Fish But Not Supplements Consumed in Pregnancy Associated With Lower Rates of Autism Diagnosis And Related Traits, ECHO Cohort Study Finds

Authors: Emily Oken, Kristen Lyall, et al.

Who sponsored this study?

The Environmental influences on Child Health Outcomes (ECHO) Program, Office of the Director, National Institutes of Health supported this research.

Why was this study needed?

Fish consumption during pregnancy provides an important source of omega-3 fatty acids, an essential nutrient for supporting child health and neurodevelopment. However, in the U.S., people who are pregnant or can become pregnant are not eating enough fish or get enough omega-3 fatty acids through diet or supplements. Few studies have explored prenatal fish consumption and supplement use in association with autism spectrum disorder (ASD) diagnosis or autism-related traits. This study aims to investigate the relationship between fish consumption or omega-3 supplement use and an ASD diagnosis or the presence of autism-related traits.

What were the study results?

Fish consumption during pregnancy was associated with a 20% lower likelihood of ASD diagnosis and fewer autism-related traits in offspring. The associations were somewhat stronger for female offspring. Taking fish oil supplements containing omega-3 fatty acids during pregnancy was not associated with an ASD diagnosis or autism-related traits. However, supplement use was associated with a slight increase in scores on the Social Responsiveness Scale (SRS), a widely used survey completed by parents or caregivers to report on their child’s possible autism-related traits.

What was the study's impact?

These findings are consistent with current dietary guidelines that support fish intake during pregnancy and support continued public health efforts to encourage fish intake.

Who was involved?

The participants were children born between 1999 and 2019 and their parents at three of the Environmental influences on Child Health Outcomes (ECHO) Cohort research sites. The sites selected from samples considered a higher likelihood for autism, either due to family history or preterm birth.

What happened during the study?

The researchers studied the relationship between maternal fish intake and omega-3/fish oil supplement use during pregnancy and the occurrence of clinician-diagnosed autism and parent-reported autism-related traits. These traits were measured using the Social Responsiveness Scale (SRS), a widely used survey completed by parents or caregivers. Fish consumption and supplement use were assessed based on self-reported dietary information from participants.

Note: Results reported here are for a single study. Other or future studies may provide new information or different results. You should not make changes to your health without first consulting your healthcare professional.

What happens next?

Future research could examine how chemical contaminants found in some fish could potentially influence child health and development. Additional studies could look at the relationship between self-reported data on fish consumption and supplement use during pregnancy, biological markers of fish consumption, and child health outcomes. Combining biological data and self-reported data could provide a more complete picture of the overall benefits of fish consumption during pregnancy.

Where can I learn more?

Access the full journal article titled “Association of Maternal Fish Consumption and Omega-3 Supplement Use During Pregnancy with Child Autism-Related Outcomes: Results from a Cohort Consortium Analysis” in the American Journal of Clinical Nutrition.

The content is the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

Published September 2024

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Fish But Not Supplements Consumed in Pregnancy Associated With Lower Rates of Autism Diagnosis And Related Traits, ECHO Cohort Study Finds

Eating Fish But Not Omega-3 Supplements During Pregnancy Associated With Lower Likelihood Of Autism Diagnosis, NIH-Funded Study Finds

Posted on September 3, 2024August 27, 2025 by Jodi Snare

FOR IMMEDIATE RELEASE

Eating any amount of fish during pregnancy was associated with about a 20% lower likelihood of autism spectrum disorder (ASD) diagnosis, particularly in females, and a slight reduction in autism-related traits in offspring, according to a new study funded by the Environmental influences on Child Health Outcomes (ECHO) Program at the National Institutes of Health.

However, researchers did not find the same association with supplements containing omega-3 fatty acids.

Fish is an important source of omega-3 fatty acids, an essential nutrient during pregnancy for supporting maternal health and child neurodevelopment. A recent analysis of ECHO Cohort data revealed that about 25% of the pregnant participants reported never eating fish or consuming it less than once a month during their pregnancy. Even fewer participants reported taking omega-3 fish oil supplements.

ECHO Cohort researchers wanted to see whether low fish consumption and omega-3 supplement use during pregnancy might be associated with the occurrence of an autism diagnosis or parent-reported autism-related traits.

“Our study contributes to a growing body of evidence that demonstrates the role that prenatal diet can play in autism-related outcomes in offspring,” said ECHO Cohort researcher Emily Oken, MD, MPH, of Harvard Medical School.

Dr. Oken said the findings underscored the need for better public health messaging about guidelines for fish consumption for pregnant women, considering the low fish intake in the U.S. and the rising diagnoses of autism.

What happened during the study?

Researchers analyzed data from about 4,000 participants, examining the relationships among fish intake, supplement use, and neurodevelopmental outcomes related to autism.

Fish consumption and omega-3 supplement use were measured with dietary information reported by participants. Participants’ fish consumption was categorized as less than once a month, more than once a month but less than weekly, weekly, and two or more servings per week. About 20% of adult participants reported no fish intake, and most reported not using omega-3 or fish oil supplements.

The researchers then looked at the relationship between maternal fish intake and omega-3 fish oil supplement use during pregnancy and the occurrence of clinician-diagnosed autism and parent-reported autism-related traits. These traits were measured using the Social Responsiveness Scale (SRS), a widely used survey completed by parents or caregivers. Higher scores on the SRS indicate the presence of more autism-related behaviors.

Consuming fish during pregnancy was associated with a lower likelihood of offspring being diagnosed with autism and a slight decrease in total SRS scores compared to not eating fish. These results were consistent across all levels of fish consumption, from "any" amount or "less than once per week" to "more than twice per week." No significant associations were found between omega-3 fish oil supplements and autism diagnosis compared to no use.

Experts recommend that people consume additional omega-3 fatty acids during pregnancy. Prenatal fish intake is a key source of omega-3 fatty acids that are critical for fetal brain development. However, fish and omega-3 fatty acid supplementation in the U.S. is low.

“This study provides yet more evidence for the safety and benefit of regular fish consumption during pregnancy,” said Dr. Oken. “Other proven benefits include lower risk for preterm birth and improved cognitive development.”

Dr. Oken led this collaborative research published in the American Journal of Clinical Nutrition.

Oken, E. & Lyall, K. (2024) Association of maternal fish consumption and ω-3 supplement use during pregnancy with child autism-related outcomes: results from a cohort consortium analysis. American Journal of Clinical Nutrition. 10.1016/j.ajcnut.2024.06.013

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About ECHO: Launched in 2016, the Environmental influences on Child Health Outcomes (ECHO) Program is a research program in the Office of the Director at the NIH with the mission to enhance the health of children for generations to come. ECHO investigators study the effects of a broad range of early environmental influences on child health and development. For more information, visit echochildren.org.

About the NIH: NIH, the nation’s medical research agency, includes 27 Institutes and Centers and is a component of the U.S. Department of Health and Human Services. NIH is the primary federal agency conducting and supporting basic, clinical, and translational medical research, and is investigating the causes, treatments, and cures for both common and rare diseases. For more information, visit www.nih.gov.

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ECHO Study Finds Children with Autism at Higher Risk for a Range of Diverse Health Outcomes

Authors: Elizabeth Kaplan-Kahn, Kristen Lyall, Heather Volk, et al.

Who sponsored this study?

The Environmental influences on Child Health Outcomes (ECHO) Program, Office of the Director, National Institutes of Health supported this research.

Why was this study needed?

Approximately 3% of children in the United States have a diagnosis of autism spectrum disorder (or autism). A large proportion of autism research focuses on understanding the factors that influence the development of autistic traits. However, many people on the autism spectrum report that they would rather prioritize research into the factors that influence their overall health and well-being. This study addresses that priority by investigating the physical, emotional, and overall health outcomes of children on the autism spectrum.

What were the study results?

This study showed that autistic children are at higher risk than non-autistic children for poorer health outcomes indicated by lowest scores in Global Health and highest dysregulation scores (e.g. attention problems, aggressive behavior, and anxious-depressive symptoms). However, there is variability in health outcomes within autistic youth as shown by a group of autistic participants who showed high scores on positive health outcomes across domains. Additionally, compared to non-autistic children, more autistic children were born prematurely, had diagnoses of intellectual disability and ADHD, and had a sibling with autism.

What was the study's impact?

The results of this study offer a glimpse into the diversity of emotional, physical, and overall health outcomes for children on the autism spectrum. A deeper understanding of the range of health outcomes children with autism experience, and the factors that can affect these outcomes, may help families and practitioners identify and target areas for support or intervention.

Who was involved?

The study included over 4,500 children and adolescents at 29 ECHO research sites across the United States, including 286 participants with autism. The participants varied in age from 5 to 20 years old.

What happened during the study?

The researchers compared the health outcomes and demographic characteristics of a large sample of children, with 286 participants with autism and 4,225 participants without. They then used a subsample of 1,809 participants, of which 116 were autistic, to group children with similar physical health, emotional health, and overall well-being outcomes into one of three categories, “positive health,” “poorer health,” and “mixed health.” These categories were mostly determined by the results of multiple Patient-Reported Outcomes Measurement Information System (PROMIS) scales and other reports that evaluated participants’ peer relations, life satisfaction, behavior dysregulation, sleep disturbances, physical activity, etc. The three profiles of participants were then further analyzed to study differences in health outcomes between children on the autism spectrum to non-autistic children.

Footnote: Results reported here are for a single study. Other or future studies may provide new information or different results. You should not make changes to your health without first consulting your healthcare professional.

What happens next?

Future work may focus on understanding the factors that influence poor or positive health for children with autism and how those factors change over time. This work might identify opportunities to support these children and promote positive health outcomes.

Where can I learn more?

Access the full journal article, titled “Describing Multidomain Health Outcomes in Autistic Children in the ECHO Program,” in the Journal of the American Academy of Child and Adolescent Psychiatry.

The content is the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

Published August 27, 2024

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ECHO Study Finds Children with Autism at Higher Risk for a Range of Diverse Health Outcomes

ECHO Study Shows Fish Consumption and Omega-3 Supplement Use Uncommon During Pregnancy

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ECHO Study Shows Fish Consumption and Omega-3 Supplement Use Uncommon During Pregnancy

Authors: Emily Oken, Kristen Lyall, et al.

Who sponsored this study?

The Environmental influences on Child Health Outcomes (ECHO) Program, Office of the Director, National Institutes of Health supported this research.

Why was this study needed?

Omega-3 fatty acids are essential nutrients for supporting positive health outcomes. Getting enough of these nutrients during pregnancy is vital for child health and neurodevelopment and may also improve other pregnancy outcomes. Prior research on the demographic characteristics associated with fish and supplement use during pregnancy has been limited, involving fewer participants and older data that may not represent current intake.

What were the study results?

During the study, about 25% of pregnant participants did not eat any fish or ate it less than once per month. Older participants were more likely to eat fish. Participants who were non-Hispanic Black, non-Hispanic Asian, or Hispanic ate less fish on average when compared to those who identified as non-Hispanic White. Participants categorized as overweight were also less likely to eat fish. Only about 1 in 6 pregnant participants reported taking omega-3 supplements. Supplement use was more common in participants who were older and had more education, had a lower body mass index (BMI), and ate fish.

What was the study's impact?

One-quarter of participants in this large, nationwide study rarely or never consumed fish during pregnancy, and omega-3 supplement use was uncommon, even among those who did not consume fish. Given the role of omega-3 fatty acids in preventing preterm birth and supporting child health and neurodevelopment, experts recommend pregnant women get at least 500 mg of omega-3 fatty acids per day through supplements or consuming fish that is low in mercury.

Learn more about the FDA’s and EPA’s current recommendations for eating fish during pregnancy here.

Who was involved?

This study included 10,800 pregnant participants enrolled in 23 ECHO research sites that collected information on fish consumption and 12,646 participants at 35 ECHO research sites that collected information on omega-3 supplement use. Information on fish consumption and omega-3 supplement use was collected from pregnant participants from 1999 to 2020.

What happened during the study?

The researchers collected information on fish intake during pregnancy and grouped participants based on the frequency of their fish consumption: never or less than once per month, once per month to less than once per week, one to two times per week, or more than twice per week. The researchers also collected information on participants’ omega-3 supplement intake. They then compared participant fish consumption and supplement use information across various demographic and lifestyle characteristics, including age, race, ethnicity, education, weight, and smoking status.

Note: Results reported here are for a single study. Other or future studies may provide new information or different results. You should not make changes to your diet without first consulting your healthcare professional.

What happens next?

Future research may examine how fish consumption during pregnancy relates to childhood developmental outcomes such as autism-related traits.

Where can I learn more?

Access the full journal article titled “Demographic and health characteristics associated with fish and n-3 fatty acid supplement intake during pregnancy: results from pregnancy cohorts in the ECHO program” in Public Health Nutrition.

The content is the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

Published February 27, 2024

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ECHO Study Shows Fish Consumption and Omega-3 Supplement Use Uncommon During Pregnancy