Abstract
To evaluate whether a public health intervention using focused dietary advice combined with a hair-mercury analysis can lower neurotoxic methylmercury exposure among pregnant women without decreasing their overall intake of seafood. A total of 146 pregnant women were consecutively recruited from the antenatal clinic at a Danish university hospital at their initial ultrasound scan. Dietary advice was provided on avoiding methylmercury exposure from large predatory fish and a hair sample from each participant was analysed for mercury, with the results being communicated shortly thereafter to the women. A dietary questionnaire was filled in. Follow-up three months later included a dietary questionnaire and a repeat hair-mercury analysis. In the follow-up group, 22% of the women had hair-mercury concentrations above a safe limit of 0.58 µg/g at enrolment, decreasing to 8% three months later. Average hair-mercury concentrations decreased by 21%. However, the total seafood intake remained at the same level after three months. Increased exposure to methylmercury among pregnant women is an important public health concern in Denmark. The observed lowering of hair-mercury concentrations associated with dietary advice corresponds to a substantial public health benefit that probably makes such an intervention highly profitable.
Highlights
In a recent statement, an international society of gynaecologists and obstetricians recommended that health professionals make environmental public health part of health care and champion environmental justice [1]
As mercury contamination of seafood cannot be minimized in the short term, the only feasible public health intervention must rely on some form of dietary advice
Despite advisories issued by national food agencies, methylmercury exposures remain elevated among pregnant women in reproductive age groups [5]
Summary
An international society of gynaecologists and obstetricians recommended that health professionals make environmental public health part of health care and champion environmental justice [1]. Public health interventions to limit methylmercury exposures should focus on avoidance of fish known to be high in mercury [6], while avoiding simplified advisories that may scare women from eating otherwise healthy seafood [7]. Nudging can be a useful approach to public health and dietary interventions [8], and the present study relies on measurement of individual exposure levels to promote low-mercury seafood among pregnant women. We have previously used hair-mercury measurements as an indicator of recent methylmercury exposure after a revised seafood advisory [10], and an elevated hair-mercury result seems to motivate a subject to abstain from eating large, predatory fish [9]. We used individual hair-mercury analyses to motivate pregnant women to follow dietary guidelines with a view to limiting methylmercury exposures from contaminated seafood. An updated calculation suggests a more protective exposure limit of about 0.58 μg/g hair [12], and this limit was applied in an EU-wide comparison study [5] and in the present study as well
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