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A fishy recommendation: omega‐3 fatty acid intake in pregnancy

With recent concern about aquatic contamination from potential teratogens including heavy metals, dioxins, pharmaceutical residues, polychlorinated biphenyls (PCBs), and synthetic estrogens,1–6 some public health agencies throughout the world have recommended limiting gestational fish consumption to minimise fetal harm associated with toxicant exposure.7 Conversely, a well-publicised research paper in Lancet concluded that adequate seafood consumption in pregnancy correlates with improved child development and that ‘advice to limit seafood consumption could actually be detrimental’.8 This commentary will consider the issue of maternal fish consumption in the context of recent medical literature on nutrition and essential fatty acids (EFAs). With discussion of intricate laparoscopic techniques, avant-garde reproductive interventions, complex microsurgery, and epigenetic therapies, many medical practitioners find the practice of dietary or nutritional therapy to be dull, alternative, and perhaps simplistic medicine. Exploration of the aetiological factors contributing to the global escalation in chronic disease,9 however, has revealed that some contemporary ill health results from nutritional compromise.10 Furthermore, recent research demonstrates that certain obstetric and paediatric afflictions might effectively be prevented by provision during pregnancy of the nutrients required for optimal development and sustained function. The correlation between deficient folate and neural tube defects11 (NTDs) previously prompted widespread periconceptional supplementation and recent concerns about potential fetal sequelae (including cleft palate)12 of maternal biotin deficiency13 as well as considerable risk for NTDs with low maternal vitamin B12 status14 have fuelled intensified research on the link between gestational nutrient requirements and maternal and fetal outcome. Correlations including those of maternal selenium levels with pre-eclampsia15 and maternal vitamin D status with subsequent risk in the offspring for diabetes,16 asthma,17 adverse bone health,18 and multiple sclerosis19 illustrate the truism that the human being requires specific nutrients during gestation to carry out the molecular processes within cells and tissues, processes which on the macroscale influence both maternal physiology and fetal development. Considerable attention has recently focused on the role of EFAs in maternal and fetal metabolism.