(Reaffirmed March 2020)
This is an area of evolving care and practice. Fellows should check periodically for revisions and updates. ACOG will communicate important changes and updates to these guidelines.
On January 19, 2017, the U.S. Food and Drug Administration (FDA) and the U.S. Environmental Protection Agency (EPA) issued revised advice regarding fish consumption for pregnant women or women who may become pregnant, as well as breastfeeding mothers and parents of young children 1. The American College of Obstetricians and Gynecologists has preliminarily reviewed the revised advice and concurs with the FDA/EPA recommendations as follows:
- ACOG encourages pregnant women, women who may become pregnant, and breastfeeding mothers to follow the FDA and EPA’s revised advice to:
- Eat 2-3 servings a week (8 to 12 ounces in total) of a variety of fish (see Figure 1 Best Choices);
- Eat only 1 serving a week (no more than 6 ounces) of some fish, such as albacore (white) tuna and fish with similar mercury concentrations to albacore (white) tuna (see Figure 1 Good Choices);
- Avoid certain fish with the highest mercury concentrations (see Figure 1 Choices to Avoid); and
- Check for advisories for fish caught by family and friends and where no advisories exist, limit eating those fish to one serving a week and do not eat other fish that week.
Women who follow this advice may experience the benefits of seafood consumption without experiencing an increase in related risk from mercury to themselves or their babies.
- Although not mentioned in the revised 2017 advice, it is important that pregnant women avoid all raw and undercooked seafood, eggs, and meat (see ACOG’s patient education information and ACOG’s clinical guidance on Listeria for more information).
- ACOG suggests that women discuss with their obstetrician-gynecologists or other obstetric providers the revised FDA and EPA advice and the potential benefits of seafood consumption, while keeping in mind the 3 serving/12 ounce per week limit in order to avoid the harmful effects of mercury.
This revised 2017 advice is different from the FDA and EPA’s previous 2014 draft advice, which was developed after information became available suggesting that consumption of low-mercury seafood can be particularly beneficial during pregnancy, with benefits including improved neurodevelopmental outcomes, but fish consumption by pregnant women was well-below the recommended level at the time 2. While the 2014 draft advice did recommend that pregnant women, women who might become pregnant, and breastfeeding mothers eat at least 8 and up to 12 ounces per week of a variety of fisher lower in mercury, it did not go into the same level of detail as the revised 2017 advice. The revised 2017 advice categorizes more than 60 fish types into three categories (“Best Choices”, “Good Choices”, and “Choices to Avoid”). The revised 2017 advice also differs from the 2014 draft advice in that, unlike the draft 2014 advice, it uses a cautious and highly protective analytical approach and it incorporates feedback from public comment and an external peer review.
The revised 2017 advice aligns with ACOG’s 2013 Committee Opinion on Exposure to Toxic Environmental Agents and Guidelines for Perinatal Care, 7th Edition, both of which recommend that obstetricians encourage their pregnant patients to consume up to 12 ounces a week of fish and shellfish that are low in mercury 3 4. As the leading health care organization dedicated to the health of women and their families, ACOG will continue to review the topic and further integrate into ACOG guidance as appropriate.
To learn more about what led the FDA to update its recommendations, read Why We Want Pregnant Women and Children to Eat More Fish. To learn more about the FDA’s revised advice, visit Eating Fish: What Pregnant Women and Parents Should Know. For more information on nutrition during pregnancy, see ACOG’s Nutrition During Pregnancy FAQ.