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.

Five-year View

One of the most exciting areas of clinical investigation concerns the potential neuroprotective effects of omega-3 fatty acids, particularly DHA. Epidemiologic studies suggest that adults who consume greater amounts of fish and seafood may be at reduced risk for Alzheimer's disease, and intervention trials of fatty acid supplementation for prevention or treatment of this disease are ongoing.^[102,103] Likewise, epidemiologic evidence suggests that maternal diets rich in fish are associated with reduced risk for cerebral palsy, while diets rich in meat are associated with increased risk.^[104] We are currently undertaking investigations in rodent models aimed at the study of the neuroprotective effects of DHA in hypoxia–ischemia and activation of the systemic inflammatory response.^[105] The question of whether omega-3 fatty acids might prevent or attenuate acquired brain injury in the perinatal period is under investigation. Trials are also needed to determine whether prenatal omega-3 fatty acid supplementation can reduce the risk of attention and behavioral disorders in children born to families with high genetic risk.

We know that omega-3 fatty acids participate in diverse biologic processes deemed beneficial to health, most significantly with respect to immune function regulation and inflammatory processes. We also know that significant changes in dietary patterns in industrialized nations during the past several centuries have resulted in a reduction in intake of omega-3 fats and an increase in omega-6 fats, total fat, saturated fat and linoleic acid. This raises health concerns for the population overall and certainly for pregnant women, fetuses and children. Research that clarifies the benefits and risks of omega-3 supplementation and dietary fish consumption can contribute to a better understanding of the importance of its intake in pregnancy; consistent, appropriate recommendations for pregnant women and, potentially, improved pregnancy and fetal outcomes, and outcomes for children.

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Financial & competing interests disclosure
Ellen Mozurkewich is the Principal Investigator on an NIH-supported randomized controlled trial of fish oil for prevention of depressive symptoms during pregnancy. Ellen Mozurkewich and Deborah Berman are co-investigators on a University of Michigan internal pilot grant of docosahexaenoic acid for neuroprotection in a perinatal rat model. However, these grants did not provide any compensation for writing this manuscript. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.
No writing assistance was utilized in the production of this manuscript.

Cite this: Role of Omega-3 Fatty Acids in Maternal, Fetal, Infant and Child Wellbeing - Medscape - Jan 01, 2010.

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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