Both higher fish consumption and longer breastfeeding are linked to better physical and cognitive development in infants, according to a study of mothers and infants from Denmark. Maternal fish consumption and longer breastfeeding were independently beneficial.

“These results, together with findings from other studies of women in the U.S. and the United Kingdom, provide additional evidence that moderate maternal fish intake during pregnancy does not harm child development and may on balance be beneficial,” said Assistant Professor Emily Oken, lead author of the study.

The study, which appeared in the September issue of the American Journal of Clinical Nutrition, was conducted by researchers from the Department of Ambulatory Care and Prevention of Harvard Medical School and Harvard Pilgrim Health Care and the Maternal Nutrition Group from the Department of Epidemiology at Statens Serum Institut in Copenhagen, Denmark. These findings provide further evidence that the omega-3 fatty acids found in fish and compounds in breast milk are beneficial to infant development.

The study team looked at 25,446 children born to mothers participating in the Danish Birth Cohort, a study that includes pregnant women enrolled from 1997-2002. Mothers were interviewed about child development markers at 6 and 18 months postpartum and asked about their breastfeeding at 6 months postpartum. Prenatal diet, including amounts and types of fish consumed weekly, was assessed by a detailed food frequency questionnaire administered when they were six months pregnant.

During the interviews mothers were asked about specific physical and cognitive developmental milestones such as whether the child at six months could hold up his/her head, sit with a straight back, sit unsupported, respond to sound or voices, imitate sounds, or crawl. At 18 months, they were asked about more advanced milestones such as whether the child could climb stairs, remove his/her socks, drink from a cup, write or draw, use word-like sounds and put words together, and whether they could walk unassisted.

The children whose mothers ate the most fish during pregnancy were more likely to have better motor and cognitive skills. For example, among mothers who ate the least fish, 5.7% of their children had the lowest developmental scores at 18 months, compared with only 3.7% of children whose mothers had the highest fish intake. Compared with women who ate the least fish, women with the highest fish intake (about 60 grams - 2 ounces - per day on average) had children 25% more likely to have higher developmental scores at 6 months and almost 30% more likely to have higher scores at 18 months.

Longer duration of breastfeeding was also associated with better infant development, especially at 18 months. Breastmilk also contains omega-3 fatty acids. The benefit of fish consumption was similar among infants breastfed for shorter or longer durations.

Women in the U.S. have been advised to limit their fish intake to two servings a week because some fish contains high traces of mercury, which has demonstrated toxic effects. Information regarding mercury levels was not available in this population, but most women consumed cod, plaice, salmon, herring, and mackerel, fish types that tend to have low mercury content. In this study, consumption of three or more weekly servings of fish was associated with higher development scores, so in this case the nutrient benefits of prenatal fish appeared to outweigh toxicant harm.

“In previous work in a population of U.S. women, we similarly found that higher prenatal fish consumption was associated with an overall benefit for child cognitive development, but that higher mercury levels attenuated this benefit,” says Dr. Oken. “Therefore, women should continue to eat fish - especially during pregnancy - but should choose fish types likely to be lower in mercury.”

The Danish National Birth Cohort was financed by the Danish National Research Foundation, Danish Pharmaceutical Association, Ministry of Health, National Board of Health, Statens Serum Institut, BIOMED, March of Dimes Birth Defects Foundation, Danish Heart Association, Danish Medical Research Council, and Sygekassernes Helsefond. This project was also supported by the Early Nutrition Programming Project. Dr. Oken was supported by a grant from the National Institutes of Health (HD44807) and a fellowship from the American Scandinavian Foundation, Inger and Jens Bruun Foundation.

Full Citation:

American Journal of Clinical Nutrition, Vol. 88, No. 3, 789-796, September 2008

“Associations of maternal fish intake during pregnancy and breastfeeding duration with attainment of developmental milestones in early childhood: a study from the Danish National Birth Cohort”

Emily Oken, Marie Louise Østerdal, Matthew W Gillman, Vibeke K Knudsen, Thorhallur I Halldorsson, Marin Strøm, David C Bellinger, Mijna Hadders-Algra, Kim Fleischer Michaelsen, and Sjurdur F Olsen

From the Department of Ambulatory Care and Prevention, Harvard Medical School and Harvard Pilgrim Health Care, Boston, MA (EO and MWG); the Maternal Nutrition Group, Department of Epidemiology Research, Statens Serum Institut, Copenhagen, Denmark (MLO, VKK, TIH, MS, and SFO); the Department of Nutrition, Harvard School of Public Health, Boston, MA (MWG and SFO); the Department of Neurology, Children’s Hospital Boston and Harvard Medical School, Boston, MA (DCB); the Department of Neurology, University Medical Center Groningen, Groningen, Netherlands (MH-A); and the Department of Human Nutrition, Faculty of Life Sciences, University of Copenhagen, Fredriksberg, Denmark (KFM)

Harvard Medical School http:// hms.harvard.edu has more than 7,500 full-time faculty working in 11 academic departments located at the School’s Boston campus or in one of 47 hospital-based clinical departments at 18 Harvard-affiliated teaching hospitals and research institutes. Those affiliates include Beth Israel Deaconess Medical Center, Brigham and Women’s Hospital, Cambridge Health Alliance, Children’s Hospital Boston, Dana-Farber Cancer Institute, Forsyth Institute, Harvard Pilgrim Health Care, Hebrew SeniorLife, Joslin Diabetes Center, Judge Baker Children’s Center, Immune Disease Institute, Massachusetts Eye and Ear Infirmary, Massachusetts General Hospital, McLean Hospital, Mount Auburn Hospital, Schepens Eye Research Institute, Spaulding Rehabilitation Hospital, and VA Boston Healthcare System.

Harvard Pilgrim Health Care http://www. hphc.org is a not-for-profit health care plan operating in Massachusetts, New Hampshire, and Maine with a network of more than 22,000 doctors, 135 hospitals, and more than 970,000 members. Harvard Pilgrim was the first New England health plan to establish a nonprofit foundation with the sole purpose of serving the community at large. The efforts of the foundation reflect Harvard Pilgrim’s mission, which is to improve the health of its members and the health of society.

FINDINGS
Higher prenatal fish consumption leads to better physical and cognitive development in infants, according to a study of mothers and infants from Denmark. Longer breastfeeding was also independently beneficial.

RELEVANCE
Pregnant women in the US have been advised to minimize their fish intake due to concerns over mercury levels. This study suggests that pregnant women should increase their consumption of low-mercury fish (such as cod, plaice, salmon, herring, and mackerel) to three or more servings per week. In addition, this study adds to the growing body of evidence emphasizing the developmental benefits of breastmilk.

Source: Harvard Medical School