Sathyanarayana et al address the important matter of counseling of reproductive age women on minimizing risks of prenatal environmental exposure that can influence fetal development and maternal health negatively. Mercury exposure is of special interest because the benefits of seafood consumption, mentioned but not emphasized, must be balanced against risks. Untested messaging on this topic is known to cause avoidance of all fish by pregnant women, which leads them to eat less fish rather than to shift away from some species but to maintain overall fish consumption.

The term large tuna was inserted into the list of high-mercury fish that pregnant women should avoid; the recommendation was attributed to the US Environmental Protection Agency (EPA). However, current guidance issued jointly by the EPA and the US Food and Drug Administration (FDA) lists shark, swordfish, king mackerel, and tilefish to be avoided by pregnant women. EPA/FDA guidelines emphasize that pregnant women should consume up to 12 ounces each week of a variety of fish and shellfish. The EPA/FDA cite canned light tuna as 1 of the 5 most commonly eaten fish that are low in mercury and indicate that up to 6 ounces per week of albacore (“white”) tuna is safe and healthful. There is no tuna species that the EPA or FDA recommends avoiding completely.

The 2010 Dietary Guidelines for Americans (US Departments of Agriculture and of Health and Human Services) agree and suggest that pregnant and breastfeeding women should eat no less than 8 ounces of seafood a week to ensure the best possible brain and eye development for their babies. More recently, the World Health Organization recommended that experts should communicate that eating a variety of fish helps to improve the baby’s brain development and not eating fish may deprive the baby of this health benefit. Healthcare professionals should bear in mind that the FDA estimates that pregnant women eat less than a serving per week; they should convey to their patients that many pregnant women do not consume the recommended amount of seafood (8-12 ounces per week) and should consume more, and that pregnant women should avoid shark, swordfish, king mackerel, and tilefish and to adhere to local advisories about recreationally caught fish.

Obstetricians, gynecologists, and other reproductive healthcare professionals are indeed in the unique position to counsel pregnant women on the best nutritional practices. Care to a balanced message that emphasizes the latest evidence-based consensus should be the standard.