The information included in Dear Stephanie posts is for educational purposes only. It is not intended nor implied to be a substitute for professional medical advice. Always consult your healthcare provider to determine the appropriateness of the information for your own situation, or if you have any questions regarding conception, pregnancy, or your prenatal treatment plan. For more Dear Stephanie posts, click here. Have a question for Steph? Click here to e-mail her.

Dear Steph,

I’ve been having a fierce tuna craving lately! Is fish a safe option during pregnancy? – Helen R., HMHB Mama 

There is seemingly conflicting information out there, so I understand your concern. It can be confusing to read about the benefits of EPA/DHA (essential fatty acids found in fish) one day while seeing warnings against mercury, a neurotoxin, the next. The last thing you want to do is harm your baby, so this can easily lead some mamas to avoid fish completely. While it’s true that mercury is present to some degree in all fish, there’s certainly more to the story. My hope is that the information below will help you feel more comfortable about including certain fish in your prenatal diet.

In 2004, fish consumption by pregnant women was well below the recommended level. Women were told to limit fish to no more than 12 ounces a week to protect their baby from mercury, but the recommendation did not include information regarding which fish should be limited/avoided and which fish were safe. As a result, pregnant women generally ate as little as two ounces of fish per week, if at all.  In 2017, ACOG revised these recommendations to help pregnant women feel more comfortable with their choice to consume fish. They did this by categorizing fish into three categories —best choices (low-mercury fish), good choices (moderate in mercury), and choices to avoid (high in mercury).

The Recommendations

The ACOG, the FDA, and the EPA agree that by following their recommendations, women reduce their exposure to mercury while providing a wide spectrum of nutrient benefits from fish. The recommendations for pregnant women, women who may become pregnant, and/or breastfeeding mothers are as follows:

  • Consume 2-3 palm-sized servings of a variety of low-mercury fish (labeled “best choices”) each week. This includes salmon, tilapia, cod, shrimp, or scallops.
  • Consume no more than 6 ounces of fish labeled “good choices,” such as albacore tuna, mahi mahi, and sea bass.
  • Avoid fish with the highest mercury concentrations (labeled “choices to avoid”) such as bigeye tuna (ahi and yellowfin) and swordfish.
  • Avoid raw and undercooked seafood.
  • Take extra precaution with fish caught by family and friends.

With the exception of swordfish, you’re probably not going to find many of the fish high in mercury at your local grocery store. What you will find is plenty of fish low in mercury such as sardines, wild sockeye salmon, sardines, herring, and anchovies. If you’re ever concerned, you can reference this helpful guide and the accompanying FAQ. If you want to choose sustainably-raised fish you can search for specific fish on Fish Watch.

Notice that this recommendation includes women who want to conceive and nursing women. These populations are also vulnerable to mercury exposure. While mercury can be naturally removed from the body over time, the process can take months. In order to reduce your toxic burden before conceiving, it’s best to follow these recommendations at least three months before conceiving. Methylmercury may also transfer to breast milk, which makes it a consideration for nursing mamas. In general, it wouldn’t hurt to follow them at any time to reduce your exposure to mercury.

More than EPA/DHA

You may be wondering about the role of a fish oil supplement in conjunction with fish consumption. I highly recommend a fish oil supplement to a majority of the women I work with. It’s true that you can get the recommended dose of DHA (at least 300 mg/day) from a supplement, but by doing so you’re missing out on other important nutrients such as protein, vitamin B6, vitamin B12, selenium, iron, iodine, and zinc.

In fact, the selenium in fish may even have protective effects against mercury toxicity. We also know that iodine needs are increased by 50% during pregnancy to support mom and baby’s thyroid function (especially during the first trimester) as well as fetal brain development. If you’re not consuming iodized salt or other sources of iodine like seaweed this can be an issue, especially since many women entering pregnancy are iodine deficient.

It can be hard to consume 8-12 oz of fatty, low-mercury fish each week due to aversions, nausea, finances, or simply just forgetting. In that case, a fish oil supplement can be very beneficial for optimal health for mom and baby. Look for a fish oil supplement that meets the following criteria:

  • Third-party tested
  • Meets international pharmaceutical standards that set maximum allowances on heavy metals, dioxins, PCBs, such as the European Pharmacopoeia Standard (EPS), Council for Responsible Nutrition (CRN) and the Global Organization for EPA and DHA Omega-3 (GOED)
  • Free from fishy smell or taste, which can mean it’s oxidized
  • Sourced with sustainability in mind
  • Processed without excessive heat and chemicals

What About Sushi?

In the US, pregnant women are advised to avoid eating raw and undercooked fish, such as sushi and sashimi, due to risks of food poisoning. Did you know that this isn’t the case for all countries? For example, UK guidelines state, “It’s usually safe to eat sushi and other dishes made with raw fish when you’re pregnant. But depending on what fish the sushi is made from, you may need to make sure that it’s been frozen first.” The exception is raw shellfish, which should only be consumed cooked as it can contain harmful viruses and bacteria that account for nearly 75% of seafood-associated outbreaks of food-borne illnesses.

So can you eat it? It’s a personal choice that only you can make after doing a risk-benefit analysis. Some moms feel safe including it in their diet as long as they’re certain it’s high-quality (flash-frozen, sushi-grade, wild-caught) from their favorite, trust-worthy restaurant while others decide it’s best to wait and enjoy it as a postpartum celebration. If you want to learn more about the pros/cons of fish consumption during pregnancy, including the safety of raw fish, listen to my interview with Lily Nichols on the Real Food Mamas podcast.

The Bottom Line

Follow the recommendations above to guide your fish consumption during pregnancy. Cold-water fish, such as wild-caught salmon, sablefish, herring, sardines, Whole30 Approved Safe Catch tuna/salmon, and wild salmon roe are great options! Safe Catch has provided an exclusive discount code for 15% off and free shipping on all orders, using the code WHOLEMAMAS*. If you’re unable to consume 8-12 oz of fish each week, talk to your provider about including a high-quality fish oil supplement, such as Nordic Naturals, which you can purchase through my Fullscript account. Stay tuned for next week, when we’ll do a round up of Whole30 compliant recipes including a variety of fish.

 

*Free shipping is within continental U.S. only. Promotion ends 12/31/18.

Header Photo: Dana DeVolk


Stephanie Greunke is a registered dietitian with a master’s degree in nutrition who specializes in women’s health. She is a certified personal trainer and prenatal and postnatal corrective exercise specialist. Stephanie has guided and supported women locally and globally through her web-based private practice, RockYourHormones.com, and continues to do so in her role as program manager with Healthy Mama, Happy Baby.