. 2018 Mar 26;21(11):2149–2159. doi: 10.1017/S1368980018000599

Table 2.

Recommendations on fish consumption related to mercury in pregnancy in individual countries

Country	Year	Do not eat	Limit	Eat freely/General advice
North America
USA⁽ ²⁵ ⁾ ^*,^†	2017	For women of childbearing age (16–49 years) and especially during pregnancy and breast-feeding: ∙ King mackerel, marlin, orange roughy, shark, swordfish, tilefish (Gulf of Mexico), tuna (bigeye) ∙ Additional warning on large carp, catfish, trout and perch caught by family and friends: check with state advisories (if no advisory in place, eat only 1 serving and no other fish that week)	For women of childbearing age (16–49 years) and especially during pregnancy and breast-feeding: Eat 2–3 servings per week^†† from ‘Best choices’ or 1 serving per week^†† from ‘Good choices’ list ∙ ‘Good choices’. Eat 1 serving/week: bluefish, buffalo fish, carp, Chilean sea bass/Patagonian toothfish, grouper, halibut, mahi mahi/dolphinfish, monkfish, rockfish sable fish, sheepshead, snapper, Spanish mackerel, striped bass (ocean), tilefish (Atlantic Ocean), tuna (albacore/white tuna, canned and fresh/frozen), tuna (yellowfin), white croaker/pacific croaker ∙ ‘Best choices’. Eat 2–3 servings/week: anchovy, Atlantic croaker, Atlantic mackerel, black sea bass, butterfish, catfish, clam, cod, crab, crawfish, flounder, haddock, hake, herring, lobster (American and spiny), mullet, oyster, Pacific chub mackerel, perch (freshwater and ocean), pickerel, plaice, pollock, salmon, sardine, scallop, shad, shrimp, skate, smelt, sole, squid, tilapia, trout (freshwater), tuna (canned light – includes skipjack), whitefish, whiting)	For women of childbearing age (16–49 years) and especially during pregnancy and breast-feeding: ∙ Eat a variety of fish
Canada⁽ ³² ⁾ ^†	ND	–	When trying to get pregnant/during pregnancy/during breast-feeding: ∙ Limit some predatory fish to less than 150 g per month: tuna (fresh and frozen), shark, swordfish, marlin, orange roughy, escolar ∙ Limit canned (white) albacore tuna to no more than 300 g per week	When trying to get pregnant/during pregnancy/during breast-feeding: ∙ Eat at least 150 g of cooked fish per week ∙ Vary type of fish eaten ∙ No limit on other types of canned tuna (e.g. skipjack, yellowfin, tongol)
Australasia
Australia/New Zealand⁽ ²⁹ ⁾	2011	–	When trying to get pregnant/during pregnancy: ∙ 2–3 servings per week of any fish and seafood not listed below; or ∙ 1 serving (150 g cooked) per week of orange roughy (sea perch) or catfish and no other fish that week; or ∙ 1 serving (150 g cooked) per fortnight of shark (flake), marlin or broadbill/swordfish, and no other fish that fortnight	–
New Zealand⁽ ⁶⁸ ⁾	ND	–	During pregnancy: ∙ No more than 3 servings (150 g/serving) per week: uncanned wild-caught (not farmed) salmon, uncanned albacore tuna or mackerel, kahawai, red cod, orange roughy and ling ∙ Once every 2 weeks (or not at all if eating other types of fish): school shark, southern bluefin tuna, marlin and trout from geothermal regions and Lake Rotomahana ∙ Bluff and pacific oysters, queen scallops^**	During pregnancy: ∙ Canned tuna (skipjack or albacore), canned salmon, mackerel, sardines, farmed salmon, terakihi, blue cod, hoki, john dory, monkfish, warehou, whitebait, flat fish (e.g. flounder)
Europe
UK⁽ ²⁰ ^– ²³ ⁾ ^‡	2017, 2015, 2015, 2015	When trying to get pregnant/during pregnancy: ∙ Shark, swordfish, marlin ∙ Raw shellfish^¶	When trying to get pregnant: ∙ Limit amount of tuna^‡‡ to not more than (i) two tuna steaks per week (each about 140 g cooked weight or 170 g when raw) or (ii) four medium-sized cans of tuna per week (about 140 g per can when drained) During pregnancy: ∙ Limit amount of tuna^‡‡ to not more than (i) two tuna steaks per week (each about 140 g cooked weight or 170 g when raw) or (ii) four medium-sized cans of tuna per week (about 140 g when drained) ∙ Limit amount of oily fish^‡‡ to not more than two portions per week (oily fish includes fresh tuna, salmon, trout, mackerel, herring, sardines, pilchards) ∙ Limit amount of other fish to not more than two portions per week (other fish includes dogfish (rock salmon), sea bass, sea bream, turbot, halibut, crab)^§§ During breast-feeding: ∙ Not more than two portions of oily fish per week ∙ No limit on canned tuna ∙ Not more than one portion per week of shark, swordfish or marlin^§§	Eat at least two portions of fish per week (at least one should be oily fish but no more than two) No need to limit or avoid other types of white and non-oily fish such as cod, haddock, plaice, coley, skate, hake, flounder, gurnard^††
Germany⁽ ⁶⁹ ⁾	2013	During pregnancy: ∙ Carnivorous fish such as tuna and swordfish ∙ Smoked fish	–	During pregnancy: ∙ Two portions of fish per week, with one portion of oily fish (mackerel, herring, sardines or salmon) ∙ For women who do not eat seafood regularly, it is recommended that they take a supplement containing DHA
France⁽ ³⁰ ⁾	2016	During pregnancy/during breast-feeding: ∙ Shark, lamprey, swordfish, marlin, siki	During pregnancy/during breast-feeding: ∙ Limit to 150 g per week: monkfish or angler fish, Atlantic wolf-fish, bonito, eels and elvers, emperor, orange roughy, rosy soldierfish, grenadier, Atlantic halibut, megrim, mullet, pike, plain bonito, poor cod, Portuguese dogfish, rays (skate), redfish, Atlantic sailfish, silver and black scabbardfish, sea bream, pandora, black or striped escolar, oilfish, snake mackerel, sturgeon, tuna, etc.	Eat fish twice per week, including oily fish (salmon, mackerel, sardines, anchovies, smoked trout, herring, etc.) Eat a variety of fish
Spain⁽ ⁷⁰ ⁾	ND	During pregnancy: ∙ Swordfish, fresh tuna, pike, shark ∙ Raw fish, smoked fish, oysters, clams, raw mussels	–	Eat a wide variety of fish Eat fish 3–4 times per week (mainly oily fish)
Italy⁽ ⁷¹ ⁾	2016	–	During pregnancy: ∙ 1–2 up to 3–4 servings of fish per week; prefer small fish such as sardines, mackerel and anchovies with high n-3 fatty acid content During breast-feeding: ∙ 2 servings of fish per week	–
The Netherlands⁽ ¹⁹ ⁾	2015	During pregnancy: ∙ Predatory fish such as sharks, king mackerel, swordfish, tilefish, tuna (except canned tuna) ∙ Wild eels and mitten crabs from Dutch waters	–	Eat fish twice per week, including at least one portion of oily fish
Ireland⁽ ³¹ ⁾	2004	Shark, swordfish, marlin	During pregnancy: ∙ Not more than two portions of oily fish per week ∙ Not more than two fresh tuna steaks per week or four cans of tuna per week	Eat two portions per week, including one portion of oily fish
Sweden⁽ ²⁴ ⁾	2008	–	During pregnancy: ∙ Eat maximum 2–3 times per year: Atlantic halibut, burbot, perch, pike, pikeperch, ray, shark, swordfish, tuna (fresh/frozen) ∙ Eat maximum 2–3 times per year^**: Baltic herring, fermented herring, salmon and salmon trout from the Baltic Sea, Lakes Vaneren and Vattern, and char from Lake Vattern	Eat fish 2–3 times per week Eat a variety of fish Safe to eat: all farmed fish, Alaska pollock, anchovies, blue mussels, canned tuna, catfish, cod, crab (white flesh), crayfish, fishballs, fish-fingers, flounders/dabs, haddock, hake, herring (including pickled), hoki, lobster, mackerel, plaice, prawns, saithe, salmon, trout, sardines, scallops, stockfish, tilapia, whitefish, etc.
Finland⁽ ³⁴ ⁾	ND	During pregnancy/while breast-feeding: ∙ Pike ∙ Raw-cured or smoke-cured fish, raw fish	During pregnancy: ∙ Fish from the Baltic Sea, such as salmon, trout and large Baltic herrings (>17 cm), should not be eaten more than once or twice per month	During pregnancy: ∙ Eat a variety of fish (such as saithe, trout, rainbow trout, Arctic char, whitefish and vendace) two to three times per week
Norway⁽ ³³ ⁾	2011	Shrimp, Greenland halibut >3 kg, freshwater fish (pike, perch >25 cm, trout >1 kg, char >1 kg), exotic fish (hai, swordfish, skater, fresh tuna), fish liver and fish liver products Avoid brown crab meat, digestive tract in scallops, kidneys of horse mussels^** Additional advisories online regarding on fish caught by friends and family: preferably avoid	–	Eat fish 2–3 times per week (300–450 g) (at least 200 g should be oily fish: salmon, trout, mackerel, herring) Canned tuna
Denmark⁽ ⁷² ⁾	ND	During pregnancy: ∙ Canned white tuna or albacore When trying to get pregnant/during pregnancy/during breast-feeding: ∙ Large predatory fish such as tuna, rockfish, halibut, escolar, swordfish, herring, shark, perch, pike and pikeperch	When trying to get pregnant/during pregnancy/during breast-feeding: ∙ Not more than one serving (125 g) of salmon from the Baltic Sea per month^**	During pregnancy: ∙ Eat 350 g per week, 200 g of which should be oily and from a variety of fish (plaice, red tuna, flounder, cod, haddock, hake, squid, fish eggs, and oily fish such as mackerel, herring and farmed salmon)
Iceland⁽ ⁷³ ⁾	ND	Pregnancy: ∙ Raw fish, cured fish, cold-smoked fish, dried fish, sushi, pickled whale, cod liver, shark, swordfish, large halibut, fulmar, fulmar eggs	During pregnancy: ∙ Eat no more than one serving per week of tuna fish steak, orange roughy ∙ Eat no more than two servings per week of canned tuna, guillemot eggs, minke whale meat	Eat fish twice per week
Asia
Israel⁽ ⁷⁴ ⁾	2017	During pregnancy: ∙ Large fish such as shark, swordfish, king mackerel, tilefish, tuna steaks and white tuna (albacore) ∙ Raw and cold cured fish	–	Consume fish from locally available fish, including pond fish and canned light tuna. Eat a variety of fish
Japan⁽ ²⁷ ⁾ ^§	2005	–	During pregnancy: ∙ Up to 80 g (average 1 meal) per 2 months: bottlenose dolphin ∙ Up to 80 g (1 meal) per 2 weeks: short-finned pilot whale ∙ Up to 80 g (1 meal) per week: swordfish, bluefin tuna, bigeye tuna, finely striate buccinum^║║, Baird’s beaked whale, sperm whale ∙ Up to 160 g (average 2 meals) per week: yellowback sea bream, marlin, Hilgendorf’s saucord, southern bluefin tuna, blue shark, Dall’s porpoise	Tuna species other than those listed plus canned tuna
Korea⁽ ⁷⁵ ⁾ ^║	2013	Tuna, raw fish	–	During pregnancy: ∙ Eat fish daily

ND, not dated.

Includes an infographic illustrating the categories and portion sizes. Endorsed by the American College of Obstetricians and Gynaecologists with the additional advice that pregnant women should avoid raw and undercooked seafood⁽ ⁷⁶ ⁾.

^†

Other guidelines and advisories for North American populations are shown in Oken et al. (2012)⁽ ²⁸ ⁾.

^‡

Based on the NHS Choices website ‘Should pregnant and breastfeeding women avoid some types of fish?’⁽ ²¹ ⁾.

^§

Online translation from original.

^║

Newspaper article reporting advice from the Korea Health Promotion Foundation.

^¶

Raw shellfish is not advised in pregnancy as it can be a microbiological hazard, but cooked shellfish can be eaten freely⁽ ²² ⁾.

^**

High levels of Cd, Pb, polychlorinated biphenyls and/or dioxins.

^††

A serving is defined as 4 oz for an adult (about 110 g). The guidance also applies to ‘young children’, who are advised to eat 1–2 servings of fish/week starting at age 2 years (child’s serving defined as 2 oz (about 55 g)).

^‡‡

Under the guidance, canned tuna does not count as oily fish so is not included in the maximum of two portions of oily fish per week. However, because of the higher Hg level in tuna, if eating canned tuna, the advice is not to pick fresh tuna as one of the tally of oily fish.

^§§

The NHS Choices website ‘Your pregnancy and baby guide. Foods to avoid in pregnancy’ omits these points⁽ ²⁰ ⁾.

^║║

A type of whelk.