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.

Allergy & Immunologic Disease

Evidence from Epidemiologic Studies

As with depression, allergy and immunologic diseases in the industrialized world have increased in parallel to the major dietary changes described previously.^[92] Several epidemiologic studies have found consumption of oily fish or an increased of omega-3:omega-6 fatty acids ratio in the diet to be protective against wheezing and the likelihood of developing asthma.^[93,94] Based on their biologic roles as modulators of immune function, some investigators have hypothesized that fatty acid imbalance during gestation may affect the likelihood that the child will develop allergy or immune disease in later life.^[95]

Evidence from Clinical Trials

Few trials of prenatal omega-3 fatty acid supplementation for the prevention of allergic disease in the offspring have been conducted.^[96–98] The Dunstan et al. trial randomized 98 pregnant women at risk for allergic disorders to receive fish oil or placebo. The investigators found no reduction in atopic dermatitis at 1 year of age but did note decreased severity of atopy among infants whose mothers received fish oil.^[96] The Childhood Asthma Prevention Study randomized 616 pregnant women with a family history of asthma to an active diet intervention, including omega-3-rich cooking oils and spreads or placebo during pregnancy, followed by tuna oil supplementation or placebo after weaning. This study demonstrated an initial reduction in wheezing symptoms of these women's offspring at 18 months among those whose omega-3 exposure were in the highest quintile,^[97] but no overall reduction of atopy or asthma at 5 years of life.^[98] Further studies are needed to demonstrate whether prenatal dietary modification will have any effect on susceptibility to immune disease during postnatal life.

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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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