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Table of Contents
Vol. 56, No. 2, 2010
Issue release date: March 2010
Section title: Original Paper
Free Access
Ann Nutr Metab 2010;56:119–126
(DOI:10.1159/000275918)

Higher Fish Consumption in Pregnancy May Confer Protection against the Harmful Effect of Prenatal Exposure to Fine Particulate Matter

Jedrychowski W.a · Perera F.d · Mrozek-Budzyn D.a · Flak E.a · Mroz E.a · Sochacka-Tatara E.a · Jacek R.a · Kaim I.b · Skolicki Z.c · Spengler J.D.e
aEpidemiology and Preventive Medicine and bObstetrics and Gynecology, College of Medicine, Jagiellonian University, and cObstetrics and Gynecology, Municipal Hospital, Krakow, Poland; dCenter for Children’s Environmental Health, Mailman School of Public Health, Columbia University, New York, N.Y., and eDepartment of Environmental Health, School of Public Health, Harvard University, Boston, Mass., USA
email Corresponding Author

Abstract

Background/Aim: The objective of this study was to assess a hypothesized beneficial effect of fish consumption during the last trimester of pregnancy on adverse birth outcomes resulting from prenatal exposure to fine air particulate matter. Methods: The cohort consisted of 481 nonsmoking women with singleton pregnancies, of 18–35 years of age, who gave birth at term. All recruited women were asked about their usual diet over the period of pregnancy. Measurements of particulate matter less than 2.5 µm in size (PM2.5) were carried out by personal air monitoring over 48 h during the second trimester of pregnancy. The effect of PM2.5 and fish intake during gestation on the birth weight of the babies was estimated from multivariable linear regression models, which beside the main independent variables considered a set of potential confounding factors such as the size of the mother (height, prepregnancy weight), maternal education, parity, the gender of the child, gestational age and the season of birth. Results: The study showed that the adjusted birth weight was significantly lower in newborns whose mothers were exposed to particulate matter greater than 46.3 µg/m3 (β coefficient = –97.02, p = 0.032). Regression analysis stratified by the level of maternal fish consumption (in tertiles) showed that the deficit in birth weight amounted to 133.26 g (p = 0.052) in newborns whose mothers reported low fish intake (<91 g/week). The birth weight deficit in newborns whose mothers reported medium (91–205 g/week) or higher fish intake (>205 g/week) was insignificant. The interaction term between PM2.5 and fish intake levels was also insignificant (β = –107,35, p = 0.215). Neither gestational age nor birth weight correlated with maternal fish consumption. Conclusions: The results suggest that a higher consumption of fish by women during pregnancy may reduce the risk of adverse effects of prenatal exposure to toxicants and highlight the fact that a full assessment of adverse birth outcomes resulting from prenatal exposure to ambient hazards should consider maternal nutrition during pregnancy.

© 2010 S. Karger AG, Basel


  

Key Words

  • Air pollutants
  • Prenatal exposure
  • Fish consumption
  • Birth size
  • Cohort study

References

  1. Perera F, Whyatt R, Jedrychowski W, et al: Recent developments in molecular epidemiology: a study of the effects of environmental polycyclic aromatic hydrocarbons on birth outcomes in Poland. Am J Epidemiol 1998;147:309–314.
  2. Sram RJ: Impact of air pollution on reproductive health. Environ Health Perspect 1999;107:542–543.

    External Resources

  3. Perera FP, Rauch V, Tsai WY, et al: Effects of transplacental exposure to environmental pollutants on birth outcomes in a multiethnic population. Environ Health Perspect 2003;111:201–205.
  4. Perera FP, Rauh V, Whyatt RM, et al: Molecular evidence of an interaction between prenatal environmental exposures and birth outcomes in a multiethnic population. Environ Health Perspect 2004;112:626–630.
  5. Bosley AR, Sibert JR, Newcombe RG: Effects of maternal smoking on fetal growth and nutrition. Arch Dis Child 1981;56:727–729.
  6. Martin TR, Bracken MB: Association of low birth weight with passive smoke exposure in pregnancy. Am J Epidemiol 1986;124:633–642.
  7. National Research Council: Environmental Tobacco Smoke: Measuring Exposures and Assessing Health Effects. Washington, National Academy Press, 1986.
  8. Ogawa H, Tominaga S, Hori K, Noguchi K, Kanou I, Matsubara M: Passive smoking by pregnant women and fetal growth. J Epidemiol Community Health 1991;45:164–168.
  9. Office of Health and Environmental Assessment, Office of Research and Development, US Environmental Protection Agency: The Respiratory Health Effects of Passive Smoking: Lung Cancer and Other Disorders. Publication No. EPA/600/6-90/006F. Washington, US Environmental Protection Agency, 1992.
  10. Jedrychowski W, Flak E: Confronting the prenatal effects of active and passive tobacco smoking on the birth weight of children. Cent Eur J Public Health 1996;3:201–205.
  11. Windham GC, Eaton A, Hopkins B: Evidence for an association between environmental tobacco smoke exposure and birthweight: a meta-analysis and new data. Paediatr Perinat Epidemiol 1999;13:35–57.
  12. Xu X, Ding H, Wang X: Acute effects of total suspended particles and sulfur dioxides on preterm delivery: a community-based cohort study. Arch Environ Health 1995;50:407–415.
  13. Wang X, Ding H, Ryan L, et al: Association between air pollution and low birth weight: a community-based study. Environ Health Perspect 1997;105:514–520.
  14. Woodruff TJ, Grillo J, Schoendorf KC: The relationship between selected causes of postneonatal infant mortality and particulate air pollution in the United States. Environ Health Perspect 1997;105:608–612.
  15. Pereira LA, Loomis D, Conceicao GM, et al: Association between air pollution and intrauterine mortality in Sao Paulo, Brazil. Environ Health Perspect 1998;106:325–329.
  16. Dejmek J, Selevan SG, Benes I, et al: Fetal growth and maternal exposure to particulate matter during pregnancy. Environ Health Perspect 1999;107:475–480.
  17. Bobak M: Outdoor air pollution, low birth weight, and prematurity. Environ Health Perspect 2000;108:173–176.
  18. Yang CY, Chiu HF, Tsai SS, et al: Increased risk of preterm delivery in areas with cancer mortality problems from petrochemical complexes. Environ Res 2002;89:195–200.
  19. Jedrychowski W, Bentkowska I, Flak E, et al: Estimated risk for altered fetal growth resulting from exposure to fine particles during pregnancy: an epidemiological prospective cohort study in Poland. Environ Health Perspect 2004;112:1398–1402.
  20. Choi H, Jedrychowski W, Spengler J, et al: International studies of prenatal exposure to polycyclic aromatic hydrocarbons and fetal growth. Environ Health Perspect 2006;114:1744–1750.
  21. Ghebremeskel K, Burns L, Burden TJ, et al: Vitamin A and related essential nutrients in cord blood: relationship with anthropometric measurements at birth. Early Hum Dev 1994;39:177–188.
  22. Navarro J, Bourgeay M, Desquillet N, et al: The vitamin status of low birth weight infants and their mothers. J Pediatr Gastroenterol Nutr 1994;3:744–748.

    External Resources

  23. Godfrey K, Robinson S, Barker DJP, et al: Maternal nutrition in early and late pregnancy in relation to placental and fetal growth. BMJ 1996;312:410–414.
  24. Godel JC, Basu TK, Pabst HF, et al: Perinatal vitamin A (retinol) status of northern Canadian mothers and their infants. Biol Neonate 1996;69:13–19.
  25. Kramer, MS: Maternal nutrition, pregnancy outcome and public health policy. Can Med Assoc J 1998;159:663–665.
  26. Mathews F, Yudkin P, Neil A: Influence of maternal nutrition on outcome of pregnancy: prospective cohort study. BMJ 1999;319:339–343.
  27. Rao S, Yajnik CS, Kanade A, et al: Intake of micronutrient-rich foods in rural Indian mothers is associated with the size of their babies at birth: Pune Maternal Nutrition Study. J Nutr 2001;131:1217–1224.
  28. Kramer MS: The epidemiology of adverse pregnancy outcomes: an overview. J Nutr 2003;133:1592–1596.
  29. Jedrychowski W, Masters E, Choi H, et al: Pre-pregnancy dietary vitamin A intake may alleviate the adverse birth outcomes associated with prenatal pollutant exposure: epidemiologic cohort study in Poland. Int J Occup Environ Health 2007;13:175–180.
  30. Clandidnin M, VanAende J, Antonson D, et al: Formulas with docosahexaenoic acid (GHA) and arachidonic acid (AA) promote better growth and development scores in very low birth weight infants. Pedriatr Res 2002;51:187–188.
  31. O’Connor D, Hall R, Adamkin D, et al. Growth and development in preterm infants fed log-chained polyunsaturated fatty acids: a prospective, randomized controlled trial. Pediatrics 2001;108:359–371.
  32. Olsen SF, Secher NJ: Low consumption of seafood in early pregnancy as a risk factor for preterm delivery: prospective cohort study. BMJ 2002;324:447–450.
  33. Fewtrell MF, Abbot RA, Kennedy K, et al: Randomized, double-blind trial of long-chain polyunsaturated fatty acid supplementation with fish oil and borage oil in preterm infants. J Pediatr 2004;144:471–479.
  34. Jedrychowski W, Whyatt RM, Camman DE, et al: Effect of prenatal PAH exposure on birth outcomes and neurocognitive development in a cohort of newborns in Poland. Study design and preliminary ambient data. Int J Occup Med Environ Health 2003;16:21–29.
  35. Spengler JD, Samet JM, McCarthy JF: Indoor Air Quality Handbook. New York, McGraw-Hill, 2001. Chapter 9: Air cleaning-particles, pp 9.1—9.28; Chapter 26: Multiple chemical intolerance and indoor air quality, pp 26.1–26.27; Chapter 70: Risk analysis framework, pp 70.3–70.38.
  36. Connor WE: Importance of n-3 fatty acids in health and disease. Am J Clin Nutr 2000;71 (1 suppl):171S—175S.
  37. Marckmann P, Gronbaek M: Fish consumption and coronary heart disease mortality: a systematic review of prospective cohort studies. Eur J Clin Nutr 1999;53:585–590.
  38. Guallar E, Sanz-Gallardo MI, Van’t Veer P, et al: Mercury, fish oils, and the risk of myocardial infarction. N Engl J Med 2002;347:1747–1754.
  39. Norat T, Bingham S, Fererari P, et al: Meat, fish, and colorectal cancer risk: the European Prospective Investigation into cancer and nutrition. J Natl Cancer Inst 2005;97:906–916.
  40. Jedrychowski W, Maugeri U, Pac A, et al: Protective effect of fish consumption on colorectal cancer risk. Hospital-based case-control study in Eastern Europe. Ann Nutr Metab 2008;53:295–302.
  41. Mori TA, Dunstan DW, Burke V, et al: Effects of dietary fish and exercise training on urinary F2-isoprostane excretion in non-insulin dependent diabetic patients. Metabolism 1999;48:1402–1408.
  42. Mori TA, Woodman RJ, Burke V, et al: Effect of eicosapentaenoic acid and docosahexaenoic acid on oxidative stress and inflammatory markers in treated-hypertensive type 2 diabetic subjects. Free Radic Biol Med 2003;35:772–781.
  43. Mori TA, Beilin LJ: Omega-3 fatty acids and inflammation. Curr Atheroscler Rep 2004;6:461–467.
  44. Yu D, Berlin JA, Penning TM, et al: Reactive oxygen species generated by PAH o-quinones cause change-in-function mutations in p53. Chem Res Toxicol 2002;15:832–842.
  45. Burdick AD, Davis JW, Liu KJ, et al: Benzo(a)pyrene quinones increase cell proliferation, generate reactive oxygen species, and transactivate the epidermal growth factor receptor in breast epithelial cells. Cancer Res 2003;63:7825–7833.
  46. Wu MT, Pan CH, Huang YL, et al: Urinary excretion of 8-hydroxy-2-deoxyguanosine and 1-hydroxypyrene in coke-oven workers. Environ Mol Mutagen 2003;42:98–105.
  47. Seike K, Murata M, Oikawa S, et al: Oxidative DNA damage induced by benz[a]anthracene metabolites via redox cycles of quinone and unique non-quinone. Chem Res Toxicol 2003;16:1470–1476.
  48. Ishimoto H, Natori M, Tanaka M, et al: Role of oxygen-derived free radicals in free growth retardation induced by ischemia-reperfusion in rats. Am J Physiol 1997;272:701–705.
  49. Saito K, Maeda M, Yoshihara H, et al: Effect of SOD-mimetic Fe-chlorine e6-Na on the level of brain lipid peroxide of rat fetal brains exposed to reactive oxygen species leading to intrauterine growth retardation. Biol Neonate 2000;77:109–114.
  50. Scholl TO, Stein TP: Oxidant damage to DNA and pregnancy outcome. J Matern Fetal Med 2001;10:182–185.
  51. Karowicz-Bilinska A, Suzin J, Sieroszewski P: Evaluation of oxidative stress indices during treatment in pregnant women with intrauterine growth retardation. Med Sci Monit 2002;8:211–216.
  52. Grandjean P, Weihe P, White RF, et al: Cognitive deficit in 7-year-old children with prenatal exposure to methylmercury. Neurotoxicol Teratol 1997;19:417–428.
  53. Chang LW, Reuhl KR, Spyker JM: Ultrastructural study of the latent effects of methyl mercury on the nervous system after prenatal exposures. Environ Res 1997;13:171–185.

    External Resources

  54. Davidson PW, Myers GJ, Cox C, et al: Effects of prenatal and postnatal methylmercury exposure from fish consumption on neurodevelopment: outcomes at 66 months of age in the Seychelles Child Development Study. JAMA 1998;280:701–707.
  55. Meyers GJ, Marsh DO, Davidson PW, et al: Prenatal methylmercury exposure from ocean fish consumption in the Seychelles Child Development Study. Lancet 2003;361:1686–1692.
  56. Center for Food Safety and Applied Nutrition: Consumer advisory: an important message for pregnant women and women of childbearing age who may become pregnant about the risks of mercury in fish. Food and Drug Administration, College Park, 2001.

  

Author Contacts

Wieslaw Jedrychowski, MD, PhD
Epidemiology and Preventive Medicine, College of Medicine Jagiellonian University
7, Kopernika str., PL–31-034 Krakow (Poland)
Tel. +48 12 423 1003, Fax +48 12 422 8795, E-Mail myjedryc@cyf-kr.edu.pl

  

Article Information

Received: February 16, 2009
Accepted after revision: September 17, 2009
Published online: February 4, 2010
Number of Print Pages : 8
Number of Figures : 0, Number of Tables : 4, Number of References : 56

  

Publication Details

Annals of Nutrition and Metabolism (Journal of Nutrition, Metabolic Diseases and Dietetics)

Vol. 56, No. 2, Year 2010 (Cover Date: March 2010)

Journal Editor: Elmadfa I. (Vienna)
ISSN: 0250-6807 (Print), eISSN: 1421-9697 (Online)

For additional information: http://www.karger.com/ANM


Copyright / Drug Dosage / Disclaimer

Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher or, in the case of photocopying, direct payment of a specified fee to the Copyright Clearance Center.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in goverment regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.

Abstract

Background/Aim: The objective of this study was to assess a hypothesized beneficial effect of fish consumption during the last trimester of pregnancy on adverse birth outcomes resulting from prenatal exposure to fine air particulate matter. Methods: The cohort consisted of 481 nonsmoking women with singleton pregnancies, of 18–35 years of age, who gave birth at term. All recruited women were asked about their usual diet over the period of pregnancy. Measurements of particulate matter less than 2.5 µm in size (PM2.5) were carried out by personal air monitoring over 48 h during the second trimester of pregnancy. The effect of PM2.5 and fish intake during gestation on the birth weight of the babies was estimated from multivariable linear regression models, which beside the main independent variables considered a set of potential confounding factors such as the size of the mother (height, prepregnancy weight), maternal education, parity, the gender of the child, gestational age and the season of birth. Results: The study showed that the adjusted birth weight was significantly lower in newborns whose mothers were exposed to particulate matter greater than 46.3 µg/m3 (β coefficient = –97.02, p = 0.032). Regression analysis stratified by the level of maternal fish consumption (in tertiles) showed that the deficit in birth weight amounted to 133.26 g (p = 0.052) in newborns whose mothers reported low fish intake (<91 g/week). The birth weight deficit in newborns whose mothers reported medium (91–205 g/week) or higher fish intake (>205 g/week) was insignificant. The interaction term between PM2.5 and fish intake levels was also insignificant (β = –107,35, p = 0.215). Neither gestational age nor birth weight correlated with maternal fish consumption. Conclusions: The results suggest that a higher consumption of fish by women during pregnancy may reduce the risk of adverse effects of prenatal exposure to toxicants and highlight the fact that a full assessment of adverse birth outcomes resulting from prenatal exposure to ambient hazards should consider maternal nutrition during pregnancy.

© 2010 S. Karger AG, Basel


  

Author Contacts

Wieslaw Jedrychowski, MD, PhD
Epidemiology and Preventive Medicine, College of Medicine Jagiellonian University
7, Kopernika str., PL–31-034 Krakow (Poland)
Tel. +48 12 423 1003, Fax +48 12 422 8795, E-Mail myjedryc@cyf-kr.edu.pl

  

Article Information

Received: February 16, 2009
Accepted after revision: September 17, 2009
Published online: February 4, 2010
Number of Print Pages : 8
Number of Figures : 0, Number of Tables : 4, Number of References : 56

  

Publication Details

Annals of Nutrition and Metabolism (Journal of Nutrition, Metabolic Diseases and Dietetics)

Vol. 56, No. 2, Year 2010 (Cover Date: March 2010)

Journal Editor: Elmadfa I. (Vienna)
ISSN: 0250-6807 (Print), eISSN: 1421-9697 (Online)

For additional information: http://www.karger.com/ANM


Article / Publication Details

First-Page Preview
Abstract of Original Paper

Received: 2/16/2009
Accepted: 9/17/2009
Published online: 2/4/2010
Issue release date: March 2010

Number of Print Pages: 8
Number of Figures: 0
Number of Tables: 4

ISSN: 0250-6807 (Print)
eISSN: 1421-9697 (Online)

For additional information: http://www.karger.com/ANM


Copyright / Drug Dosage

Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher or, in the case of photocopying, direct payment of a specified fee to the Copyright Clearance Center.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in goverment regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.

References

  1. Perera F, Whyatt R, Jedrychowski W, et al: Recent developments in molecular epidemiology: a study of the effects of environmental polycyclic aromatic hydrocarbons on birth outcomes in Poland. Am J Epidemiol 1998;147:309–314.
  2. Sram RJ: Impact of air pollution on reproductive health. Environ Health Perspect 1999;107:542–543.

    External Resources

  3. Perera FP, Rauch V, Tsai WY, et al: Effects of transplacental exposure to environmental pollutants on birth outcomes in a multiethnic population. Environ Health Perspect 2003;111:201–205.
  4. Perera FP, Rauh V, Whyatt RM, et al: Molecular evidence of an interaction between prenatal environmental exposures and birth outcomes in a multiethnic population. Environ Health Perspect 2004;112:626–630.
  5. Bosley AR, Sibert JR, Newcombe RG: Effects of maternal smoking on fetal growth and nutrition. Arch Dis Child 1981;56:727–729.
  6. Martin TR, Bracken MB: Association of low birth weight with passive smoke exposure in pregnancy. Am J Epidemiol 1986;124:633–642.
  7. National Research Council: Environmental Tobacco Smoke: Measuring Exposures and Assessing Health Effects. Washington, National Academy Press, 1986.
  8. Ogawa H, Tominaga S, Hori K, Noguchi K, Kanou I, Matsubara M: Passive smoking by pregnant women and fetal growth. J Epidemiol Community Health 1991;45:164–168.
  9. Office of Health and Environmental Assessment, Office of Research and Development, US Environmental Protection Agency: The Respiratory Health Effects of Passive Smoking: Lung Cancer and Other Disorders. Publication No. EPA/600/6-90/006F. Washington, US Environmental Protection Agency, 1992.
  10. Jedrychowski W, Flak E: Confronting the prenatal effects of active and passive tobacco smoking on the birth weight of children. Cent Eur J Public Health 1996;3:201–205.
  11. Windham GC, Eaton A, Hopkins B: Evidence for an association between environmental tobacco smoke exposure and birthweight: a meta-analysis and new data. Paediatr Perinat Epidemiol 1999;13:35–57.
  12. Xu X, Ding H, Wang X: Acute effects of total suspended particles and sulfur dioxides on preterm delivery: a community-based cohort study. Arch Environ Health 1995;50:407–415.
  13. Wang X, Ding H, Ryan L, et al: Association between air pollution and low birth weight: a community-based study. Environ Health Perspect 1997;105:514–520.
  14. Woodruff TJ, Grillo J, Schoendorf KC: The relationship between selected causes of postneonatal infant mortality and particulate air pollution in the United States. Environ Health Perspect 1997;105:608–612.
  15. Pereira LA, Loomis D, Conceicao GM, et al: Association between air pollution and intrauterine mortality in Sao Paulo, Brazil. Environ Health Perspect 1998;106:325–329.
  16. Dejmek J, Selevan SG, Benes I, et al: Fetal growth and maternal exposure to particulate matter during pregnancy. Environ Health Perspect 1999;107:475–480.
  17. Bobak M: Outdoor air pollution, low birth weight, and prematurity. Environ Health Perspect 2000;108:173–176.
  18. Yang CY, Chiu HF, Tsai SS, et al: Increased risk of preterm delivery in areas with cancer mortality problems from petrochemical complexes. Environ Res 2002;89:195–200.
  19. Jedrychowski W, Bentkowska I, Flak E, et al: Estimated risk for altered fetal growth resulting from exposure to fine particles during pregnancy: an epidemiological prospective cohort study in Poland. Environ Health Perspect 2004;112:1398–1402.
  20. Choi H, Jedrychowski W, Spengler J, et al: International studies of prenatal exposure to polycyclic aromatic hydrocarbons and fetal growth. Environ Health Perspect 2006;114:1744–1750.
  21. Ghebremeskel K, Burns L, Burden TJ, et al: Vitamin A and related essential nutrients in cord blood: relationship with anthropometric measurements at birth. Early Hum Dev 1994;39:177–188.
  22. Navarro J, Bourgeay M, Desquillet N, et al: The vitamin status of low birth weight infants and their mothers. J Pediatr Gastroenterol Nutr 1994;3:744–748.

    External Resources

  23. Godfrey K, Robinson S, Barker DJP, et al: Maternal nutrition in early and late pregnancy in relation to placental and fetal growth. BMJ 1996;312:410–414.
  24. Godel JC, Basu TK, Pabst HF, et al: Perinatal vitamin A (retinol) status of northern Canadian mothers and their infants. Biol Neonate 1996;69:13–19.
  25. Kramer, MS: Maternal nutrition, pregnancy outcome and public health policy. Can Med Assoc J 1998;159:663–665.
  26. Mathews F, Yudkin P, Neil A: Influence of maternal nutrition on outcome of pregnancy: prospective cohort study. BMJ 1999;319:339–343.
  27. Rao S, Yajnik CS, Kanade A, et al: Intake of micronutrient-rich foods in rural Indian mothers is associated with the size of their babies at birth: Pune Maternal Nutrition Study. J Nutr 2001;131:1217–1224.
  28. Kramer MS: The epidemiology of adverse pregnancy outcomes: an overview. J Nutr 2003;133:1592–1596.
  29. Jedrychowski W, Masters E, Choi H, et al: Pre-pregnancy dietary vitamin A intake may alleviate the adverse birth outcomes associated with prenatal pollutant exposure: epidemiologic cohort study in Poland. Int J Occup Environ Health 2007;13:175–180.
  30. Clandidnin M, VanAende J, Antonson D, et al: Formulas with docosahexaenoic acid (GHA) and arachidonic acid (AA) promote better growth and development scores in very low birth weight infants. Pedriatr Res 2002;51:187–188.
  31. O’Connor D, Hall R, Adamkin D, et al. Growth and development in preterm infants fed log-chained polyunsaturated fatty acids: a prospective, randomized controlled trial. Pediatrics 2001;108:359–371.
  32. Olsen SF, Secher NJ: Low consumption of seafood in early pregnancy as a risk factor for preterm delivery: prospective cohort study. BMJ 2002;324:447–450.
  33. Fewtrell MF, Abbot RA, Kennedy K, et al: Randomized, double-blind trial of long-chain polyunsaturated fatty acid supplementation with fish oil and borage oil in preterm infants. J Pediatr 2004;144:471–479.
  34. Jedrychowski W, Whyatt RM, Camman DE, et al: Effect of prenatal PAH exposure on birth outcomes and neurocognitive development in a cohort of newborns in Poland. Study design and preliminary ambient data. Int J Occup Med Environ Health 2003;16:21–29.
  35. Spengler JD, Samet JM, McCarthy JF: Indoor Air Quality Handbook. New York, McGraw-Hill, 2001. Chapter 9: Air cleaning-particles, pp 9.1—9.28; Chapter 26: Multiple chemical intolerance and indoor air quality, pp 26.1–26.27; Chapter 70: Risk analysis framework, pp 70.3–70.38.
  36. Connor WE: Importance of n-3 fatty acids in health and disease. Am J Clin Nutr 2000;71 (1 suppl):171S—175S.
  37. Marckmann P, Gronbaek M: Fish consumption and coronary heart disease mortality: a systematic review of prospective cohort studies. Eur J Clin Nutr 1999;53:585–590.
  38. Guallar E, Sanz-Gallardo MI, Van’t Veer P, et al: Mercury, fish oils, and the risk of myocardial infarction. N Engl J Med 2002;347:1747–1754.
  39. Norat T, Bingham S, Fererari P, et al: Meat, fish, and colorectal cancer risk: the European Prospective Investigation into cancer and nutrition. J Natl Cancer Inst 2005;97:906–916.
  40. Jedrychowski W, Maugeri U, Pac A, et al: Protective effect of fish consumption on colorectal cancer risk. Hospital-based case-control study in Eastern Europe. Ann Nutr Metab 2008;53:295–302.
  41. Mori TA, Dunstan DW, Burke V, et al: Effects of dietary fish and exercise training on urinary F2-isoprostane excretion in non-insulin dependent diabetic patients. Metabolism 1999;48:1402–1408.
  42. Mori TA, Woodman RJ, Burke V, et al: Effect of eicosapentaenoic acid and docosahexaenoic acid on oxidative stress and inflammatory markers in treated-hypertensive type 2 diabetic subjects. Free Radic Biol Med 2003;35:772–781.
  43. Mori TA, Beilin LJ: Omega-3 fatty acids and inflammation. Curr Atheroscler Rep 2004;6:461–467.
  44. Yu D, Berlin JA, Penning TM, et al: Reactive oxygen species generated by PAH o-quinones cause change-in-function mutations in p53. Chem Res Toxicol 2002;15:832–842.
  45. Burdick AD, Davis JW, Liu KJ, et al: Benzo(a)pyrene quinones increase cell proliferation, generate reactive oxygen species, and transactivate the epidermal growth factor receptor in breast epithelial cells. Cancer Res 2003;63:7825–7833.
  46. Wu MT, Pan CH, Huang YL, et al: Urinary excretion of 8-hydroxy-2-deoxyguanosine and 1-hydroxypyrene in coke-oven workers. Environ Mol Mutagen 2003;42:98–105.
  47. Seike K, Murata M, Oikawa S, et al: Oxidative DNA damage induced by benz[a]anthracene metabolites via redox cycles of quinone and unique non-quinone. Chem Res Toxicol 2003;16:1470–1476.
  48. Ishimoto H, Natori M, Tanaka M, et al: Role of oxygen-derived free radicals in free growth retardation induced by ischemia-reperfusion in rats. Am J Physiol 1997;272:701–705.
  49. Saito K, Maeda M, Yoshihara H, et al: Effect of SOD-mimetic Fe-chlorine e6-Na on the level of brain lipid peroxide of rat fetal brains exposed to reactive oxygen species leading to intrauterine growth retardation. Biol Neonate 2000;77:109–114.
  50. Scholl TO, Stein TP: Oxidant damage to DNA and pregnancy outcome. J Matern Fetal Med 2001;10:182–185.
  51. Karowicz-Bilinska A, Suzin J, Sieroszewski P: Evaluation of oxidative stress indices during treatment in pregnant women with intrauterine growth retardation. Med Sci Monit 2002;8:211–216.
  52. Grandjean P, Weihe P, White RF, et al: Cognitive deficit in 7-year-old children with prenatal exposure to methylmercury. Neurotoxicol Teratol 1997;19:417–428.
  53. Chang LW, Reuhl KR, Spyker JM: Ultrastructural study of the latent effects of methyl mercury on the nervous system after prenatal exposures. Environ Res 1997;13:171–185.

    External Resources

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