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Maternal nutrition, infants and children

Maternal fish consumption during pregnancy and risks of wheezing and eczema in childhood: The Generation R Study



Maternal fish consumption during pregnancy might influence the fetal immune system through anti-inflammatory effects of omega-3 fatty acids, and might affect the risks of childhood asthma and atopy. In Generation R, a prospective cohort study in the Netherlands, we examined the associations of first trimester fish consumption with childhood wheezing and eczema in the first 4 years of life.


In total, 2976 mothers completed a 293-item semiquantitative food frequency questionnaire covering dietary intake in the first trimester. The occurrence of wheezing and eczema was yearly assessed by questionnaires.


Median weekly fish consumption was 83 (95% range 0–316) grams per week. We observed no consistent associations of maternal total-, lean- or fatty-fish consumption during pregnancy with the risks of childhood wheezing. Maternal shellfish consumption of 1–13 g per week was associated with overall increased risks of childhood wheezing and eczema (OR 1.20 (1.04, 1.40) and OR 1.18 (1.01, 1.37), respectively). Maternal fatty fish consumption of 35–69 g per week was associated with increased overall risks of childhood eczema (OR 1.17 (1.00, 1.38)), but maternal total- or lean-fish consumption was not.


During pregnancy, shellfish consumption was associated with increased risks of wheezing and eczema, while fatty fish consumption was associated with a higher risk of eczema only. Maternal total fish or lean fish consumption were not associated with wheezing or eczema. Further studies are needed to replicate these findings and to explore underlying mechanisms.

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  1. Duijts L . Fetal and infant origins of asthma. Eur J Epidemiol 2012; 27: 5–14.

    Article  Google Scholar 

  2. Asher MI, Montefort S, Bjorksten B, Lai CK, Strachan DP, Weiland SK et al. Worldwide time trends in the prevalence of symptoms of asthma, allergic rhinoconjunctivitis, and eczema in childhood: ISAAC Phases One and Three repeat multicountry cross-sectional surveys. Lancet 2006; 368: 733–743.

    Article  Google Scholar 

  3. Gluckman PD, Hanson MA, Cooper C, Thornburg KL . Effect of in utero and early-life conditions on adult health and disease. N Engl J Med 2008; 359: 61–73.

    CAS  Article  Google Scholar 

  4. Calder PC, Kremmyda LS, Vlachava M, Noakes PS, Miles EA . Is there a role for fatty acids in early life programming of the immune system? Proc Nutr Soc 2010; 69: 373–380.

    CAS  Article  Google Scholar 

  5. Devereux G, Seaton A . Diet as a risk factor for atopy and asthma. J Allergy Clin Immunol 2005; 115: 1109–1117., quiz 18.

    Article  Google Scholar 

  6. Prescott SL, Calder PC . N-3 polyunsaturated fatty acids and allergic disease. Curr Opin Clin Nutr Metab Care 2004; 7: 123–129.

    CAS  Article  Google Scholar 

  7. Gochfeld M, Burger J . Good fish/bad fish: a composite benefit-risk by dose curve. Neurotoxicology 2005; 26: 511–520.

    CAS  Article  Google Scholar 

  8. Calvani M, Alessandri C, Sopo SM, Panetta V, Pingitore G, Tripodi S et al. Consumption of fish, butter and margarine during pregnancy and development of allergic sensitizations in the offspring: role of maternal atopy. Pediatr Allergy Immunol 2006; 17: 94–102.

    Article  Google Scholar 

  9. Denburg JA, Hatfield HM, Cyr MM, Hayes L, Holt PG, Sehmi R et al. Fish oil supplementation in pregnancy modifies neonatal progenitors at birth in infants at risk of atopy. Pediatr Res 2005; 57: 276–281.

    CAS  Article  Google Scholar 

  10. Dunstan JA, Mitoulas LR, Dixon G, Doherty DA, Hartmann PE, Simmer K et al. The effects of fish oil supplementation in pregnancy on breast milk fatty acid composition over the course of lactation: a randomized controlled trial. Pediatr Res 2007; 62: 689–694.

    CAS  Article  Google Scholar 

  11. Furuhjelm C, Warstedt K, Larsson J, Fredriksson M, Bottcher MF, Falth-Magnusson K et al. Fish oil supplementation in pregnancy and lactation may decrease the risk of infant allergy. Acta Paediatr 2009; 98: 1461–1467.

    Article  Google Scholar 

  12. Krauss-Etschmann S, Hartl D, Rzehak P, Heinrich J, Shadid R, Del Carmen Ramirez-Tortosa M et al. Decreased cord blood IL-4, IL-13, and CCR4 and increased TGF-beta levels after fish oil supplementation of pregnant women. J Allergy Clin Immunol 2008; 121: 464–70 e6.

    CAS  Article  Google Scholar 

  13. Lauritzen L, Kjaer TM, Fruekilde MB, Michaelsen KF, Frokiaer H . Fish oil supplementation of lactating mothers affects cytokine production in 2 1/2-year-old children. Lipids 2005; 40: 669–676.

    CAS  Article  Google Scholar 

  14. Olsen SF, Osterdal ML, Salvig JD, Mortensen LM, Rytter D, Secher NJ et al. Fish oil intake compared with olive oil intake in late pregnancy and asthma in the offspring: 16 y of registry-based follow-up from a randomized controlled trial. Am J Clin Nutr 2008; 88: 167–175.

    CAS  Article  Google Scholar 

  15. Palmer DJ, Sullivan T, Gold MS, Prescott SL, Heddle R, Gibson RA et al. Effect of n-3 long chain polyunsaturated fatty acid supplementation in pregnancy on infants’ allergies in first year of life: randomised controlled trial. Bmj 2012; 344: e184.

    CAS  Article  Google Scholar 

  16. Prescott SL, Barden AE, Mori TA, Dunstan JA . Maternal fish oil supplementation in pregnancy modifies neonatal leukotriene production by cord-blood-derived neutrophils. Clin Sci (Lond) 2007; 113: 409–416.

    CAS  Article  Google Scholar 

  17. Romieu I, Torrent M, Garcia-Esteban R, Ferrer C, Ribas-Fito N, Anto JM et al. Maternal fish intake during pregnancy and atopy and asthma in infancy. Clin Exp Allergy 2007; 37: 518–525.

    CAS  Article  Google Scholar 

  18. Salam MT, Li YF, Langholz B, Gilliland FD . Maternal fish consumption during pregnancy and risk of early childhood asthma. J Asthma 2005; 42: 513–518.

    Article  Google Scholar 

  19. Sausenthaler S, Koletzko S, Schaaf B, Lehmann I, Borte M, Herbarth O et al. Maternal diet during pregnancy in relation to eczema and allergic sensitization in the offspring at 2 y of age. Am J Clin Nutr 2007; 85: 530–537.

    CAS  Article  Google Scholar 

  20. Warstedt K, Furuhjelm C, Duchen K, Falth-Magnusson K, Fageras M . The effects of omega-3 fatty acid supplementation in pregnancy on maternal eicosanoid, cytokine, and chemokine secretion. Pediatr Res 2009; 66: 212–217.

    CAS  Article  Google Scholar 

  21. Willers SM, Devereux G, Craig LC, McNeill G, Wijga AH, Abou El-Magd W et al. Maternal food consumption during pregnancy and asthma, respiratory and atopic symptoms in 5-year-old children. Thorax 2007; 62: 773–779.

    CAS  Article  Google Scholar 

  22. Willers SM, Wijga AH, Brunekreef B, Kerkhof M, Gerritsen J, Hoekstra MO et al. Maternal food consumption during pregnancy and the longitudinal development of childhood asthma. Am J Respir Crit Care Med 2008; 178: 124–131.

    Article  Google Scholar 

  23. Jaddoe VW, van Duijn CM, Franco OH, van der Heijden AJ, van Iizendoorn MH, de Jongste JC et al. The Generation R Study: design and cohort update 2012. Eur J Epidemiol 2012; 27: 739–756.

    Article  Google Scholar 

  24. Klipstein-Grobusch K, den Breeijen JH, Goldbohm RA, Geleijnse JM, Hofman A, Grobbee DE et al. Dietary assessment in the elderly: validation of a semiquantitative food frequency questionnaire. Eur J Clin Nutr 1998; 52: 588–596.

    CAS  Article  Google Scholar 

  25. Donders-Engelen M, VDHLHK Maten Gewichten Codenummers (Measures Weights Code Numbers). Vakgroep Humane Voeding, Landbouwuniversiten Wageningen en TNO Voeding Zeist: Wageningen; The Netherlands, 2003.

    Google Scholar 

  26. Heppe DH, Steegers EA, Timmermans S, Breeijen H, Tiemeier H, Hofman A et al. Maternal fish consumption, fetal growth and the risks of neonatal complications: the Generation R Study. Br J Nutr 2011; 105: 938–949.

    CAS  Article  Google Scholar 

  27. Asher MI, Keil U, Anderson HR, Beasley R, Crane J, Martinez F et al. International Study of Asthma and Allergies in Childhood (ISAAC): rationale and methods. Eur Respir J. 1995; 8: 483–491.

    CAS  Article  Google Scholar 

  28. Sonnenschein-van der Voort AM, Jaddoe VW, Raat H, Moll HA, Hofman A, de Jongste JC et al. Fetal and infant growth and asthma symptoms in preschool children: the Generation R Study. Am J Respir Crit Care Med 2012; 185: 731–737.

    Article  Google Scholar 

  29. Jaddoe VW, van Duijn CM, van der Heijden AJ, Mackenbach JP, Moll HA, Steegers EA et al. The Generation R Study: design and cohort update 2010. Eur J Epidemiol 2010; 25: 823–841.

    Article  Google Scholar 

  30. Beurs E . Brief Symptom Inventory. Leiden: The Netherlands.

  31. Nohr EA, Frydenberg M, Henriksen TB, Olsen J . Does low participation in cohort studies induce bias? Epidemiology 2006; 17: 413–418.

    Article  Google Scholar 

  32. Caudri D, Wijga A, Gehring U, Smit HA, Brunekreef B, Kerkhof M et al. Respiratory symptoms in the first 7 years of life and birth weight at term: the PIAMA Birth Cohort. Am J Respir Crit Care Med 2007; 175: 1078–1085.

    Article  Google Scholar 

  33. Harpsoe MC, Basit S, Bager P, Wohlfahrt J, Benn CS, Nohr EA et al. Maternal obesity, gestational weight gain, and risk of asthma and atopic disease in offspring: a study within the Danish National Birth Cohort. J Allergy Clin Immunol 2012, pii S0091-6749: 01502–01503.

    Google Scholar 

  34. Henderson J, Granell R, Heron J, Sherriff A, Simpson A, Woodcock A et al. Associations of wheezing phenotypes in the first 6 years of life with atopy, lung function and airway responsiveness in mid-childhood. Thorax 2008; 63: 974–980.

    CAS  Article  Google Scholar 

  35. Jenkins MA, Clarke JR, Carlin JB, Robertson CF, Hopper JL, Dalton MF et al. Validation of questionnaire and bronchial hyperresponsiveness against respiratory physician assessment in the diagnosis of asthma. Int J Epidemiol 1996; 25: 609–616.

    CAS  Article  Google Scholar 

  36. Halldorsson TI, Thorsdottir I, Meltzer HM, Nielsen F, Olsen SF . Linking exposure to polychlorinated biphenyls with fatty fish consumption and reduced fetal growth among Danish pregnant women: a cause for concern? Am J Epidemiol 2008; 168: 958–965.

    CAS  Article  Google Scholar 

  37. Miyake Y, Tanaka K, Yasutake A, Sasaki S, Hirota Y . Lack of association of mercury with risk of wheeze and eczema in Japanese children: the Osaka Maternal and Child Health Study. Environ Res 2011; 111: 1180–1184.

    CAS  Article  Google Scholar 

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The Generation R Study is conducted by the Erasmus Medical Center in close collaboration with the School of Law and the Faculty of Social Sciences at the Erasmus University, Rotterdam, the Municipal Health Service, Rotterdam area, and the Stichting Trombosedienst and Artsenlaboratorium Rijnmond (Star-MDC), Rotterdam. We gratefully acknowledge the contribution of general practitioners, hospitals, midwives and pharmacies in Rotterdam. The general design of the Generation R Study was made possible by financial support from the Erasmus Medical Center, Rotterdam, the Erasmus University Rotterdam and the Netherlands Organization for Health Research and Development. Dr Vincent Jaddoe received an additional grant from the Netherlands Organization for Health Research and Development (ZonMw 90700303, 916.10159). Prof Oscar H. Franco has received a grant from Pfizer nutrition to establish a center on ageing research called ErasmusAGE. Dr Liesbeth Duijts is the recipient of a European Respiratory Society/Marie Curie Joint Research Fellowship—Number MC 1226-2009. The research leading to these results has received funding from the European Respiratory Society and the European Community’s Seventh Framework Program FP7/2007-2013—Marie Curie Actions under grant agreement RESPIRE, PCOFUND-GA-2008-229571 and from the seventh framework program, project CHICOS (HEALTH-F2-2009-241504).

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Correspondence to L Duijts.

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Leermakers, E., Sonnenschein-van der Voort, A., Heppe, D. et al. Maternal fish consumption during pregnancy and risks of wheezing and eczema in childhood: The Generation R Study. Eur J Clin Nutr 67, 353–359 (2013).

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  • pregnancy
  • fish consumption
  • asthma symptoms
  • eczema
  • cohort study
  • atopy

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