American Journal of Epidemiology Advance Access originally published online on March 18, 2008
American Journal of Epidemiology 2008 167(10):1171-1181; doi:10.1093/aje/kwn034
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ORIGINAL CONTRIBUTIONS |
Maternal Fish Intake during Pregnancy, Blood Mercury Levels, and Child Cognition at Age 3 Years in a US Cohort
1 Department of Ambulatory Care and Prevention, Harvard Medical School and Harvard Pilgrim Health Care, Boston, MA
2 Department of Medicine, Children's Hospital Boston and Channing Laboratory, Brigham and Women's Hospital and Harvard Medical School, Boston, MA
3 Department of Neurology, Boston Children's Hospital and Harvard Medical School, Boston, MA
4 Department of Environmental Health, Harvard School of Public Health, Boston, MA
5 Department of Environmental Health, University of Michigan, Ann Arbor, MI
6 Department of Nutrition, Harvard School of Public Health, Boston, MA
Correspondence to Dr. Emily Oken, Department of Ambulatory Care and Prevention, 133 Brookline Avenue, Boston, MA 02215 (e-mail: emily_oken{at}harvardpilgrim.org).
Received for publication September 20, 2007. Accepted for publication January 29, 2008.
The balance of contaminant risk and nutritional benefit from maternal prenatal fish consumption for child cognitive development is not known. Using data from a prospective cohort study of 341 mother-child pairs in Massachusetts enrolled in 1999–2002, the authors studied associations of maternal second-trimester fish intake and erythrocyte mercury levels with children's scores on the Peabody Picture Vocabulary Test (PPVT) and Wide Range Assessment of Visual Motor Abilities (WRAVMA) at age 3 years. Mean maternal total fish intake was 1.5 (standard deviation, 1.4) servings/week, and 40 (12%) mothers consumed >2 servings/week. Mean maternal mercury level was 3.8 (standard deviation, 3.8) ng/g. After adjustment using multivariable linear regression, higher fish intake was associated with better child cognitive test performance, and higher mercury levels with poorer test scores. Associations strengthened with inclusion of both fish and mercury: effect estimates for fish intake of >2 servings/week versus never were 2.2 (95% confidence interval (CI): –2.6, 7.0) for the PPVT and 6.4 (95% CI: 2.0, 10.8) for the WRAVMA; for mercury in the top decile, they were –4.5 (95% CI: –8.5, –0.4) for the PPVT and –4.6 (95% CI: –8.3, –0.9) for the WRAVMA. Fish consumption of 
2 servings/week was not associated with a benefit. Dietary recommendations for pregnant women should incorporate the nutritional benefits as well as the risks of fish intake.
child development; fatty acids, omega-3; fishes; mercury; pregnancy
Abbreviations: CI, confidence interval; DHA, docosahexaenoic acid; EPA, eicosapentaenoic acid; PPVT, Peabody Picture Vocabulary Test; SD, standard deviation; WRAVMA, Wide Range Assessment of Visual Motor Abilities
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