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Original Investigation
April 2016

Fish Intake in Pregnancy and Child Growth: A Pooled Analysis of 15 European and US Birth Cohorts

Author Affiliations
  • 1Department of Social Medicine, Faculty of Medicine, University of Crete, Heraklion, Greece
  • 2Section of Complex Genetics, Department of Genetics and Cell Biology, NUTRIM School of Nutrition and Translational Research in Metabolism, Faculty of Health, Medicine and Life Sciences, Maastricht University Medical Centre+, Maastricht, Netherlands
  • 3Obesity Prevention Program, Harvard Pilgrim Health Care Institute, Department of Population Medicine, Harvard Medical School, Boston, Massachusetts
  • 4Department of Clinical Epidemiology, Predictive Medicine and Public Health, University of Porto Medical School, Porto, Portugal
  • 5Epidemology Research Unit, Institute of Public Health, University of Porto, Porto, Portugal
  • 6Public Health Division of Gipuzkoa, Basque Government; Health Research Institute, Biodonostia, San Sebastián, Spain
  • 7Centros de Investigación Biomédica en Red Epidemiología y Salud Pública, Spain
  • 8Centre for Research in Epidemiology and Biostatistics Paris Sorbonne Cité, Institut National de la Santé et de la Recherche Médicale, Early Origin of the Child Development and Health Team, Villejuif, France
  • 9Université Paris Descartes, Villejuif, France
  • 10Norwegian Institute of Public Health, Oslo, Norway
  • 11Department of Epidemiology, Lazio Regional Health System, Rome, Italy
  • 12Generation R Study Group, Department of Epidemiology, Erasmus University Medical Centre, Rotterdam, Netherlands
  • 13Institute for Risk Assessment Sciences, Utrecht University, Utrecht, Netherlands
  • 14Environmental Risk and Health, Flemish Institute for Technological Research, Mol, Belgium
  • 15Department of Environmental Epidemiology, Nofer Institute of Occupational Medicine, Lodz, Poland
  • 16School of Public Health, Physiotherapy, and Population Science, University College Dublin, Dublin, Ireland
  • 17Department of Epidemiology, CAPHRI School for Public Health and Primary Care, Faculty of Health, Medicine and Life Sciences, Maastricht University Medical Centre+, Maastricht, Netherlands
  • 18Fundación para el Fomento de la Investigación Sanitaria y Biomédica de la Comunitat Valenciana–Universitat Jaume I, Universitat de València Joint Research Unit of Epidemiology and Environmental Health, Valencia, Spain
  • 19Cancer Epidemiology Unit, Department of Medical Sciences, University of Turin and Reference Centre for Epidemiology and Cancer Prevention in Piemonte, Turin, Italy
  • 20Environmental Risk and Health, Flemish Institute for Technological Research, Mol, Belgium
  • 21University of Antwerp, Antwerp, Belgium; University of Southern Denmark, Odense, Denmark
  • 22Centre for Research in Environmental Epidemiology, Barcelona, Spain
  • 23Pompeu Fabra University, Barcelona, Spain
  • 24Department of Experimental and Health Sciences, Pompeu Fabra University, Barcelona, Spain
  • 25Department of Public Health, Academic Medical Centre, University of Amsterdam, Amsterdam, Netherlands
  • 26Centre for Nutrition, Prevention and Health Services, National Institute for Public Health and the Environment, Bilthoven, Netherlands
  • 27CAPHRI School for Public Health and Primary Care, Faculty of Health, Medicine and Life Sciences, Maastricht University Medical Centre+, Maastricht, Netherlands
  • 28Centre for Research in Environmental Epidemiology, Barcelona, Spain
  • 29Institut Hospital del Mar d'Investigacions Mèdiques, Barcelona, Spain
  • 30National School of Public Health, Athens, Greece
JAMA Pediatr. 2016;170(4):381-390. doi:10.1001/jamapediatrics.2015.4430

Importance  Maternal fish intake in pregnancy has been shown to influence fetal growth. The extent to which fish intake affects childhood growth and obesity remains unclear.

Objective  To examine whether fish intake in pregnancy is associated with offspring growth and the risk of childhood overweight and obesity.

Design, Setting, and Participants  Multicenter, population-based birth cohort study of singleton deliveries from 1996 to 2011 in Belgium, France, Greece, Ireland, Italy, the Netherlands, Norway, Poland, Portugal, Spain, and Massachusetts. A total of 26 184 pregnant women and their children were followed up at 2-year intervals until the age of 6 years.

Exposures  Consumption of fish during pregnancy.

Main Outcomes and Measures  We estimated offspring body mass index percentile trajectories from 3 months after birth to 6 years of age. We defined rapid infant growth as a weight gain z score greater than 0.67 from birth to 2 years and childhood overweight/obesity at 4 and 6 years as body mass index in the 85th percentile or higher for age and sex. We calculated cohort-specific effect estimates and combined them by random-effects meta-analysis.

Results  This multicenter, population-based birth cohort study included the 26 184 pregnant women and their children. The median fish intake during pregnancy ranged from 0.5 times/week in Belgium to 4.45 times/week in Spain. Women who ate fish more than 3 times/week during pregnancy gave birth to offspring with higher body mass index values from infancy through middle childhood compared with women with lower fish intake (3 times/week or less). High fish intake during pregnancy (>3 times/week) was associated with increased risk of rapid infant growth, with an adjusted odds ratio (aOR) of 1.22 (95% CI, 1.05-1.42) and increased risk of offspring overweight/obesity at 4 years (aOR, 1.14 [95% CI, 0.99-1.32]) and 6 years (aOR, 1.22 [95% CI, 1.01-1.47]) compared with an intake of once per week or less. Interaction analysis showed that the effect of high fish intake during pregnancy on rapid infant growth was greater among girls (aOR, 1.31 [95% CI, 1.08-1.59]) than among boys (aOR, 1.11 [95% CI, 0.92-1.34]; P = .02 for interaction).

Conclusions and Relevance  High maternal fish intake during pregnancy was associated with increased risk of rapid growth in infancy and childhood obesity. Our findings are in line with the fish intake limit proposed by the US Food and Drug Administration and Environmental Protection Agency.