Background: Neonates born with low birth weight or preterm are at an increased risk of long-term adverse health outcomes. Research studies on the association of fish consumption during pregnancy and birth outcomes, have led to inconsistent conclusions. Maternal dietary intakes during pregnancy have a significant impact on foetal development and growth. The aim of this project is to determine levels of maternal fish intake at <18 weeks during pregnancy and to determine the association with birth outcomes in pregnant women from Johannesburg, South Africa. Methods: This Master‘s study is nested in a larger study with a longitudinal observational research design was conducted on 250 pregnant women in Johannesburg, South Africa. For this Master‘s study, data from the first 102 participants were used. Data for this study were collected early in pregnancy (<18 week‘s gestation) and at birth. The birth data were collected by the study mid-wife. Maternal fish consumption during early pregnancy was measured using a Quantitative Food Frequency Questionnaire (QFFQ). Correlation analysis was used to examine the association between maternal fish consumption during early pregnancy and neonatal anthropometry (birth weight, crown heel length and head circumference) and gestational age at birth. Results: Majority (88.1%) of the mothers were black South Africans between the ages of 18 and 39 with a mean age of 28 ± 5 years. At enrolment, the mean BMI of the women was 27.8±5.8kg/m2 having a mean height of 158.8±6.7cm and a mean weight of 70.4±15.2kg. Most of them were unmarried (45.4%), living in households of 2 – 5 members (86.3%), wage-earning (44.6%) and had Grade 11 or 12 schooling (58.4%). Most (76.5%) of the pregnant women consumed fish rarely (once a month) and the overall median fish intake was 4.8g/day (0; 25). In the study sample 12.5% of new-borns had a low birth weight (<2500g), the percentages of preterm births were 1.0% - extremely preterm (<28 weeks), 2.0% - very preterm (28 – <32 weeks) and 10.0% - moderate to late preterm (32 – 37 weeks). The mean birth weight was 2999.2±624.4g with boys having a mean birth weight of 3157.3±571g and girls at 2819±671g. The new-borns‘ mean gestational age at birth was 38.8±2.4weeks (271.6days). The percentage of new-born head circumference ≤ 31.49cm was 9.2% and the mean head circumference was 34.3±3.6cm with the boys having a mean head circumference of 34.5±2.4cm and the girls 34.1±4.3cm. In this study sample, 3.7% of new-borns were born with crown heel length of 31 – 40cm and the mean crown heel length mean was 49.5±4.6cm with the boys having a mean crown heel length of 49.8±4.9cm and the girls having mean crown heel length of 49.3±4.3cm. In this study, there were no statistically significant associations between fish consumption at early pregnancy and birth outcomes such as gestational age at birth (r=0.051; p=0.625), birth weight (r=-0.043; p=0.695) and crown heel length (r=0.008; p=0.943). There was a positive association between maternal fish consumption in early pregnancy and head circumference of the new-born which tended towards statistical significance (r=0.193; p=0.079). Conclusions: In this study of pregnant women living in Johannesburg, a few women consumed fish at early pregnancy compared with women who did not consume fish during pregnancy. We found no statistically significant association in this study between fish consumption at early pregnancy and birth outcomes. / Life and Consumer Sciences / MCS (Consumer Science)