Seafood During Pregnancy and Lactation and Child Neurocognitive Development: A Systematic Review

Abstract

ABSTRACT Background: Assessing seafood as a food group, rather than as a source of omega-3 fatty acids or contaminants, may better inform dietary guidance for pregnancy and lactation. Objectives: This study aims to assess relationships between seafood consumption during pregnancy and lactation and neurocognitive development in the child. Methods: Three electronic databases were searched up to September 2024 to update a previous search from 2000 to 2019. Articles were included if seafood intake during pregnancy or lactation and a child outcome was assessed [neurocognitive development including cognitive, social–emotional, behavioral, movement/physical, language/communication, and aggregate scores as well as depression, anxiety, attention-deficit/hyperactivity disorder (ADHD), and autism spectrum disorder (ASD)]. Articles were screened at title, abstract, and full-text levels independently by 2 analysts. Data were extracted, quality checked, and synthesized narratively considering the direction, magnitude, and statistical significance of results. The risk of bias was assessed using study design-specific tools. Certainty of evidence was assessed using Grading of Recommendations Assessment, Development and Evaluations. Results: Forty articles [1 randomized controlled trial (RCT), 24 prospective cohorts, and 1 retrospective cohort] during pregnancy were identified; none for lactation. Evidence suggested relationships between higher seafood consumption and better social–emotional and behavioral development in children and adolescents aged 0–18 y as well as better aggregate scores of development for those <4 y. The certainty of the evidence was very low to moderate due to the lack of RCTs. Evidence for overall cognitive development was inconsistent but higher seafood may be related to better attention, reasoning and problem-solving, and verbal intelligence. However, evidence was limited in the number of studies and ages assessed. Evidence was inconsistent for movement/physical and language/communication development, and a paucity of studies was found for ADHD and ASD. Conclusions: Seafood consumption within currently recommended amounts during pregnancy may be associated with better social- –emotional, behavioral, and aggregate scores of development in the child, as well as potentially some aspects of cognitive development. This study was registered at PROSPERO as CRD42023432844. Keywords: fish, shellfish, omega-3 fatty acids, childhood, adolescence, infants and toddlers