Omega-3s for pregnancy and fertility

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Why is it that when I ask a client if she eats seafood, 90% of the time her response has something to do with salmon?  If you are not a salmon lover, there are still plenty of ways to get your seafood in. Salmon is not the only fish in the sea, my friends.




Obsessed may be a little strong of a word.  I am not obsessed, but I do understand the importance of consuming low-mercury fish and seafood two times a week for women (and men) who are trying to become pregnant (naturally OR undergoing assisted reproduction), pregnant, or lactating. Eating fish and seafood is one of the best things you can do for yourself and for your future baby.  There are many stars of the fish and seafood show, and one superstar is the omega-3 fatty acid.  Two omega-3 fatty acids found under the sea are DHA and EPA. There are many foods that are rich in omega-3 fatty acids like nuts, but they do not provide the DHA and EPA omega-3 fatty acids. Ensuring that you are getting these two specific omega-3 fatty acids in during this time is key.




A handful of well-designed studies suggest that seafood intake is positively related to positive fertility outcomes to ignore.  Whether one is undergoing assisted reproduction  or trying naturally fish and seafood should be an important part of a couple’s diet.  Many attribute the fertility aspect to the DHA and EPA Omega-3 fatty acids that these marine animals provide, but others believe there is so much more to it.  Not only do these fish provide a boost of these healthy fats, but they provide a slew of other nutrients.  Depending on the fish or seafood choice, finding a healthy dose of selenium, zinc, and Vitamin D (to name a few) is easy to come by. 


Results from one study that came out of Harvard suggests that higher levels of serum omega-3 fatty acids were associated with higher likelihood of clinical pregnancy and live birth. The chances of clinical pregnancy and live birth increased by 8% for every 1% increase in serum omega-3 level.  


DHA tends to steal the spotlight when it comes to marine fatty acids and pregnancy, but there is another player called eicosapentaenoic acid (say that five times real fast…or just call it EPA).  The EPA fatty acid is found in fish/seafood and some supplements.  If your supplement only contains DHA, it is in your best interest to sneak in some fish/seafood two times a week, or consider a supplement with both DHA and EPA if Captain D’s is not an option (ew Captain D’s). There are some vegan supplement choices of EPA too.


For those couples focusing on pro-inflammatory foods (and staying away from anti-inflammatory foods) for fertility support or due to a PCOS diagnosis, fish and seafood absolutely fit the bill.  DHA and EPA supplements work too.




DHA is one omega-3 fatty acid that has been shown to support baby’s brain and eye development when mom is pregnant.  Since many fish and seafood choices are so rich in DHA, consumption of this fatty acid has become essential in many opinions.  Fish and seafood are also a wonderful protein source that is low in saturated fat and high in natural vitamins and minerals.  Some choices (particularly the ones that are naturally pink or red like shrimp or salmon) naturally contain an antioxidant called astaxanthin. 


Amazing correlations have been found between seafood intake and pregnancy outcomes.  In a literature review published this year, the authors suggest that seafood intake is protective against preterm birth. 


In a recent study evaluating 55,139 women (that is a LOT of women), the data suggests that fish (and veggie) intake resulted in a reduced pre-eclampsia risk among pregnant women. 


Some experts are even suggesting that mom’s intake of the omega 3 fatty acids found in fish and seafood may be protective against her baby from developing Attention-Deficient/Hyperactivity Disorder (ADHD) and/or Autism Spectrum Disorders (ASD).  


The omega-3 fatty acids found in fish and seafood must be an integral part of the prenatal diet.  The fatty acids are way too important for baby’s development to ignore! 




Because DHA is essential for child brain development, breast milk DHA levels should be improved by making sure that mom is eating well.   Since baby’s eyes and brain are still developing, DHA is essential.  Fortunately, dietary DHA is well absorbed and transferred to breast milk.




Many people don’t like salmon, and that’s ok!  Salmon is a wonderful choice, but for those non-fish eaters, it tends to have more of a “fishy” taste and smell.  Thankfully, there are plenty of other options out there for those trying to conceive or pregnant.  


Some say that Pollok, Crab, Barramundi, Shrimp, and Seabass are the least-fishy of the bunch.   Flounder, Halibut, Grouper, Sole, and Perch are other options that are not as fishy as other choices. 


Another way to explore fish and seafood intake is to play with spices and sauces.  Hot sauce or red pepper flakes are always a winner when trying to add some flavor without enhancing the fishiness of the protein. 


Using this guide to help you determine how often you can eat certain fish. Some are higher in mercury than others.


Some recipes featuring non-fishy fish and seafood for your eating pleasure were borrowed from the Seafood Nutrition Partnership and are featured below. Photo credit of all food: The Seafood Partnership


Crab and Rice Stuffed Portobellos

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Some avoid fish and seafood due to mercury concerns.  Many experts agree that the benefits of eating fish/seafood outweigh the risks associated with the small mercury intake, assuming a woman is sticking to the “low” category of fish/seafood options.  In one study conducted by my favorite researcher based out of Harvard, hair mercury concentrations were tested on women undergoing IVF.  One would assume if a woman has a high mercury concentration in her hair, she would have consumed adequate seafood and fish since there aren’t many other ways that mercury is ingested other than fish/seafood.  The researchers concluded that hair mercury levels were not related to ovarian stimulation outcomes (peak estradiol levels, total and mature egg yields) or to fertilization rate, embryo quality, clinical pregnancy rate or live birth rate. In other words, higher mercury levels did not equate to poor fertility outcomes. Don’t let mercury concern sway you from eating two servings of low-mercury fish or seafood a week.




Some studies evaluate DHA and EPA intake and it’s benefits in supplement form and not in fish form. Although I would love to extrapolate that data and say that fish intake would offer the same benefits, I just can’t.  One noteworthy potential benefit may be that supplementing the fatty acid EPA intake during pregnancy or postpartum may reduce some symptoms associated with depression. DHA supplementation tin healthy pregnant women may also reduce the risk of postpartum depression (PPD). One small study’s results imply that the balance of omega 3 and omega 6 fatty acids may play a role in a woman developing PPD. In other words, taking in not enough of the “good” fats from fish/seafood/supplements and taking in too much of the “bad” fats from processed foods and certain oils may be related to PPD symptoms. Some studies regarding this topic are conflicting, and some results imply no benefit of omega-3 fatty acid intake and PPD symptoms/depression. As a clinician, I weight the risks and benefits and believe that there is little (to any) risk with taking EPA and DHA supplements during pregnancy and lactation.  


Prenatal depression is another concern that has been shown to be improved with supplementation of DHA and EPA.   Prenatal depression is a common psychiatric disorder in pregnant women and leads to psychosocial dysfunction, high suicidal rate, and adverse childcare. Patients with this condition have been shown to have lower levels of DHA/EPA. Ensuring adequate intake of these fatty acids may be one way to reduce the risk of this condition occurring in some women. 


If you are considering supplementation, PLEASE run your options by your doctor or registered dietitian to ensure purity and quality.  You tend to get what you pay for when it comes to omega-3 supplements and it is best to have a professional provide guidance to ensure quality, accuracy, purity, and dosage. As always, I am happy to help! Email me at for guidance!