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Fish Consumption, Erythrocyte Fatty Acids, and Preterm Birth

Klebanoff, Mark A. MD, MPH; Harper, Margaret MD, MSc; Lai, Yinglei PhD; Thorp, John Jr MD; Sorokin, Yoram MD; Varner, Michael W. MD; Wapner, Ronald J. MD; Caritis, Steve N. MD; Iams, Jay D. MD; Carpenter, Marshall W. MD; Peaceman, Alan M. MD; Mercer, Brian M. MD; Sciscione, Anthony DO; Rouse, Dwight J. MD; Ramin, Susan M. MD; Anderson, Garland D. MD

doi: 10.1097/AOG.0b013e31821645dc
Original Research

OBJECTIVE: To estimate the association between fish consumption and erythrocyte omega-3 long-chain polyunsaturated fatty acids and preterm birth in a high-risk cohort.

METHODS: This was an ancillary study to a randomized trial of omega-3 supplementation to prevent preterm birth in women with at least one previous spontaneous preterm delivery. Dietary fish intake was assessed by questionnaire and erythrocyte fatty acids were measured at enrollment (16–21 completed weeks of gestation). The association between fish consumption and preterm delivery was modeled with linear and quadratic terms.

RESULTS: The probability of preterm birth was 48.6% among women eating fish less than once a month and 35.9% among women eating fish more often (P<.001). The adjusted odds ratio for preterm birth among women reporting moderately frequent fish consumption (three servings per week) was 0.60 (95% confidence interval 0.38–0.95), with no further reduction in preterm birth among women who consumed more than three servings of fish per week. Erythrocyte omega-3 levels correlated weakly but significantly with frequency of fish intake (Spearman r=0.22, P<.001); women in the lowest quartile of erythrocyte omega-3 levels were more likely to report consuming less than one fish meal per month (40.3%) than were women in the highest three quartiles (26.3%, P<.001).

CONCLUSION: Moderate fish intake (up to three meals per week) before 22 weeks of gestation was associated with a reduction in repeat preterm birth. More than moderate consumption did not confer additional benefit. These results support the recommendations of the U.S. Food and Drug Administration and the American Congress of Obstetricians and Gynecologists for fish consumption during pregnancy.



Compared with women who rarely or never eat fish, women who do eat fish two or three times per week experience reduced occurrence of preterm birth. SUPPLEMENTAL DIGITAL CONTENT IS AVAILABLE IN THE TEXT.

*For a list of other members of the NICHD MFMU, see the Appendix online at

From the Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, Maryland; The Research Institute at Nationwide Children's Hospital, Columbus, Ohio; the Departments of Obstetrics and Gynecology, at Wake Forest University Health Sciences, Winston-Salem, North Carolina; The George Washington University Biostatistics Center, Washington, DC; University of North Carolina, Chapel Hill, North Carolina; Wayne State University, Detroit, Michigan; University of Utah Health Sciences Center, Salt Lake City, Utah; Columbia University, New York, New York; University of Pittsburgh, Pittsburgh, Pennsylvania; The Ohio State University, Columbus, Ohio; Women and Infants Hospital, Brown University, Providence, Rhode Island; Northwestern University, Chicago, Illinois; Case Western Reserve University-MetroHealth Medical Center, Cleveland, Ohio; Drexel University College of Medicine, Philadelphia, Pennsylvania; University of Alabama at Birmingham, Birmingham, Alabama; University of Texas at Houston, Houston, Texas; and University of Texas Medical Branch, Galveston, Texas.

Supported by grants from the Eunice Kennedy Shriver National Institute of Child Health and Human Development (HD27860, HD27917, HD40560, HD34208, HD40485, HD21410, HD27915, HD40500, HD40512, HD40544, MO1-RR-000080, HD34136, HD27869, HD40545, HD36801, and HD19897) and does not necessarily represent the official views of the NICHD or the National Institutes of Health.

The authors thank Dr. Mary Harris of Colorado State University, whose laboratory conducted the red cell assays; Catherine Y. Spong, MD, for protocol development and oversight; Elizabeth Thom, PhD, and Julia Zachary for protocol and data management and statistical analysis; and Melssa Swain, RN, and Karen Dorman, RN, MS, for protocol development and coordination between clinical research centers.

Presented at the Annual Meeting of the Society for Pediatric and Perinatal Epidemiologic Research, June 22–23, 2009, Anaheim, California (fish consumption results) and at the Annual Scientific Meeting of the Society for Maternal-Fetal Medicine, February 1–6, 2010, Chicago, Illinois (erythrocyte omega-3 fatty acids results).

Corresponding author: Mark A. Klebanoff, MD, MPH, Nationwide Children's Hospital, Room W285; 700 Children's Drive, Columbus, OH 43205; e-mail:

Financial Disclosure The authors did not report any potential conflicts of interest.

© 2011 by The American College of Obstetricians and Gynecologists. Published by Wolters Kluwer Health, Inc. All rights reserved.