Awareness of Fish Advisories and Mercury Exposure in Women of Childbearing Age

May 2006: (I)250–256Brief Critical Review

Awareness of Fish Advisories and Mercury Exposure inWomen of Childbearing AgeSohyun Park, PhD, and Mary Ann Johnson, PhD

Methylmercury crosses the placenta and increases therisk of impaired neurodevelopment in the fetus. Fed-eral guidelines for fish intake and fish advisories arein place to help people of all ages limit their exposureto mercury from fish. However, recent studies suggestthat the awareness of fish advisories is low amongwomen of childbearing age. Fish intake is stronglycorrelated with hair mercury concentrations. Inwomen in states with fish advisories, hair mercuryconcentrations were 7-fold higher in women whoconsumed 20 or more servings of fish than in thosewho reported no fish consumption in the past 3 months(0.59 vs. 0.08 �g/g). Among this high fish con-sumption group, the 75th and 95th percentile of hairmercury concentrations were 0.99 and 2.29 �g/g,respectively. This is of concern because the US Envi-ronmental Protection Agency (EPA) recommends thathair mercury be less than 1 �g/g. Public healthcampaigns to reduce mercury exposure need furtherrefinement to reach women of childbearing age.© 2006 International Life Sciences Institute

doi: 10.1301/nr.2006.may.250–256

INTRODUCTION

Mercury is a toxic heavy metal that can be found infish, thermometers, dental amalgams, vaccine preserva-tives, and in the atmosphere. The primary mercurysource in humans is methylmercury-contaminated fish.1,2

Methylmercury in fish muscle is bound to protein; there-fore, skinning, trimming, and cooking do not reduce thecontent.3 Methylmercury toxicity is associated with se-rious health problems such as mental retardation, cere-bral palsy, deafness, blindness, and dysarthria due toprenatal exposure in infants and children, as well as

sensory impairment, motor impairment, and adverse ef-fects on the cardiovascular system in adults.2,4 Methyl-mercury has profound adverse effects on the immaturecentral nervous system of the fetus and infant and fewereffects on the mature central nervous system ofadults.2,5,6 Almost all methylmercury (90%–100%) israpidly absorbed after ingestion and spread throughoutthe human body.4 An amino acid carrier may transportmethylmercury across the blood-brain barrier and resultin accumulation of methylmercury in the fetal and adultbrain.7 In humans, the half-life of methylmercury isabout 50 days (range, 48–53 days) in the blood measuredin blood and hair samples and 70 to 80 days in the wholebody.4 The major excretory pathways of methylmercuryare bile, feces, urine, and breast milk.4

During pregnancy, methylmercury traverses the pla-centa and is amassed in the blood, brain, and othertissues of the fetus.2,3 Therefore, women of childbearingage are one of the special populations targeted for fishadvisories to minimize their exposure to methylmer-cury.8 Despite the critical effects of methylmercury onneurodevelopment in the fetus and in infants, the prev-alence of awareness of fish advisories related to mercurywas low (20%) in women of childbearing age.1,9

BIOMARKERS OF MERCURY EXPOSURE

There are several biomarkers for measuring mercuryconcentration in the body, such as hair, blood, cordblood, and breast milk.2,4 Among those biomarkers, bothhair and total blood mercury concentration are reason-able biomarkers for methylmercury concentration in theblood.4,10 Total mercury in blood reflects the most recentexposure of both methylmercury and inorganic mercury;however, methylmercury is the dominant form of totalmercury in blood.4 There is a high correlation betweenblood mercury concentration and estimated mercury in-take.10 In contrast, hair mercury concentration reflectsrelatively long-term mercury exposure according to thehair length analyzed, and indicates history of bloodmercury concentration.10 Methylmercury is about 90%of total mercury in hair.4 The average head hair growth

Drs. Park and Johnson are with the Department ofFoods and Nutrition, Faculty of Gerontology, The Uni-versity of Georgia, Athens, Georgia, USA.

Please address all correspondence to: Dr. MaryAnn Johnson, Department of Foods and Nutrition, TheUniversity of Georgia, Dawson Hall, Athens, GA30602; Phone: 706-542-2292; Fax: 706-542-5059;E-mail: [email protected].

250 Nutrition Reviews�, Vol. 64, No. 5

rate is 1.1 cm per month.4 Using this information, hairstrands can be cut into hair segments corresponding tothe dates of pregnancy, birth, and breast-feeding histo-ry.4,11 A mercury concentration in hair of 1 �g/g is themaximum safe level and corresponds to the EPA’s ref-erence dose of 5.8 �g/L in cord blood.4,12 Total mercuryconcentration of maternal blood plasma was correlatedwith total mercury concentration in newborn infants’cord blood.13 Cord blood mercury concentration ishighly correlated with fetal blood mercury concentrationduring the last trimester close to delivery.4,14 The con-centration of mercury in maternal hair was correlatedwith cord blood.15,16 Generally, mercury concentrationin hair is about 250-fold higher than in blood, and theratio depends on age. There is a median ratio of 196 atbirth, 370 at age 7, and 264 at age 14 years.16,17 Mercuryis excreted in breast milk.4 The concentration of totalmercury in breast milk varies among countries, with themean ranging from 0 to 13.9 �g/L.18 Methylmercury isabout 16% to 20% of total mercury in breast milk.4,13

Thus, infants could receive considerable exposure frombreast milk.

STANDARDS FOR MERCURY EXPOSURE

Benchmark dose levels (BMDL) have been set in theUnited States, and represent the lowest concentrations inhair and blood that are associated with a small increasedrisk of adverse effects of methylmercury. An estimatedBMDL of mercury in cord blood of 58 �g/L correspondsto a BMDL of 12 �g/g in hair. Applying a 10-fold safetyfactor to the BMDL yields a reference dose (RfD), anestimated amount of a chemical that a person can beexposed to on a daily basis without causing adversehealth effects over that person’s lifetime. The currentRfD for methylmercury intake is 0.1 �g/kg of bodyweight/d. This was set by the EPA in 200117 and by theNutrition Research Council in 2000.4 For a 60-kg person,this corresponds to an intake of 6 �g daily. The JointFood and Agriculture Organization of the United Na-tions/World Health Organization (FAO/WHO) ExpertCommittee on Food Additives set a provisional tolerableweekly intake of 1.6 �g/kg of body weight/week that isconsidered safe to the developing fetus, and would cor-respond to an intake of 14 �g daily (or 98 �g weekly) fora 60-kg person.19 Different underlying assumptions ac-count for the difference between the RfD and the provi-sional tolerable weekly intake.

A limit of 2 �g/L of mercury in drinking water hasbeen set by the EPA,20 and a limit of 1 �g/g of mercuryin seafood has been established by the US Food andDrug Administration (FDA).21 The consumption of 6ounces of fish weekly with 1 �g/g of mercury wouldprovide 28 �g/ounce, 168 �g/week, or an average of 24

�g daily, which provides the rationale for the recommen-dation that fish with higher mercury contents such asshark, swordfish, king mackerel, and tilefish (�1 �g/g)not be eaten by young children, nursing mothers, preg-nant women, and women of childbearing age.22

Methylmercury is the predominant form of mercuryin fish.4 The ratio of total mercury to methylmercury infish varies. Methylmercury content contributes approxi-mately 83% to 96% of total mercury in fish muscletissue.23,24

FISH ADVISORIES

The EPA and FDA jointly released fish advisorieson mercury in fish and shellfish in 2004 for the public.8

This national mercury advisory contains recommenda-tions for fish and shellfish intake with low mercuryexposure targeting the most vulnerable populations, suchas women, infants, and children.8,25 Current EPA andFDA advisories for “women who might become preg-nant, women who are pregnant, nursing mothers, andyoung children are”:

(1) do not eat fish high in mercury concentration,such as shark, swordfish, king mackerel, or tilefish;(2) eat up to 12 ounces (2 average meals) a week ofa variety of fish and shellfish that are lower inmercury such as shrimp, canned light tuna, salmon,pollock, and catfish. Albacore (white) tuna hasmore mercury content than canned light tuna. So,intake of albacore tuna should not exceed 6 ounces(one average meal) per week; (3) check localadvisories about the safety of fish caught in thelocal lakes, rivers, and coastal areas. If no advisoryis available, eat up to 6 ounces per week of fishcaught from local waters without any other fishintake during the same week.8

The FDA regulates and monitors mercury content indomestic and imported seafood in the United States.9,26

In addition to national mercury advisories, states volun-tarily issue local fish advisories and guidelines, includingmercury advisories in their water bodies, to protect thepopulation.9,27,28 State-issued fish advisories apply tonon-commercial fish and shellfish caught for sport, rec-reation, or subsistence activities.27 States monitor possi-ble chemical contamination by sampling fish. There isvariability in the tests and criteria state to state, so eachfish advisory is different.27 Therefore, it is difficult togeneralize and establish national advisories. States alsoissue safe-eating guidelines to the public providing in-formation on chemical contamination and notifyingwhich fish and shellfish are safe to eat without restric-tions.27 In some states, the fish advisory is also providedas a booklet when people purchase fishing licenses.9,28

251Nutrition Reviews�, Vol. 64, No. 5

FISH INTAKE

Fish intake is associated with hair and/or bloodmercury. Hair mercury concentration was positively as-sociated with advanced age and frequency of fish intakein NHANES data (1999–2000).29 Fish intake amongAmericans was lower than the current recommendation.In children ages 1 to 5 years, 26.4% had consumed fishone or two times and 24.8% had consumed more thanthree servings of fish in the past 30 days.29 In women 16to 49 years of age, 28.1% had eaten no fish/shellfish inthe past 30 days, 45.7% had consumed fish one to fourtimes (less than once a week), 13.5% had consumedfish/shellfish five to eight times (between once and twicea week), and only 9% had consumed fish/shellfish morethan nine times (more than twice a week) in the past 30days.30

Even though the average fish intakes among Amer-icans were relatively low, after the FDA released thenational mercury advisories in 2001,31 average fishconsumption was further decreased among pregnantwomen.32 The decreased fish consumption amongpregnant women in this cohort was caused by concernabout adverse health effects of mercury exposure.32

Some argue that high fish consumption with lowmercury intake during pregnancy has beneficial effectson neurodevelopment in fetuses and infants due to a highcontent of omega-3 fatty acids in fish.33 Therefore, ratherthan limiting fish intake, pregnant women should con-sume smaller-size fish and shellfish with low methylmer-cury content to meet the recommended amount of ome-ga-3 fatty acid and obtain other health benefits fromfish.34 Adequate intake for omega-3 fatty acid (�-linole-nic acid) during pregnancy is 1.4 g/d.35 Omega-3 fattyacids and mercury contents in commonly eaten fish areshown in Table 1. Consumption of 6 ounces per week ofthe fish listed would not exceed the weekly limits rec-ommended for mercury intakes.

NEUROTOXIC RISK OF METHYLMERCURYEXPOSURE DURING PREGNANCY ANDBREAST-FEEDING

Some, but not all, studies in human, animal, andcell-cultured models found that prenatal and postnatalmethylmercury exposure may impair the immature cen-tral nervous system in fetuses and infants.2,5,6,15,33,38-46

The major source of methylmercury exposure to fetusesand infants is maternal consumption during pregnancyand lactation of fish that were contaminated with meth-ylmercury.2 Prenatal and postnatal methylmercury expo-sure may cause adverse effects such as abnormalities inthe tendon, poor language development, lower neuro-logic optimality score, and neuropsychological deficits

(language, attention, memory, visuospatial, and motorfunctions) on fetuses, infants, and children.6,46 Althoughit is well documented that methylmercury is associatedwith a variety of health problems, the prevalence andimpacts of fish advisory awareness on mercury exposurein women of childbearing age is not well characterizedand will be discussed further below.1

FISH CONSUMPTION, ADVISORYAWARENESS, AND HAIR MERCURY LEVELSAMONG WOMEN OF CHILDBEARING AGE

Knobeloch et al.1 examined 3015 women 18 to 45years of age in 12 states to determine fish intake duringthe past 12 months, mercury advisory awareness, and

Table 1. Omega-3 Fatty Acid and Mercury Levelsin Commonly Eaten Fish Based on theConsumption of 6 Ounces (170 g) per Week

Fish/Shellfish DHA � EPA* Mercury†

g/6 ozSalmon (Atlantic and

farmed) 3.65 NDHerring 3.42 6.8Salmon (Atlantic and wild) 3.13 NDWhitefish 2.74 11.9Anchovy 2.46 6.8Oyster (Pacific) 2.34 NDMackerel (Atlantic) 2.05 8.5Sardines (Atlantic and

canned) 1.67 3.4Trout 1.59 5.1Bass (saltwater) 1.30 45.9Pollock 0.92 10.2Whiting 0.88 NDFlatfish 0.85 8.5Crab (blue) 0.81 10.2Oyster (eastern and

farmed) 0.75 NDCrab (Alaskan king) 0.70 10.2Snapper 0.55 32.3Shrimp 0.54 NDTuna (light and canned) 0.46 20.4Catfish 0.40 8.5Haddock 0.40 5.1

ND � No data; mercury concentration below the level ofdetection (0.001 �g/g).*From US Department of Health and Human Services and USDepartment of Agriculture. Addendum A: EPA and DHA Con-tent of Fish Species (Data from NDB SR 16-1). Available at:http://www.health.gov/dietaryguidelines/dga2005/report/HTML/table_g2_adda2.htm. Accessed April 7, 2006.†From US Food and Drug Administration. Mercury Levels inCommercial Fish and Shellfish. Available at: http://www.cfsan.fda.gov/%7Efrf/sea-mehg.html. Accessed April 7, 2006.


hair mercury concentrations. A random-digit-dial tele-phone survey was conducted from December 1998through August 1999. A women of child-bearing agefrom each household participated in this survey. Sixstates had issued statewide advisories and six had usedsite-specific advisories. Women were asked to estimatetheir average weekly or monthly intake of commercialand sport-caught fish during the past 12 months, as wellas their weekly or monthly intake of shellfish, commer-cial fish such as canned tuna, fish sticks, fish fillets, orfish sandwiches, and sport-caught fish. Women alsoreported whether their state had a consumption advisoryfor mercury in sport-caught fish.

Participants were invited to provide hair samples.Hair mercury was analyzed according to EPA method1631 (Revision B: mercury in water by oxidation, purge,and trap and cold vapor atomic absorption and fluores-cence), which has a detection limit of 0.002 �g/g forhair. For the total sample, demographic characteristicswere 78% Caucasian, 9% Hispanic/Spanish, 8% AfricanAmerican, 2% Asian/Pacific Islander, 2% American In-dian, and 1% other or unknown race/ethnicity. Sixty-fourpercent were married, 50% had incomes of more than$35,000 annually, about 30% had attended technicalschool or college, and 32% were college graduates.

Most participants had consumed fish in the past 12months (an average of 46 meals), and consumption ofsport-caught fish was lower than the other categories offish intake (Figure 1). Only 20% of women were awarethat their state had issued a fish consumption advisory formercury; awareness ranged from 8% to 32% among thevarious states, and did not vary between those states with

statewide advisories and those with site-specific adviso-ries. Among sport fish consumers, 28% knew that theirstate had issued an advisory for mercury. Mercuryawareness was higher in older than in younger women(27% of those 35 to 45 years of age vs. 7% of those 18to 24 years of age), higher education than lower educa-tion (24% among college graduates vs. 9% with less thanhigh school), higher income (24% with greater than$75,000 vs. 13% with less than $15,000), AmericanIndian women compared with other ethnic groups (31%vs. 7% to 22%), and those with fishing licenses (28%with fishing licenses vs. 16% without fishing licenses).Fish consumption was highest among Asian (46 meals/year) and American Indian women (53 meals/year);however, Asian women had the lowest fish advisoryawareness (7%) and American Indian women had thehighest (31%) among all ethnic groups. Women aware offish advisories consumed annually an average of 48 fishand seafood meals, compared with 41 meals for those notaware. Eating sport-caught fish was also associated withincreased awareness of the advisories (28% vs. 17%).Having a sport fish license was positively correlated withfish intake, such that those with a license consumedannually 47 fish and seafood meals and 9 sport fishmeals, while those without a license consumed 40 fishand seafood meals and 2 sport fish meals.

The subgroup of women (n � 414) who volunteeredfor mercury analyses of their hair was older, more likelyto be Caucasian, college educated, and have a householdincome greater than $35,000 compared with those whodid not provide hair samples. Hair donors were also morelikely to live in a household with a fishing license.

Figure 1. Consumption rates and types of fish eaten in past 12 months. Data are from Knobeloch L, Anderson HA, Imm P, PetersD, Smith A. Fish consumption, advisory awareness, and hair mercury levels among women of childbearing age. Environ Res.2005;97:220–227.


Although the number of women in minority groups wassmall, mean hair mercury was highest in Asian (1.24�g/g) and lowest in Hispanic (0.33 �g/g) and AmericanIndian (0.32 �g/g) women. Hair mercury concentrationswere more than twice as high among those with higherannual incomes compared with those with lower incomes(0.38 �g/g in those with incomes under $20,000 vs. 0.85�g/g in those with incomes over $75,000). Hair mercuryincreased with age (0.31, 0.52, and 0.50 �g/g in those18–25, 26–35, and 36–45 years of age, respectively),education (0.38, 0.39, and 0.61 �g/g in those with a highschool degree, some college, and a college degree, re-spectively), and being married compared with not beingmarried (0.54 �g/g vs. 0.39 �g/g, respectively). Havinga fishing license in the household or the consumption ofsports fish did not affect hair mercury. Overall fishconsumption was strongly associated with hair mercury(Figure 2). Average mercury concentrations in hair were7-fold higher in women who consumed 20 or moreservings of fish compared with those who reported nofish consumption in the past 3 months (0.59 vs. 0.08�g/g, respectively). Hair mercury levels exceeded 1.0�g/g in 12% of the women who provided hair samples,even though the amount of fish consumed was within thesafe range recommended by the FDA and EPA.

Hair mercury levels were similar to those reported insimilar age groups in NHANES 1999-2000 (geometricmean of 0.2 �g/g with 95% CI of 0.16–0.24).29 Othershave also reported that awareness of fish advisories arelow47 and that fish intake is associated with hair mer-cury.29 This study provides new information regarding

states with fish advisories and the limited impact thatthey appear to be having on mercury exposure. Strengthsof the study were that large numbers of women, severalminority groups, and 12 states participated. However,differences in ethnic groups should be interpreted withcaution because of the small number of women in severalof them. Also, the types of tuna and other fish consumedwere not reported. For example, there are differences inthe content of various types of tuna, with light cannedtuna (0.12 �g/g) having less mercury than albacorecanned tuna (0.35 �g/g).37

It may be difficult for women to determine anappropriate intake of fish because of conflicting mes-sages; for example, that the neurodevelopment of infantsmay benefit from the omega-3 fatty acids in fish33,34,48

but may be impaired by methylmercury in somefish.2,5,6,15,33,38-45 Also, the study by Knobeloch et al.1

does raise concern because approximately 12% ofwomen who reported eating fish in amounts consistentwith the FDA/EPA guidelines had hair mercury concen-trations in excess of recommended guidelines. Althoughthe types of fish were not reported in this study, thisobservation warrants further investigation in other pop-ulations to investigate the intake and types of fish andshellfish as well as other sources of mercury. Rather thaneliminating fish, women of childbearing age should con-tinue to consume fish that are known to be lowest inmercury—in amounts consistent with the FDA/EPA fishadvisories—so that their offspring receive the beneficialhealth effects of fish and shellfish.

Figure 2. Hair mercury at the 50th percentile and number of fish meals eaten in past 3 months prior to hair collection. Data are fromKnobeloch L, Anderson HA, Imm P, Peters D, Smith A. Fish consumption, advisory awareness, and hair mercury levels amongwomen of childbearing age. Environ Res. 2005;97:220–227.


REFERENCES

1. Knobeloch L, Anderson HA, Imm P, Peters D, SmithA. Fish consumption, advisory awareness, and hairmercury levels among women of childbearing age.Environ Res. 2005;97:220–227.

2. Counter SA, Buchanan LH. Mercury exposure inchildren: a review. Toxicol Appl Pharmacol. 2004;198:209–230.

3. US Environmental Protection Agency. Mercury Up-date: Impact on Fish Advisories 2001. USEPA-823-F-01-011. Available at: http://epa.gov/ost/fishadvice/mercupd.pdf. Accessed April 6, 2006.

4. National Research Council. Toxicological Effects ofMethylmercury. Washington, DC: National AcademyPress; 2000.

5. Davidson PW, Myers GJ, Weiss B. Mercury expo-sure and child development outcomes. Pediatrics.2004;113:1023–1029.

6. Castoldi AF, Coccini T, Ceccatelli S, Manzo L. Neu-rotoxicity and molecular effects of methylmercury.Brain Res Bull. 2001;55:197–203.

7. Kerper LE, Ballatori N, Clarkson TW. Methylmercurytransport across the blood-brain barrier by an aminoacid carrier. Am J Physiol. 1992;262(5 part 2):R761–R765.

8. US Department of Health and Human Services andUS Environmental Protection Agency. FDA and EPAAnnounce the Revised Consumer Advisory onMethylmercury in Fish. Available at: http://www.fda.gov/bbs/topics/news/2004/NEW01038.html.Accessed April 6, 2006.

9. Anderson HA, Hanrahan LP, Smith A, Draheim L,Kanarek M, Olsen J. The role of sport-fish consump-tion advisories in mercury risk communication: a1998-1999 12-state survey of women age 18-45.Environ Res. 2004;95:315–324.

10. Clarkson TW. Mercury. Ann Rev Public Health.1983;4:375–380.

11. Clarkson TW. Mercury: major issues in environmen-tal health. Environ Health Perspect. 1993;100:31–38.

12. US Environmental Protection Agency. MercuryStudy Report to Congress. Volume IV: An Assess-ment of Exposure to Mercury in the United States.1997. EPA-452/R-97-006. Available at: http://www.epa.gov/ttn/oarpg/t3/reports/volume4.pdf. AccessedApril 6, 2006.

13. Skerfving S. Mercury in women exposed to methyl-mercury through fish consumption, and in theirnewborn babies and breast milk. Bull Environ Con-tam Toxicol. 1988;41:475–482.

14. Gill US, Schwartz HM, Bigras L. Results of multiyearinternational interlaboratory comparison programfor mercury in human hair. Arch Environ ContamToxicol. 2002;43:466–472.

15. Grandjean P, Budtz-Jørgensen E, White RF, et al.Methylmercury exposure biomarkers as indicatorsof neurotoxicity in children aged 7 years. Am JEpidemiol. 1999;150:301–305.

16. Budtz-Jørgensen E, Grandjean P, Jørgensen PJ,Weihe P, Keiding N. Association between mercuryconcentrations in blood and hair in methylmercury-exposed subjects at different ages. Environ Res.2004;95:385–393.

17. US Environmental Protection Agency. Water QualityCriterion for the Protection of Human Health: Meth-ylmercury, Final. 2001. USEPA-823-R-01-001.Available at: http://www.epa.gov/waterscience/criteria/methylmercury/merctitl.pdf. Accessed April6, 2006.

18. Barbosa AC, Dorea JG. Indices of mercury contam-ination during breast feeding in the Amazon Basin.Environ Toxicol Pharmacol. 1998;6:71–79.

19. Food and Agriculture Organization of the UnitedNations and World Health Organization. Joint FAO/WHO Expert Committee on Food Additives. Sixty-First Meeting, Rome, 10-19 June 2003: Summaryand Conclusions. Available at: ftp://ftp.fao.org/es/esn/jecfa/jecfa61sc.pdf. Accessed April 6, 2006.

20. US Environmental Protection Agency. TechnicalFactsheet on Mercury. Available at: http://www.epa.gov/OGWDW/dwh/t-ioc/mercury.html. AccessedApril 6, 2006.

21. US Food and Drug Administration. Center for FoodSafety & Applied Nutrition. Fish and Fisheries Prod-ucts Hazards and Controls Guidance: 3rd Ed. 2001.Chapter 10: Methyl Mercury (A Chemical Hazard).Available at: http://www.cfsan.fda.gov/�comm/haccp4j.html. Accessed April 6, 2006.

22. US Food and Drug Administration. Backgrounder forthe 2004 FDA/EPA Consumer Advisory: What YouNeed to Know About Mercury in Fish and Shell-fish. Available at: http://www.fda.gov/oc/opacom/hottopics/mercury/backgrounder.html. AccessedApril 6, 2006.

23. Kehrig HA, Malm O, Akagi H, Guimaraes JRD,Torres JPM. Methylmercury in fish and hair samplesfrom the Balbina Reservoir, Brazilian Amazon. En-viron Res Section A. 1998;77:84–90.

24. Kannan K, Smith Jr. RG, Lee RF, et al. Distributionof total mercury and methyl mercury in water, sed-iment, and fish from south Florida Estuaries. ArchEnviron Contam Toxicol. 1998;34:109–118.

25. US Department of Health and Human Services andUS Environmental Protection Agency. What YouNeed to Know about Mercury in Fish and Shellfish.Available at: http://www.epa.gov/waterscience/fishadvice/advice.html. Accessed April 6, 2006.

26. US Food and Drug Administration. Mercury Con-centrations in Fish: FDA Monitoring Program (1990-2004). Available at: http://www.cfsan.fda.gov/�frf/seamehg2.html. Accessed April 6, 2006.

27. US Environmental Protection Agency. National List-ing of Fish Advisories. Available at: http://epa.gov/waterscience/fish/advisories/factsheet.pdf. AccessedApril 7, 2006.

28. US Environmental Protection Agency. ConsumptionAdvice. Joint Federal Advisory for Mercury in Fish.Advisory Programs in Your State. Available at: http://epa.gov/waterscience/fish/states.htm. Accessed April7, 2006.

29. McDowell MA, Dillon CF, Osterloh J, et al. Hairmercury levels in US children and women of child-bearing age: reference range data from NHANES1999-2000. Environ Health Perspec. 2004;112:1165–1171.

30. Mahaffey KR, Clickner RP, Bodurow CC. Bloodorganic mercury and dietary mercury intake: Na-tional Health and Nutrition Examination Survey,


1999 and 2000. Environ Health Perspect. 2004;112:562–570.

31. US Food and Drug Administration. FDA AnnouncesAdvisory on Methylmercury in Fish (FDA Talk Paper).Available at: http://www.cfsan.fda.gov/�lrd/tphg-fish.html. Accessed April 7, 2006.

32. Oken E, Kleinman KP, Berland WE, Simon SR, Rich-Edwards JW, Gillman MW. Decline in fish consump-tion among pregnant women after a national mer-cury advisory. Obstet Gynecol. 2003;102:346–351.

33. Daniels JL, Longnecker MP, Rowland AS, GoldingJ, the ALSPAC study team-University of Bristol In-stitute of Child Health. Fish intake during pregnancyand early cognitive development of offspring. Epi-demiol. 2004;15:394–402.

34. Sakamoto M, Kubota M, Liu XJ, Murata K, Nakai K,Satoh H. Maternal and fetal mercury and n-3 poly-unsaturated fatty acids as a risk and benefit of fishconsumption to fetus. Environ Sci Technol. 2004;38:3860–3863.

35. Food and Nutrition Board, Institute of Medicine.Dietary Reference Intakes for Energy, Carbohydrate,Fiber, Fat, Fatty Acids, Cholesterol, Protein, andAmino Acids (Macronutrients). Washington, DC: Na-tional Academies Press; 2002. Available at: http://www.nap.edu/books/0309085373/html. AccessedApril 7, 2006.

36. US Department of Health and Human Services andUS Department of Agriculture. Addendum A: EPAand DHA Content of Fish Species (Data from NDBSR 16-1). Available at: http://www.health.gov/dietaryguidelines/dga2005/report/HTML/table_g2_adda2.htm. Accessed April 7, 2006.

37. US Food and Drug Administration. Mercury Levelsin Commercial Fish and Shellfish. Available at:http://www.cfsan.fda.gov/%7Efrf/sea-mehg.html.Accessed April 7, 2006.

38. Grandjean P, White RF, Weihe P, JørgensenPJ. Neurotoxic risk caused by stable and variableexposure to methylmercury from seafood. Ambula-tory Pediatrics. 2003;3:18–23.

39. Davidson PW, Myers GJ, Cox C, et al. Effects of

prenatal and postnatal methylmercury exposurefrom fish consumption on neurodevelopment out-comes at 66 months of age in the Seychelles ChildDevelopment Study. JAMA. 1998;280:701–707.

40. Myers GJ, Davidson PW, Cox C, Shamlaye CF,Cernichiari E, Clarkson TW. Twenty-seven yearsstudying the human neurotoxicity of methylmercuryexposure. Environ Res Section A. 2000;83:275–285.

41. Myers GJ, Davidson PW, Cox C, et al. Prenatalmethylmercury exposure from ocean fish consump-tion in the Seychelles child development study. Lan-cet. 2003;361:1686–1692.

42. Castoldi AF, Barni S, Turin I, Gandini C, Manzo L.Early acute necrosis, delayed apoptosis and cy-toskeletal breakdown in cultured cerebellar granuleneurons exposed to methylmercury. J NeurosciRes. 2000;59:775–787.

43. Nagashima K, Fujii Y, Tsukamoto T, et al. Apoptoticprocess of cerebellar degeneration in experimentalmethylmercury intoxication of rats. Acta Neuro-pathol. 1996;91:72–77.

44. Bulleit RF, Cui H. Methylmercury antagonizes thesurvival-promoting activity of insulin-like growthfactor on developing cerebellar granule neurons.Toxicol Appl Pharmacol. 1998;153:161–168.

45. Vicente E, Boer M, Leite M, et al. Cerebrospinal fluidS100B increases reversibly in neonates of methylmercury-intoxicated pregnant rats. Neurol Toxicol.2004;25:771–777.

46. US Environmental Protection Agency. MercuryStudy Report to Congress. Volume V: Health Effectsof Mercury and Mercury Compounds. 1997. EPA-452/R-97-007. Available at: http://www.epa.gov/ttn/oarpg/t3/reports/volume5.pdf. Accessed April 7,2006.

47. Steenport DM, Anderson HA, Hanrahan LP, et al.Fish consumption habits and advisory awarenessamong Fox river anglers. Wisconsin Medical Jour-nal. 2000;November:43–46.

48. Smith KM, Sahyoun NR. Fish consumption: Recom-mendations versus advisories, can they be recon-ciled? Nutr Rev. 2005;63:39–46.


Documents

Awareness of Fish Advisories and Mercury Exposure in Women of Childbearing Age