Assessing Omega-3 Fatty Acid Supplementation During Pregnancy and Lactation to Optimize Maternal Mental Health and Childhood Cognitive Development

Chelsea M Klemens; Kataneh Salari; Ellen L Mozurkewich

Clin Lipidology. 2012;7(1):93-109.

Future Perspective

More work is needed to determine whether EPA or DHA or a combination of both may be beneficial for mothers at risk for perinatal depression. Likewise, the role for omega-3 fatty acid supplementation for neonates at greatest risk for suboptimum development, such as those born preterm or after perinatal hypoxia–ischemia requires further study. DHA, or its derivative NPD1, may ultimately be shown to have a neuroprotective role in perinatal hypoxia–ischemia, but this potential use is speculative at the current time, as it has been only tested in animal models. It is unclear whether the more beneficial therapeutic approaches will be established for maternal and infant dietary supplementation with omega-3 long-chain PUFAs among mother–infant dyads at the highest risk for suboptimal cognitive development, or whether stable synthetic analogs of resolvins and protectins, the bioactive metabolites of omega-3 fatty acids, will find therapeutic uses.

1 2 3 4 5 6 7 8 9 10 11 12

Next Section

Financial & competing interests disclosure
EL Mozurkewich has received support for a randomized controlled trial comparing eicosapentaenoic acid-rich fish oil, docosahexaenoic acid-rich fish oil and placebo for the prevention of depressive symptoms during pregnancy and postpartum. The Nordic Naturals company (Watsonville, CA, USA) donated fish oil capsules and placebo capsules to the study. EL Mozurkewich has also received support from the National Institutes of Health. K Salari has received funding from the American College of Obstetricians and Gynecologists to study the effect of docosahexaenoic acid on gene expression in a rat model of perinatal hypoxia–ischemia. 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: Assessing Omega-3 Fatty Acid Supplementation During Pregnancy and Lactation to Optimize Maternal Mental Health and Childhood Cognitive Development - Medscape - Feb 01, 2012.

Table 1. Summary of randomized controlled trials of omega-3 fatty acids for the prevention or treatment of perinatal depression.
Study	Year	Inclusion criteria	Participants	Duration of supplementation	Composition and dose	Outcome measures	Results (significance)	Ref.
Llorente et al.	2003	Healthy lactating women	138 (37 drop-outs)	4 months during the postpartum period	200 mg DHA; placebo not described	BDI, EPDS and SCID	No significant differences	[45]
Krauss-Etschmann et al.	2007	Healthy pregnant women	311	From week 22 until delivery	500 mg DHA and 150 mg EPA/400 µg 5-MTHF/both/placebo; placebo not described	EPDS	No significant differences among the groups	[46]
Rees et al.	2008	Major depressive disorder diagnosed at baseline	26	Pregnancy and/or postpartum	6 g fish oil (27.3% DHA, 6.8% EPA), 80 mg vitamin E or placebo (sunola oil)	EPDS, HAM-D and MADRS	No difference between groups	[47]
Freeman et al.	2008	Major depressive disorder diagnosed at baseline	59	Pregnancy or postpartum	Supportive psychotherapy ± 1.1 g EPA plus 0.8 g DHA or placebo; maize oil with 1% fish oil placebo	EPDS and HAM-D	No difference between groups	[48]
Su et al.	2008	Major depressive disorder diagnosed at baseline	36	Pregnancy	2.2 g EPA plus 1.2 g DHA or placebo (olive oil ethyl esters)	HAM-D, EPDS and BDI	Significantly higher response rate and lower HAM-D, EPDS and BDI scores with intervention	[49]
Mattes et al.	2009	Healthy	98	Pregnancy (from 20 weeks' gestation until delivery)	4 g fish oil (56% DHA and 27.7% EPA) vs placebo (olive oil)	BDI	No difference between groups	[50]
Doornbos et al.	2009	Healthy	182	Pregnancy and postpartum	220 mg DHA vs 220 mg DHA + 220 mg ARA vs placebo (soy oil)	EPDS	No difference in outcomes	[51]
Makrides et al.	2010	Healthy	2399	From <21 weeks until delivery	800 mg DHA plus 100 mg EPA or vegetable oil	EPDS >12	No difference in outcomes	[44]

Table 2. Summary of randomized controlled trials of maternal omega-3 fatty acid supplementation during pregnancy and/or lactation for optimization of infant cognitive development.
Author	Year	Participants	Duration of supplementation	Intervention	Control	Outcome	Length of follow-up	Results (significance)	Ref.
Dunstan et al.	2008	98	From 20 weeks' gestation until delivery	Fish oil (DHA 2.2 g/day plus EPA 1.1 g/day)	Olive oil 2.7 g/day	GMDS; PPVT; CBC (age 2.5 years)	2.5 years	Children in supplemented group had improved hand–eye coordination	[74]
Judge et al.	2007	29	From 24 weeks' gestation until delivery	DHA-containing cereal bars (˜214 mg/day DHA)	Corn oil-containing cereal bars	Two-step problem-solving test from Willatts; FTII (9 months)	9 months	Significant improvement in problem-solving tasks; no difference in FTII	[78]
Tofail et al.	2006	400 (249 assessed)	From 25 weeks' gestation until delivery	Fish oil containing 1.2 g DHA and 1.8 g EPA daily	Soy oil placebo; LA 2.25 g/day plus ALA 0.27 g/day	BSID, WMBA (10 months)	10 months	No significant differences	[79]
Jensen et al.	2005	227	For 4 months after delivery in breastfeeding mothers	Algal oil capsules ˜200 mg DHA/day	Vegetable oil capsules: LA 56.3%; ALA 3.9%	PSI and MDI (30 months); GDI (12 and 30 months); CLAMS, visual–motor problem-solving (12 and 30 months); CAT (12 and 30 months)	30 months	PSI at 30 months of age significantly increased compared with controls	[80]
Lauritzen et al. and Cheatham et al.	2005, 2011	122	For 4 months after delivery in breastfeeding mothers	Microencapsulated fish oil added to muesli bars or to cookies or as capsules containing 900 mg/day of DHA, low content of EPA	Microencapsulated olive oil added to muesli bars or cookie or as capsules	IPT at 9 months; CDI at 1 and 2 years; ST and SDQ at 7 years	7 years	Passive vocabulary reduced in fish oil group compared with controls at 1 year of age; no difference at 2 years of age; no difference at 7 years of age	^[81,82]
Helland et al.	2001, 2003, 2008	341	From 18 weeks until 3 months after delivery	Cod liver oil containing DHA 1.183 g/day plus EPA 0.803 g/day, vitamins A, D and E	Corn oil containing LA 4.747 g/day, ALA 0.092 g/day, vitamins A, D and E	FTII at 6 and 9 months, K-ABC at 4 years; K-ABC at 7 years	7 years	No difference in outcomes at 6 and 9 months; improvements in verbal IQ scores of children whose mothers received DHA; no difference in outcomes at 7 years of age	^[75,76,83]
Makrides et al.	2010	726	From <21 weeks until delivery	800 mg DHA plus 100 mg EPA	Vegetable oil	Bayley III (18 months)	18 months	No difference in outcomes at 18 months	[44]
Escolano-Margarit et al. and Campoy et al.	2011	161	From 20th week of pregnancy until delivery	500 mg DHA and 150 mg EPA/400 µg 5-MTHF/both	Placebo not described	HE (4 years); TE (5.5 years); K-ABC (5.5 and 6.5 years)	6.5 years	No significant differences	[84,85]
van Goor et al.	2011	114	From 15.6–17.4 weeks' gestation through pregnancy and the first 3 months of lactation	DHA (220 mg), DHA plus ARA (220 mg DHA plus 220 mg ARA)	Soy oil placebo	HE, BSID (both at 18 months)	18 months	No difference in outcomes	[86]

Comments

Commenting is limited to medical professionals. To comment please Log-in.

Comments on Medscape are moderated and should be professional in tone and on topic. You must declare any conflicts of interest related to your comments and responses. Please see our Commenting Guide for further information. We reserve the right to remove posts at our sole discretion.

Return to Article

Post as:

processing....

Assessing Omega-3 Fatty Acid Supplementation During Pregnancy and Lactation to Optimize Maternal Mental Health and Childhood Cognitive Development

Future Perspective

Tables

Tables

References

Authors and Disclosures

Authors and Disclosures

Sidebar

Sidebar

Executive Summary

Comments

Most Popular Articles

Email This

Feedback