Fish Consumption during Pregnancy in Relation to National Guidance in England in a Mixed-Methods Study: The PEAR Study
2.1. Overall Design
2.2. Questionnaire: Quantitative Data
- Screening questions (consent, location during pregnancy, age of baby).
- Demographics (e.g., geographical location, ethnicity, age, highest educational qualification, household income, parity). Where comparable data were available, the values were compared with the most recent values for the population in England to gauge the representativeness of the participants [21,22,23].
- Consumption of fish (before and during pregnancy). There were three questions in relation to fish consumption (Table 1). The items included were seafood items listed in the NHS website with guidance to avoid or limit during pregnancy because of potential mercury exposure. The questionnaire did not include items that involved guidance on preparation or cooking methods (uncooked shellfish, sushi without freezing the raw fish) or supplements derived from fish oil (for example, cod liver oil). Assessment of compliance with guidance on thoroughly cooking smoked fish or only eating sushi comprising cooked fish was not included as these were added as updates to the guidance after the survey had closed.
- Sources of information about the guidance (e.g., midwife or other healthcare professional, NHS website, other websites, leaflets, apps, friends and relatives). Participants were also asked to provide free text on which sources of information they trusted and which they felt less confident in. The questions in this section allowed for multiple answers to be given.
2.3. In-Depth Interviews: Qualitative Data
2.4.1. Questionnaire: Quantitative Data
2.4.2. In-Depth Interviews: Qualitative Data
3.1. Questionnaire: Quantitative Data
3.2. In-Depth Interviews: Qualitative Data
3.2.1. Changes in Fish Consumption during Pregnancy
3.2.2. Salient Fish Messages: Avoid, Limit and Cook Thoroughly
3.2.3. Fish Guidance Is the Most Complicated
3.2.4. Reasons for Low Fish Consumption during Pregnancy
4.1. Strengths and Limitations
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
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|Questions in Relation to Fish||Response Options|
|Thinking about fish, was there any difference in how often you ate it during your recent pregnancy compared with before you were pregnant?||Ate more often|
Ate less often
Ate before pregnancy but avoided during recent pregnancy
Don’t eat anyway
Don’t know/Can’t remember
|Before your recent pregnancy how often did you eat fish?|
While you were pregnant recently how often did you eat fish?
Less than twice a week
Twice a week
More than twice a week
Don’t know/Can’t remember
|Before your recent pregnancy how often did you eat these types of fish and seafood?|
While you were pregnant recently how often did you eat these types of fish and seafood?
Less than once per month
1–2 times a month
Once a week
Several times a week
Don’t know/Can’t remember
|Characteristic||Completing Questionnaire||Completing In-Depth Discussion|
|n||Value||National Indicator [23,24,25]||n||Value|
|Age (years)||548||Range 21–46, Median 33 (IQR 30–36)||Mean maternal age at birth 30.5||14||Range 30–41, Median 34|
|North East/North West/Yorkshire and Humberside||153 (26%)||28%||0|
|East Midlands/West Midlands||106 (18%)||20%||3|
|East/Greater London/South East/South West||339 (57%)||53%||11|
|Highest educational attainment||596||14|
|None/GCSE/Vocational level 1 and 2/AS or A level/Vocational level 3||114 (19%)||50%||1|
|University degree (BSc, BA)/Professional qualification/Vocational levels 4 and 5/University higher degree (MA, MSc, PhD)||482 (81%)||50%||13|
|Age of baby (months)||598||14|
|Followed a particular diet before pregnancy||598||14|
|Paid work during pregnancy||598||14|
|Home internet access||598||14|
|Total Fish||N||Frequency of Consumption in Total Group a||Compliance with Guidance on Total Number of Portions per Week b|
|Total a||Consumers||Never||<Twice per Week||Twice per Week||>Twice per Week||Chi Square Test p Value||All Respondents||Consumers Only|
|Before pregnancy||595||500 (84%)||95 (16%)||319 (54%)||142 (24%)||39 (7%)||<0.001||181 (30%)||181 (36%)|
|During pregnancy||595||495 (83%)||100 (17%)||338 (57%)||131 (22%)||26 (4%)||157 (26%)||157 (32%)|
|Fish Type||N||Frequency of Consumption in Total Group a|
|Total||Consumers||Never||Less than Once per Month||About One or Two Times per Month||About Once per Week||Several Times per Week||Chi Square Test p Value|
|Before pregnancy||597||483 (81%)||114 (19%)||104 (17%)||246 (41%)||123 (21%)||10 (2%)||<0.001|
|During pregnancy||598||466 (78%)||131 (22%)||120 (20%)||205 (34%)||133 (22%)||8 (1%)|
|Before pregnancy||595||405 (68%)||190 (32%)||93 (16%)||159 (27%)||131 (22%)||22 (4%)||<0.001|
|During pregnancy||596||364 (61%)||232 (39%)||87 (15%)||144 (24%)||118 (20%)||15 (3%)|
|Before pregnancy||586||45 (8%)||541 (92%)||45 (7%)||0 (0%)||0 (0%)||0 (0%)||<0.001|
|During pregnancy||590||5 (1%)||585 (99%)||5 (1%)||0 (0%)||0 (0%)||0 (0%)|
|Before pregnancy||595||420 (71%)||175 (29%)||112 (19%)||182 (31%)||103 (17%)||23 (4%)||<0.001|
|During pregnancy||593||377 (64%)||216 (36%)||113 (19%)||157 (26%)||95 (16%)||12 (2%)|
|Before pregnancy||588||163 (28%)||425 (72%)||131 (22%)||22 (4%)||5 (1%)||5 (1%)||<0.001|
|During pregnancy||587||50 (9%)||537 (91%)||39 (7%)||11 (2%)||0 (0%)||0 (0%)|
|Before pregnancy||593||359 (61%)||234 (39%)||170 (29%)||135 (23%)||49 (8%)||5 (1%)||<0.001|
|During pregnancy||595||216 (36%)||379 (64%)||108 (18%)||75 (13%)||30 (5%)||3 (1%)|
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Beasant, L.; Ingram, J.; Taylor, C.M. Fish Consumption during Pregnancy in Relation to National Guidance in England in a Mixed-Methods Study: The PEAR Study. Nutrients 2023, 15, 3217. https://doi.org/10.3390/nu15143217
Beasant L, Ingram J, Taylor CM. Fish Consumption during Pregnancy in Relation to National Guidance in England in a Mixed-Methods Study: The PEAR Study. Nutrients. 2023; 15(14):3217. https://doi.org/10.3390/nu15143217Chicago/Turabian Style
Beasant, Lucy, Jenny Ingram, and Caroline M. Taylor. 2023. "Fish Consumption during Pregnancy in Relation to National Guidance in England in a Mixed-Methods Study: The PEAR Study" Nutrients 15, no. 14: 3217. https://doi.org/10.3390/nu15143217