordfish.

Reality: The Maternal Nutrition Group considered the important public health question of communicating risks and benefits related to fish consumption in pregnancy. The Group chose to focus on positive messaging and does not recommend consumption of tilefish, shark, king mackerel and swordfish that have been prohibited for pregnant women by the FDA. Examples of fish highlighted by the Group that are available, affordable and can safely be consumed in pregnancy include salmon, tuna, sardines and mackerel as well as shellfish. The Group also recommended that 6 ounces of albacore tuna can be consumed weekly.

It was essential to focus on a positive message because the confusion around the FDA/EPA advisory is contributing to pregnant women not to eat enough fish. The Group intentionally did not recommend fish with higher levels of mercury like tilefish, shark, king mackerel and swordfish. While the Group does still have questions about the risks these fish present, it believes there is not a major public health concern because these fish are not commonly eaten nor are they generally available or affordable. In order to clarify the issue of fish limited by the FDA, the Group posted on its Web site that women should avoid eating tilefish, shark, swordfish and king mackerel during pregnancy.

Myth: The Maternal Nutrition Group is recommending that women should eat all the fish they want.

Reality: The goal was to encourage pregnant women to eat a balanced, varied diet, which should include 2 to 3 meals of seafood per week as a part of a varied and balanced diet. The Maternal Nutrition Group wants to help pregnant women overcome fears of eating fish. Mothers can consume seafood in confidence and should know that, in doing so, they are doing the healthiest thing for themselves and their babies.

Myth: The Maternal Nutrition Group was formed by the National Healthy Mothers, Healthy Babies Coalition.

Reality: The Maternal Nutrition Group is an independent group of obstetricians, nutritionists and researchers. These individuals formed a special interest group. They do not represent an independent organization, nor are they part of a formal structure of the National Healthy Mothers, Healthy Babies Coalition. Many of the Group members have been meeting for more than five years in a Nutritional Special Interest Group within the Society for Maternal Fetal Medicine. As the importance of seafood consumption during pregnancy became clear to the Group, it became involved with HMHB to begin a dialogue about this urgent health issue. The Group asked HMHB to use the findings from their recommendation for an education program.

The Maternal Nutrition Group are faculty at the following institutions: New York University, Brown University Warren Alpert Medical School, Stony Brook University School of Medicine, Cornell University, Weill Cornell Medical College, University of North Carolina School of Medicine, Medical University of South Carolina, University of Southern California Keck School of Medicine, Colorado State University, University of Miami School of Nursing and Health Studies, Intermountain Healthcare, and Cedars- Sinai Medical Center.

Myth: Some members of the National Healthy Mothers, Healthy Babies Coalition refused to endorse the Group's recommendations.

Reality: The National Healthy Mothers, Healthy Babies Coalition has a Board of Directors that serves as its leadership. Like other, similar membership organizations, the Board’s process for making program decisions does not require the approval of the various organizations that make up its membership. This is an issue that requires careful study and deliberation, and the Maternal Nutrition Group looks forward to its dialogue with public health organizations. Because HMHB's members are listed on its Web site, some observers incorrectly assumed they all had endorsed the recommendations. A disclaimer on both the Healthy Mothers, Healthy Babies site and the microsite developed for this project states, “Any statement that is supported by the HMHB Board in no way implies that it has been endorsed by our member organizations.”

Myth: The National Healthy Mothers, Healthy Babies Coalition lost members because of the Maternal Nutrition Group’s recommendations.

Reality: While some members have or are planning to release their own statements, none of them have cancelled their membership as a result of the Maternal Nutrition Group’s recommendations. If you noticed a difference in membership on www.hmhb.org, the reason is that the Coalition launched a new, redesigned Web site the day before the press conference and its membership is constantly in flux because each organization’s renewal comes at a different time.

Myth: The Maternal Nutrition Group’s recommendations are propaganda from a national lobbying firm.

Reality: Maternal Nutrition Group members consist of obstetricians, nutritionists and researchers from top academic institutions around the country. Many of them have been meeting for years on the importance of nutrition. Among them they have published hundreds of articles in peer reviewed publications over the last 20 years on the importance of long-chain omega-3 fatty acids. They are passionate about ensuring optimal health and nutrition for mothers and babies and have dedicated their careers to this pursuit. They reviewed research from peer reviewed publications that was not funded by industry. They are all well-established faculty members at leading academic institutions with a longstanding interest in women's health and would never compromise their integrity for a commercial interest.

After their meeting, Burson-Marsteller, a public relations firm, facilitated this Group sharing its findings with HMHB. HMHB was founded in 1981 by The American College of Obstetricians and Gynecologists (ACOG), the March of Dimes, the American Academy of Pediatrics (AAP), the American Nurses Association (ANA), the National Congress of Parents and Teachers and the U.S. Public Health Service. Many of the members of the Maternal Nutrition Group were familiar with the National Healthy Mothers, Healthy Babies Coalition and its educational campaigns. HMHB has also worked with Burson-Marsteller for many years on different education projects. Burson-Marsteller was aware of the Maternal Nutrition Group because of its work with the seafood industry and its client, the National Fisheries Institute, which provided HMHB with a grant to carry out education on seafood consumption in pregnancy. HMHB is working with Burson-Marsteller to educate healthcare professionals and women about the Maternal Nutrition Group’s findings.

Myth: Burson-Marsteller has a conflict of interest with HMHB’s support of the Maternal Nutrition Group because one of its employees sits on HMHB’s Board.

Reality: The representation of a Burson-Marsteller employee on HMHB’s Board is by the individual, not the Burson-Marsteller firm. He has worked with HMHB on many different issues over the years and his role in the seafood consumption effort was limited to introducing HMHB to the work of the Maternal Nutrition Group. He recused himself from the Board’s consideration of this project and he does not work on issues related to the seafood industry.