title: A pilot randomized controlled trial to promote healthful fish consumption during pregnancy: the Food for Thought Study.
abstract: BACKGROUND
  Nutritionists advise pregnant women to eat fish to obtain adequate docosahexaenoic acid (DHA), an essential nutrient important for optimal brain development. However, concern exists that this advice will lead to excess intake of methylmercury, a developmental neurotoxicant.
  
  
  OBJECTIVE
  Conduct a pilot intervention to increase consumption of high-DHA, low-mercury fish in pregnancy.
  
  
  METHODS
  In April-October 2010 we recruited 61 women in the greater Boston, MA area at 12-22 weeks gestation who consumed <=2 fish servings/month, and obtained outcome data from 55. We randomized participants to 3 arms: Advice to consume low-mercury/high-DHA fish (n=18); Advice + grocery store gift cards (GC) to purchase fish (n=17); or Control messages (n=20). At baseline and 12-week follow-up we estimated intake of fish, DHA and mercury using a 1-month fish intake food frequency questionnaire, and measured plasma DHA and blood and hair total mercury.
  
  
  RESULTS
  Baseline characteristics and mean (range) intakes of fish [21 (0-125) g/day] and DHA from fish [91 (0-554) mg/d] were similar in all 3 arms. From baseline to follow-up, intake of fish [Advice: 12 g/day (95% CI: -5, 29), Advice+GC: 22 g/day (5, 39)] and DHA [Advice: 70 mg/d (3, 137), Advice+GC: 161 mg/d (93, 229)] increased in both intervention groups, compared with controls. At follow-up, no control women consumed >= 200mg/d of DHA from fish, compared with 33% in the Advice arm (p=0.005) and 53% in the Advice+GC arm (p=0.0002). We did not detect any differences in mercury intake or in biomarker levels of mercury and DHA between groups.
  
  
  CONCLUSIONS
  An educational intervention increased consumption of fish and DHA but not mercury. Future studies are needed to determine intervention effects on pregnancy and childhood health outcomes.
  
  
  BACKGROUND
  Registered on clinicaltrials.gov as NCT01126762.
authors.affiliation: Department of Population Medicine, Harvard Medical School and the Harvard Pilgrim Health Care Institute, 133 Brookline Avenue, Boston, MA 02215, USA. emily_oken@hphc.org
authors.forename: Emily
authors.initials: E
authors.lastname: Oken
authors.forename: Lauren B
authors.initials: LB
authors.lastname: Guthrie
authors.forename: Arienne
authors.initials: A
authors.lastname: Bloomingdale
authors.forename: Deborah N
authors.initials: DN
authors.lastname: Platek
authors.forename: Sarah
authors.initials: S
authors.lastname: Price
authors.forename: Jess
authors.initials: J
authors.lastname: Haines
authors.forename: Matthew W
authors.initials: MW
authors.lastname: Gillman
authors.forename: Sjurdur F
authors.initials: SF
authors.lastname: Olsen
authors.forename: David C
authors.initials: DC
authors.lastname: Bellinger
authors.forename: Robert O
authors.initials: RO
authors.lastname: Wright
mesh_terms: D000328:Adult; D000818:Animals; D015415:Biomarkers / Q000097:blood; D001900:Boston; D004281:Docosahexaenoic Acids / Q000008:administration & dosage / Q000097:blood*; D005260:Female; D005399:Fishes; D005500:Follow-Up Studies; D005506:Food Contamination / Q000032:analysis; D006801:Humans; D008767:Methylmercury Compounds / Q000008:administration & dosage / Q000097:blood*; D010865:Pilot Projects; D011247:Pregnancy; D011256:Pregnancy Outcome; D012959:Socioeconomic Factors; D011795:Surveys and Questionnaires
chemical_list: D015415:Biomarkers; D008767:Methylmercury Compounds; D004281:Docosahexaenoic Acids