Role of Omega-3 Fatty Acids in Maternal, Fetal, Infant and Child Wellbeing

Ellen Mozurkewich; Deborah R Berman; Julie Chilimigras

Expert Rev of Obstet Gynecol. 2010;5(1):125-138.

Attention & Behavior

Evidence from Epidemiologic Studies

In his 'Barker Hypothesis', Barker speculated that nutritional factors (specifically undernutrition) during fetal life might place children at risk for certain morbidities during childhood and adulthood, particularly coronary artery disease and diabetes.^[86] Recent research suggests that events during fetal life may also predispose children to psychiatric morbidity.^[87] Rat feeding studies have found that a prenatal diet with excess omega-6 fatty acids and deficient omega-3 fatty acids have irreversible reductions in the DHA content of the hypothalamus of the offspring. These deficiencies are not entirely reversed after omega-3 fatty acid repletion, suggesting that certain neurobehaviors may be 'set' by the fatty acid content of the prenatal diet.^[88] Thus, low maternal omega-3 fatty acid consumption may put the developing child at risk for suboptimal cognitive development and later development of attention and mood disorders.

In a longitudinal analysis of the relationship between umbilical blood DHA at birth and problem behavior at 7 years of age among 393 children, Krabbendam demonstrated a significant inverse relationship between DHA at birth and internalizing problem behaviors at 7 years of age.^[89] Similarly, school-age children with attention-deficit hyperactivity disorder (ADHD) have been demonstrated to have significantly lower plasma levels of DHA and arachidonic acid than normal controls.^[90] However, no differences in dietary intake have been demonstrated, suggesting that the observed differences may result from genetic alterations in fatty acid metabolism among children with ADHD, making them more vulnerable to dietary deficiencies.^[90] To test this hypothesis, Brookes et al. carried out a case–control study comparing single nucleotide polymorphisms in fatty acid desaturase genes. These genes code for the enzymes that catalyze the conversion of linoleic acid and α-linolenic acid into arachidonic acid and EPA. The investigators compared single nucleotide polymorphisms for these genes in children with ADHD and ethnically matched controls. They found a significant association of ADHD with single nucleotide polymorphism rs498793 in the fatty acid desaturase two gene, suggesting that alterations in the ability of affected individuals to synthesize LC-PUFA from the parent fatty acids may be associated with this disorder.^[91] However, there is currently no evidence from clinical trials on whether behavior and attention disorders might be prevented by prenatal omega-3 fatty acid supplementation.

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Table 1. Omega-3 fatty acids and industrial contaminants in commonly eaten fish and shellfish.
Type	EPA + DHA (mg/serving) (oz)	EPA + DHA (mg/100 g) (3.5 oz)	Mercury (µg/g) (ppm)	PCBs (ng/g) (ppb)
Anchovy	1165 (2)	2055	< 0.05
Catfish, farmed	253 (5)	117	< 0.05	< 50
Cod, Atlantic	284 (6.3)	158	0.10
Fish burger (fast food)	337 (2.2)	546	< 0.05	8
Fish sticks, frozen	193 (3.2)	214	< 0.05
Halibut	740 (5.6)	465	0.25
Herring, Atlantic	1712 (3)	2014	< 0.05
Mackerel, Atlantic	1059 (3.1)	1203	0.05
Mackerel, King	618 (5.4)	401	0.73
Mahimahi	221 (5.6)	139	0.15
Pollock, Alaskan	281 (2.1)	468	< 0.05
Salmon, farmed	4504 (6)	2648	< 0.05	15–51
Salmon, wild	1774 (6)	1043	< 0.05	0.5–5
Sardines	556 (2)	982	< 0.05	22–57
Shark	583 (3)	689	0.99
Snapper	546 (6)	321	0.19
Swordfish	868 (3.7)	819	0.98
Trout	581 (2.2)	935	0.07	11
Tuna (light/skipjack)	228 (3)	270	0.12	45
Tuna (white/albacore)	733 (3)	862	0.35	100
Clams	241 (3)	284	< 0.05	2–3
Crab	351 (3)	413	0.09	6
Lobster	71 (3)	84	0.31
Mussels	665 (3)	782	< 0.15	0.8–7
Oysters	585 (3)	688	< 0.05	0.8–17
Scallops	310 (3)	365	< 0.05
Shrimp	267 (3)	315	< 0.05	0.2–2

DHA: Docosahexaenoic acid; EPA: Eicosapentaenoic acid; PCB: Polychlorinated biphenyls; ppb: Parts per billion; ppm: Parts per million.
Adapted from.^[101]

Table 2. Results of clinical trials of omega-3 fatty acid supplementation.
Parameter	Results
Preterm birth:
< 37 weeks	No benefit*
< 34 weeks	Likely benefit^§
Intrauterine growth restriction (small for gestational age)	No benefit
Preeclampsia	No benefit
Perinatal depression:
– Prevention	No benefit
– Treatment	Conflicting results^¶
Neurodevelopmental outcomes:
– Term	Conflicting results
– Preterm	Conflicting results
Prevention of allergic disease	Conflicting results

*The majority of the available clinical trials show no benefit for the intervention.
^§The majority of the available clinical trials show a benefit for the intervention.
^¶Clinical trial results are mixed, with some trials showing benefit and others not.

Box 3. Biologic activities of omega-3 fatty acids.
Decrease proinflammatory cytokine production Precursors of resolvins and neuroprotectins Improve membrane fluidity May counter or promote apoptosis, depending on circumstance Regulate gene expression Act as antioxidants Quicken neurotransmission Modulate intracellular signaling

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