During the very sensitive time of pregnancy, the fetus is subject to various nutritional, environmental, and socio-economic factors that may make or break neonatal outcomes. Supplementation with the appropriate nutrients are vital in optimal development – and may be a predictor of the quality of life of the growing fetus in its adult years.
Gestational length and birth weight
Preterm births are a significant cause of morbidity in neonates. Several trials of DHA-rich fish oil during pregnancy have found a slight increase in the length of pregnancy in women taking the supplement. This has led to small decreases in the number of children born very preterm in these studies.
In one randomized controlled trial, 350 women consumed 600 mg capsules of DHA versus placebo from less than <20 wk of gestation to birth. Blood was analyzed for red blood cell (RBC) phospholipid DHA.
In comparison with placebo, DHA supplementation resulted in higher maternal and cord RBC-phospholipid-DHA (2.6%; P < 0.001), and significantly was associated with longer gestation duration (2.9 d; P = 0.041), and greater birth weight (172 g; P = 0.004), length (0.7 cm; P = 0.022), and head circumference (0.5 cm; P = 0.012). Mothers who were given DHA had significantly fewer infants born at less than 34 weeks (P = 0.025). For those with preterm births but were still administered DHA, infants had shorter hospital stays compared to the placebo group with preterm births, with a total difference of 8.9 days versus 40.8 days. No safety concerns were identified.(1)
Asthma and allergies
DHA is known to have a role in the immune response to inflammation and infection. A review of DHA supplements in pregnancy has found children with a high-risk of developing an allergy, such as if they have a close family member with an allergy, may be less likely to develop an allergy. In the study, there were reductions in food allergy and eczema during the baby’s first year for atopic mothers who were supplemented with omega-3.(2)
Another study involved 736 pregnant women receiving 2.4 g of n−3 LCPUFA (fish oil) versus placebo daily at 24 weeks of gestation. The 695 children were followed for 3-years in a double blind randomized controlled trial. There was a significant difference in the risk of persistent wheezing or asthma. Those who were treated with fish oil had a risk of 16.9%, versus 23.7% the placebo group.(P=0.035 with a 95% confidence interval), with relative reduction of 30.7%. The study concluded that giving n−3 LCPUFA in the third trimester of pregnancy reduced the absolute risk of persistent wheeze or asthma and infections of the lower respiratory tract in offspring by approximately one third.(3)
In a double-blind randomized placebo-controlled trial in Australia, 98 pregnant women received fish oil supplementation of 2.2 g docosahexaenoic acid (DHA) and 1.1 g eicosapentaenoic acid (EPA)/day from 20 weeks’ gestation until delivery. Seventy-two infants were assessed at 2 ½ years of age. Using infant growth and developmental quotients (Griffiths Mental Development Scales), receptive language (Peabody Picture Vocabulary Test) and behaviour (Child Behaviour Checklist), they found that children in the fish oil-supplemented group (n = 33) attained a significantly higher score for eye and hand coordination (mean ((SD) score 114 (10.2)) than those in the placebo group (n = 39, mean score 108 (SD 11.3); p = 0.021, adjusted p = 0.008). They concluded that eye and hand coordination scores correlated with n-3 PUFA levels in cord blood erythrocytes (EPA: r = 0.320, p = 0.007; DHA: r = 0.308, p = 0.009).(4)
In a study in Quebec, DHA, other polyunsaturated fatty acids, and 3 environmental contaminants (polychlorinated biphenyls, mercury, and lead) were assessed in cord plasma and maternal plasma and milk in 109 Inuit infants. Multiple regression was used to examine the relation of cord DHA and DHA from breastfeeding on growth and development at 6 and 11 months, after controlling for contaminant exposure and other potential confounders. Higher cord DHA concentration was associated with longer gestation, better visual acuity and novelty preference on the Fagan Test at 6 months, and better Bayley Scale mental and psychomotor performance at 11 months. The association of higher cord DHA concentration with more optimal visual, cognitive, and motor development is consistent with the need for substantial increases in this critically important fatty acid during the third trimester when there is a spurt of brain and photoreceptor development.(5)
Finding the right omega-3
Due to the risks of other omega-3 supplements with impurities, it is important to find supplements with a high omega-3 ratio as well as the elimination of environmental pollutants. Safety standards by the European pharmacopeia (EP) and Global Organization of EPA and DHA Omega 3s (GOED) prescribes elimination of arsenic, cadmium, mercury and lead in fish oil and omega-3 products. They also recommend higher ratios of DHA relative to the rest of the components. For the purposes of normal eye and brain development of the fetus, EFSA approves an additional 200 mg/day on top of the usual adult dose of 250 mg/day of omega-3 for pregnant and lactating women. One example of a supplement that fits this description is Ultra Omega by Neomega, an omega-3 supplement with 60% essential fatty acids more than the average fish oil capsule (usually at 30%), made in Germany, which can be ordered online in the Philippines. Ultra Omega has EPA 400mg and DHA 200mg per capsule, to be taken once daily for pregnant and lactating women (6). It is suggested for consumers to consult their physicians before the use of supplements. Neomega reaches out to give options for health professionals who seek to find more cost-effective options for their patients. Learn more about their Doctor Affiliate Program.They can be reached at www.neomegalife.com, emailed at firstname.lastname@example.org or called at 7275975 or +639177016363.
Disclaimer: This article is produced through Filipino MD staff research. It is sponsored by Neomega Life, a trademark of Omniceutical corp.
(1)Carlson S, Colombo J, Gajewski BJ, Gustafson KM, Mundy D, Yeast J, Georgieff MK, Markley LA, Kerling EH, and Shaddy DJ. DHA supplementation and pregnancy outcomes. Am J Clin Nutr. 2013 Apr; 97(4): 808–815. Published online 2013 Feb 20. doi: 10.3945/ajcn.112.050021 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3607655/
(2)Gunaratne AW, Makrides M, Collin CT. Maternal prenatal and/or postnatal n-3 long chain polyunsaturated fatty acids (LCPUFA) supplementation for preventing allergies in early childhood. Cochrane Pregnancy and Childbirth Group. 10.1002/14651858.CD010085.pub2 http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD010085.pub2/full
(3)Bisgaard H, et. al. Fish Oil–Derived Fatty Acids in Pregnancy and Wheeze and Asthma in Offspring. N Engl J Med 2016; 375:2530-2539. DOI: 10.1056/NEJMoa1503734. http://www.nejm.org/doi/full/10.1056/NEJMoa1503734
(4)Dunstan JA, Simmer K, Dixon G, Prescott SL. Cognitive assessment of children at age 2(1/2) years after maternal fish oil supplementation in pregnancy: a randomised controlled trial. Arch Dis Child Fetal Neonatal Ed. 2008 Jan;93(1):F45-50. Epub 2006 Dec 21. https://www.ncbi.nlm.nih.gov/pubmed/17185423/
(5)Jacobson JL1, Jacobson SW, Muckle G, Kaplan-Estrin M, Ayotte P, Dewailly E. Beneficial effects of a polyunsaturated fatty acid on infant development: evidence from the inuit of arctic Quebec. J Pediatr. 2008 Mar;152(3):356-64. doi: 10.1016/j.jpeds.2007.07.008. Epub 2007 Oct 22. https://www.ncbi.nlm.nih.gov/pubmed/18280840/
(6)Approved Omega-3 Fatty Acid Health Claims. Epax.com. http://www.epax.com/pages/chart