Seafood Recommendations During Pregnancy and Childhood

The nutritional value of seafood may be particularly valuable during fetal growth and development, as well as in early infancy and childhood. For individuals of childbearing age, seafood consumption as part of a healthy eating pattern prior to and during pregnancy may also offer benefits, such as a reduced risk of hypertensive disorders. Seafood provides several key nutrients that are needed during pregnancy, including protein, selenium and zinc, as well as iron and iodine. It also contains the omega-3 fatty acids, docosahexaenoic and eicosapentaenoic acid, which play a role in neural and cognitive health. Research reviewed by the 2020 Dietary Guidelines Advisory Committee suggests that consuming seafood that is high in omega-3 fatty acids during pregnancy may result in "better cognitive development and language and communication development in children"

The 2020-2025 Dietary Guidelines for Americans recommend adults consume at least eight ounces of seafood per week to meet targets for these fatty acids and help reduce the risk of heart disease. For individuals who are pregnant, at least eight and up to 12 ounces of a variety of seafood that is higher in omega-3 fatty acids and lower in methylmercury is recommended. However, seafood consumption by most Americans does not align with current recommendations.

Although some subgroups may choose to avoid fish as part of a vegetarian eating style or due to food allergies, food safety concerns may also lead to reduced fish intake. To help consumers better understand appropriate fish choices and meet the recommended amounts, the U.S. Food and Drug Administration (FDA) and Environmental Protection Agency (EPA) issued advice regarding seafood consumption (fish and shellfish collectively identified as "fish") in 2017.

The advice was designed to encourage individuals who are pregnant and breastfeeding and children to consume a variety of fish that is low in mercury each week. In October of 2021, the FDA/EPA advice was revised to highlight the benefits of fish consumption in this population in accordance with the 2020-2025 Dietary Guidelines for Americans and offers a new recommendation for children 1 year of age.

The FDA/EPA advice cautions against seven types of fish that typically contain high levels of mercury: tilefish from the Gulf of Mexico, shark, swordfish, orange roughy, bigeye tuna, marlin and king mackerel. The guidance includes a chart to make it easier to choose between dozens of healthy and safe seafood options, categorized into three groups (Best Choices, Good Choices and Choices to Avoid) based on their relative mercury content.

For young children and individuals of childbearing age (16 to 49 years old), especially those that are pregnant or breastfeeding, the recommendations are:

• Eat a variety of fish.
• Check for state or local fish advisories before eating fish caught by family or friends. If there is no advisory, limit your intake to one serving and eat no other fish that week.
• For adults, choose two to three servings of fish from the "Best Choices" list or one serving from the "Good Choices" list each week. (Four ounces is considered a serving for pregnancy and breastfeeding.)
• For children, serve smaller age-appropriate servings of fish two times per week, which will result in a total of 2 to 8 ounces weekly, depending on the child's age.

Average serving sizes of fish for children, according to the FDA/EPA guidance, are:

Other adults and children over the age of 11 are also encouraged to vary their protein choices to include seafood that is higher in omega-3 fatty acids and lower in methylmercury.

References:

• Dietary Guidelines Advisory Committee. 2020. Scientific Report of the 2020 Dietary Guidelines Advisory Committee: Advisory Report to the Secretary of Agriculture and the Secretary of Health and Human Services. U.S. Department of Agriculture, Agricultural Research Service, Washington, DC.
• U.S. Department of Agriculture and U.S. Department of Health and Human Services. Dietary Guidelines for Americans, 2020-2025. 9th Edition. December 2020.
• Bernstein AS, Oken E, de Ferranti S. Technical Report: Fish, Shellfish, and Children's Health: An Assessment of Benefits, Risks, and Sustainability. Pediatrics. 2019:143(6).
• US Food and Drug Administration. FDA News Release. Advice about Eating Fish. Accessed November 10, 2021.
• US Food and Drug Administration. Questions & Answers from the FDA/EPA Advice on What Pregnant Women and Parents Should Know about Eating Fish. Accessed November 10, 2021.