What the data show about common concerns in pregnancy.(Obstetrics)

SAN FRANCISCO -- In the general ob.gyn. practice of Amy Meg Autry, M.D., visits with pregnant patients have evolved from giving equal time to examination and counseling to about 2% to examination and 98% to counseling.

Dr. Autry of the University of California, San Francisco, researched answers to some of their most common safety concerns regarding pregnancy and offered an overview of her findings at a meeting on antepartum and intrapartum management sponsored by the university:

* Fish. While eating fish can be good for maternal cardiovascular health and fetal growth and development, fish accumulate methyl mercury in their muscles from industrial pollution, which may cause neurotoxic symptoms in neonates that resemble cerebral palsy.

Only one retrospective study has found severe neurotoxic effects in children born to Japanese women who ate a steady diet of fish with high levels of mercury, even though the mothers showed minimal or no effects of mercury ingestion. Three other studies found neurologic effects in Japanese adults who ate a similar toxic-fish diet or Iraqi adults who ate grain that had been pretreated with mercury.

Two prospective studies produced conflicting results. In one, a diet high in whale blubber was associated with delays in attention, memory, and small-motor function in serial testing of children through age 6 in the Faeroe Islands of Norway. A separate study of residents of the Seychelles Islands who ate 12 meals of fish per week found that they had mercury levels 10-20 times higher than average levels in U.S. residents, yet this exposure produced no long-term neurologic effects. Other prospective studies are ongoing.

A 2004 joint advisory for consumers issued by the Environmental Protection Agency and the Food and Drug Administration recommended that pregnant women not eat shark, swordfish, king mackerel, or tilefish, because they are high in mercury.

The advisory emphasized the positive benefits of fish and stated that pregnant women may eat up to 12 ounces (two average meals) per week of fish low in mercury, such as salmon, shrimp, pollack, and catfish. Canned light tuna has less mercury than albacore tuna. For local fish, consult local and tribal advisories that apply to your area, or limit ingestion to 6 ounces per week.