McLean Pirkle Catherine, Peek-Ball Cheryl, Outerbridge Eugene, Rouja Philippe Max
Office of Public Health Studies. University of Hawai'i at Mãnoa. Honolulu, Hawai'i, United States of America.
Department of Health. Hamilton, Bermuda.
PLoS One. 2015 Oct 1;10(10):e0139459. doi: 10.1371/journal.pone.0139459. eCollection 2015.
In 2003 mean cord blood mercury concentrations in pregnant Bermudian women exceeded levels associated with adverse health outcomes in children. The principal mercury source was local fish species. Public health messages were developed suggesting pregnant women reduce consumption of fish species with higher mercury concentrations (e.g. swordfish), substituting species containing lower mercury concentrations, and elevated omega-3 fatty acids (e.g. anchovies). Recent evidence indicates mercury concentrations in Bermuda's pregnant women have fallen five- fold.
Assess whether changes in women's fish eating patterns during pregnancy are consistent with the public health messaging. Determine who is making changes to their diet during pregnancy and why.
Mixed methods study with a cross-sectional survey of 121 pregnant women, including 13 opened-ended interviews. Health system, social vulnerability, public health messaging, and socio-demographic variables were characterized and related to changes in fish consumption during pregnancy. Qualitative data were coded according to nutritional advice messages, comprehension of communication strategies, and sources of information.
95% of women surveyed encountered recommendations about fish consumption during pregnancy. 75% reported modifying fish eating behaviors because of recommendations. Principal sources of information about fish consumption in pregnancy were health care providers and the Internet. 71% of women reported reducing consumption of large fish species with greater mercury levels, but 60% reported reduced consumption of smaller, low mercury fish. No participant mentioned hearing about the benefits of fish consumption. More frequent exposure to public health messages during pregnancy was associated with lower reported consumption. Bermudian born women were less likely to reduce consumption of large fish species during pregnancy.
In Bermuda, public health messages advocating reduced consumption of larger, higher mercury-containing fish species appear effective, but masked the nutritional value message of small fish species, with low mercury concentration. Adjustment is needed to better balance the risk communication.
2003年，百慕大群岛怀孕女性的脐带血汞平均浓度超过了与儿童不良健康后果相关的水平。主要汞源是当地鱼类。为此制定了公共卫生信息，建议孕妇减少食用汞含量较高的鱼类（如箭鱼），转而食用汞含量较低且富含ω-3脂肪酸的鱼类（如凤尾鱼）。最近的证据表明，百慕大群岛孕妇的汞浓度已下降了五倍。
评估孕期女性鱼类食用模式的变化是否与公共卫生信息一致。确定孕期饮食发生变化的人群及其原因。
采用混合方法研究，对121名孕妇进行横断面调查，包括13次开放式访谈。对卫生系统、社会脆弱性、公共卫生信息和社会人口统计学变量进行了描述，并与孕期鱼类消费的变化相关联。定性数据根据营养建议信息、沟通策略的理解和信息来源进行编码。
95%的受访女性在孕期收到过关于鱼类消费的建议。75%的女性表示因这些建议改变了鱼类食用行为。孕期鱼类消费信息的主要来源是医疗保健人员和互联网。71%的女性报告减少了汞含量较高的大型鱼类的消费，但60%的女性报告减少了汞含量较低的小型鱼类的消费。没有参与者提到听说过食用鱼类的益处。孕期更频繁接触公共卫生信息与报告的消费量较低有关。在百慕大群岛出生的女性在孕期减少大型鱼类消费的可能性较小。
在百慕大群岛，倡导减少食用汞含量较高的大型鱼类的公共卫生信息似乎是有效的，但掩盖了汞含量较低的小型鱼类的营养价值信息。需要进行调整，以更好地平衡风险沟通。
