Background:
Fishing is a culturally important activity to the ethnically diverse population living in the Sacramento-San Joaquin Delta. Unfortunately, due to mercury runoff from abandoned gold mines, many fish in this region are contaminated with methylmercury, a neurodevelopmental toxin.

Objectives:
We partnered with a private practice obstetrician and his staff in Sacramento, CA to carry out a study with the following research objectives:
1. Characterize mercury exposure among a population of mostly low-income, pregnant women through a fish intake questionnaire and blood mercury tests.
2. Assess the feasibility of incorporating blood mercury testing into clinical practice, and the extent to which Medi-Cal and other health insurance providers will cover such testing.
3. Through training and education, increase knowledge among office staff and patients about health risks and benefits of fish consumption and ways to reduce exposure to mercury.

Methods:
We characterized fish-consumption practices among 180 ethnically diverse, low-income pregnant patients, and measured their blood mercury levels. Trained medical assistants conducted interviews and provided educational sessions. Protocols were developed to guide clinical staff in communicating mercury test results to the women, follow-up, and education.
Data analysis is proceeding and will include:
a) Study population characteristics
b) Fish consumption rate (commercial, sport, overall; g/d and g/kg body weight/day; above advisory limits)
c) Predictors of mercury level, fish consumption, and advisory awareness

Results:
Preliminary results indicate 11% of the women surveyed had blood mercury levels greater than recommended health-based levels of ~6 ug/l. Nationally, about 6% of women of childbearing age have blood levels >5.8 ug/l. Our preliminary results also indicate:
1. Information re benefits and risks regarding fish consumption can be successfully incorporated into preconceptual and prenatal care practices.
2. Certain ethnic populations are more likely to consume fish above recommended guidelines and may be more at risk for exposure to mercury and other chemicals commonly found in fish.
3. Guidelines and criteria for identifying women at risk of having high blood mercury levels can aid providers in referring women to obtain blood tests to determine mercury levels.

Conclusion and implications for practice: