Randomised controlled trial of effect of fish-oil supplementation on pregnancy duration

Maternal but not fetal FADS gene variants modify the association between maternal long-chain PUFA intake in pregnancy and birth weight

Several studies have shown a positive association between maternal fish intake in pregnancy and pregnancy duration and child birth weight (BW), probably due to fish n-3 (ω-3) long-chain polyunsaturated fatty acids (LC-PUFAs). n-3 LC-PUFAs can also be synthesized endogenously, and their synthesis depends on single nucleotide polymorphisms (SNPs) in the fatty acid desaturase (FADS) gene encoding for FADS. We assessed the associations of maternal docosahexaenoic acid (DHA) intake in pregnancy with pregnancy duration and BW and investigated whether these associations are modified by maternal or fetal FADS SNP genotypes. We hypothesized that we would find stronger associations in minor allele homozygous mothers or fetuses due to their lower n-3 LC-PUFA endogenous synthesis and hence higher dependence on dietary supply. Data on maternal diet, pregnancy duration, and BW were available for 2622 mother-child pairs from the KOALA (Kind, Ouders en gezondheid: Aandacht voor Leefstijl en Aanleg) Birth Cohort Study. The rs174556 FADS SNP was genotyped in 1516 mothers and 1515 children. Associations and gene-diet interactions were tested with linear regression adjusting for potential confounders, including intake of other PUFAs. Women at the 75th percentile of DHA intake had 0.7-d longer pregnancies (P = 0.016) and 28-g heavier infants (P = 0.039) than did women at the 25th percentile of intake. Associations with arachidonic acid intake were of the same order but in the opposite direction. Mothers who were homozygous for the minor allele had 2-d shorter pregnancies (P = 0.035) and infants who were nearly 140 g lighter (P = 0.006) than did mothers who were major allele homozygotes. Post hoc analyses revealed that they had higher prepregnancy BMI (P = 0.020). Among the women homozygous for the minor allele, those at the 75th percentile of DHA intake had 226-g heavier infants than those at the 25th percentile of intake (P = 0.030), whereas DHA intake was not significantly associated with BW in major allele carriers. These findings suggest that maternal and fetal fatty acid requirements during pregnancy depend on maternal genetic variation in LC-PUFA synthesis.

Fetal growth and cardio-metabolic risk factors in the 20-year-old offspring

OBJECTIVE

To investigate the association between prenatal growth patterns as estimated by biparietal diameter and cardio-metabolic risk at 20 years.

DESIGN

Follow-up study.

SETTING

Denmark 1988-2009.

POPULATION

Two cohorts of children born between 1988 and 1990 (n=707) and followed up in 2008-2009 (n=333-509).

METHODS

We have access to biparietal diameter from early ultrasound scan and birthweight. For each gender, biparietal diameter and birthweight, gestational age-specific growth-z-scores were calculated. A change in growth trajectory was depicted as a shift in z-score for the two growth measures. Multiple linear regression modeling was used to estimate associations between biparietal diameter and birthweight z-scores and later cardio-metabolic risk factors as well as estimating whether changing growth trajectory was associated with later cardio-metabolic risk.

MAIN OUTCOME MEASURES

Self-reported anthropometrics and clinically measured blood pressure, heart rate and biochemical measures associated with cardio-metabolic health.

RESULTS

After adjustments, biparietal diameter was not associated with any of the outcomes. Birthweight was positively associated with both adult height and weight and inversely associated with insulin, triglyceride and insulin resistance. Also, the data indicated a U-shaped association between growth in the second half of pregnancy and adult body mass index among individuals with a low biparietal diameter in mid-pregnancy.

CONCLUSION

Different patterns of intrauterine growth may be associated with later risk of cardio-metabolic disease.

Effect of maternal n-3 long-chain polyunsaturated fatty acid supplementation during pregnancy and/or lactation on adiposity in childhood: a systematic review and meta-analysis of randomized controlled trials

It is hypothesized that prenatal and early postnatal exposure to n-3 long-chain polyunsaturated fatty acids (LCPUFAs) is negatively associated with adiposity later in life. We conducted a systematic review and meta-analysis to evaluate whether maternal n-3 LCPUFA supplementation in pregnancy and/or lactation exerts a beneficial effect on adiposity status in childhood. We searched six electronic databases till 20 May 2014 for randomized controlled trials (RCTs) of n-3 LCPUFA supplementation to pregnant and/or lactating women that reported data on body mass index (BMI), waist circumference, sum of skinfold thicknesses or body fat mass in children. Adiposity measures were grouped into three age categories: preschool children (<5 years), school-aged children (6-12 years), and adolescents (>13 years). Trial quality was assessed. We conducted fixed-effect and random-effects meta-analyses to combine study-specific estimates of differences between the supplemented and control groups. A total of 6 RCTs (9 publications) involving 2847 participants were included. Summary estimates showed no effect of maternal supplementation on BMI in preschool (standardized mean difference (SMD)=0.07, 95% confidence interval (CI)=-0.22, 0.36, P=0.65) and school-aged children (SMD=0.12, 95% CI=-0.06, 0.30, P=0.20). Because of sparse data, it was not possible to pool study results relating to other adiposity measures. There is currently no evidence to support that n-3 LCPUFA supplementation during pregnancy and/or lactation favourably affects child adiposity. Further high-quality trials are needed.

Food for thought: dietary changes in essential fatty acid ratios and the increase in autism spectrum disorders

The last decades have shown a spectacular and partially unexplained rise in the prevalence of autism spectrum disorders (ASD). This rise in ASD seems to parallel changes in the dietary composition of fatty acids. This change is marked by the replacement of cholesterol by omega-6 (n-6) fatty acids in many of our food products, resulting in a drastically increased ratio of omega-6/omega-3 (n-6/n-3). In this context, we review the available knowledge on the putative role of fatty acids in neurodevelopment and describe how disturbances in n-6/n-3 ratios may contribute to the emergence of ASDs. Both clinical and experimental research is discussed. We argue that a change in the ratio of n-6/n-3, especially during early life, may induce developmental changes in brain connectivity, synaptogenesis, cognition and behavior that are directly related to ASD.

Transgenerational healing: Educating children in genesis of healthy children, with focus on nutrition, emotion, and epigenetic effects on brain development

Although our continuing evolution can never achieve our perfection, we long for our children's birth and health to be near-perfect. Many children are born healthy, though fewer than is possible. Birthing and health rapidly improved generally due to modern housing, sanitation and medicine, as well as birth interventions. Arguably interventions have exceeded the optimal level, without enough regard for natural physical and intuitive resources. Conception, often too easy, receives too little personal preparation unless a couple has problems. Nurturing the health of sperm and ovum seems hard to focus on, yet is needed by both parents - and even by the four grandparents. What are the key factors? Positive: The fields of hormones/emotions and of nutrition/metabolism. Negative: stress, poor nutrition, toxins, diseases; much being due to poverty. Positive and negative both have structural and also epigenetic effects. Interventions, essential or inessential, are seldom without negative side effects. Health can best, and most economically, be generated at the beginning of life, through healthy conception, gestation and birth. Understanding prime needs improves initial health. It also informs therapy of any early-life problems. Healing is therefore more efficient when transgenerational, and much more powerful than individual healing. My vision of healing is safeguarding our evolution in progress. Children's choices - eating, exercise, emotional attitudes and relationships - are already profoundly affecting any children they may have, their mental and physical health. The most practical starting point seems to be educating boys as well as girls. Childhood is therefore the time to educate them in choices. The correction of often unnoticed problems- nutrient deficits, toxins, uro-genital disease - has enabled nearly nine out of ten couples to bear fully healthy babies, even following severe problems - infertility, miscarriages, stillbirths and malformations. Correcting problems before conception prevents both structural faults and wrong setting of gene-switches. Children's habits set. Once courting most are preoccupied and many pregnant unintentionally. Childhood is the time to be adopting a healthy lifestyle, the way to healthy babies The mother's nutritional and emotional status throughout pregnancy continues to affect her child's future physical and mental health, behaviour and ability. Before conception a woman needs to build her appropriate body stores - vitamins and minerals, proteins, docosahexaenoic acid. Before bearing another child, a replenishment time of 3 years is desirable. A return to childbearing in the 20s and early 30s could reduce risks that have risen with the recent shift towards conception by school children and by women in their late 30s or more. Governments, schoolteachers, health professionals, need to adopt this policy of transgenerational health. Empowerment with knowledge is the one way to fend off the growing pandemic of mental ill health and related disorders and to make the most of a nation's genetic potential. Financially there could be no better investment, let alone in enhancing people's lives. Childhood is the most appropriate time for education in this way to generating a healthy, able and peaceful human race. Essential to our amazing genetic systems are the resources of land, sea and air. We are one with our biosphere. We need urgently to follow up the vital work of Developmental Origins of Health and Disease, and of Far East initiatives in sea-bed and sea husbandry.

Docosahexaenoic acid supplementation during pregnancy: a potential tool to prevent membrane rupture and preterm labor

Polyunsaturated fatty acids (PUFAs) are required to maintain the fluidity, permeability and integrity of cell membranes. Maternal dietary supplementation with ω-3 PUFAs during pregnancy has beneficial effects, including increased gestational length and reduced risk of pregnancy complications. Significant amounts of ω-3 docosahexaenoic acid (DHA) are transferred from maternal to fetal blood, hence ensuring high levels of DHA in the placenta and fetal bloodstream and tissues. Fetal DHA demand increases exponentially with gestational age, especially in the third trimester, due to fetal development. According to the World Health Organization (WHO) and the Food and Agriculture Organization of the United Nations (FAO), a daily intake of DHA is recommended during pregnancy. Omega-3 PUFAs are involved in several anti-inflammatory, pro-resolving and anti-oxidative pathways. Several placental disorders, such as intrauterine growth restriction, premature rupture of membranes (PROM) and preterm-PROM (pPROM), are associated with placental inflammation and oxidative stress. This pilot study reports on a preliminary evaluation of the significance of the daily DHA administration on PROM and pPROM events in healthy pregnant women. Further extensive clinical trials will be necessary to fully elucidate the correlation between DHA administration during pregnancy and PROM/pPROM occurrence, which is related in turn to gestational duration and overall fetal health.

Characterization of dietary patterns in the Danish national birth cohort in relation to preterm birth

Background

Dietary patterns better reflect eating habits as opposed to single dietary components. However, the use of dietary pattern analysis in nutritional epidemiology has been hampered by the complexity of interpreting and presenting multidimensional dietary data.

Methods

This study extracts and visualizes dietary patterns from self-reported dietary data collected in mid-pregnancy (25^th week of gestation) from nearly 60,000 mother-child pairs part of a prospective, longitudinal cohort (Danish National Birth Cohort) and further examines their associations with spontaneous and induced preterm birth (gestational age<259 days (<37 weeks)).

Results

A total of seven dietary patterns were extracted by principal component analysis, characterized and visualized by color-coded spider plots, and referred to as: Vegetables/Prudent, Alcohol, Western, Nordic, Seafood, Candy and Rice/Pasta/Poultry. A consistent dose-response association with preterm birth was only observed for Western diet with an odds ratio of 1.30 (95% CI: 1.13, 1.49) comparing the highest to the lowest quintile. This association was primarily driven by induced preterm deliveries (odds ratio = 1.66, 95% CI: 1.30, 2.11, comparing the highest to the lowest quintile) while the corresponding odds ratio for spontaneous preterm deliveries was more modest (odds ratio = 1.18, 95% CI: 0.99, 1.39). All based on adjusted analyses.

Conclusions

In conclusion, this study presented a simple and novel framework for visualizing correlation structures between overall consumption of foods group and their relation to nutrient intake and maternal characteristics. Our results suggest that Western-type diet, high in meat and fats and low in fruits and vegetables, is associated with increased odds of induced preterm birth.

Prenatal exposure to methylmercury and LCPUFA in relation to birth weight

BACKGROUND

Epidemiologic studies have been inconclusive regarding the impact of coexposure to long chain polyunsaturated fatty acids (LCPUFA) and methylmercury (MeHg) from fish consumption during pregnancy on measures of fetal development.

OBJECTIVES

We evaluated the association between birth weight and prenatal maternal LCPUFA status and MeHg exposure in the Republic of Seychelles.

METHODS

We measured LCPUFA in maternal whole blood collected at 28 weeks of gestation and following delivery and MeHg in maternal hair obtained at delivery. There were 230 births with complete data on birth weight and covariates. Multiple linear regression models controlled for infant sex, gestational age, maternal age, smoking during pregnancy, intrapartum weight gain, prepregnancy body mass index, maternal socioeconomic status, parity, gestational diabetes, and alcohol use during pregnancy.

RESULTS

The average birth weight was 3252 g (range 1654-4450) and the average gestational age was 39 weeks (range 34-41). Prenatal MeHg exposure and maternal LCPUFA status were not associated with birth weight. Infant sex and length of gestation were the only predictors, with male sex and increased gestational age consistently associated with greater birth weight.

CONCLUSIONS

These findings do not support a relationship between prenatal exposure to LCPUFA and/or MeHg from fish consumption and birth weight.

Effect of cytochrome P-450 epoxygenase and hydroxylase metabolites on rat myometrium contractility in non-pregnancy, late pregnancy and late pregnancy under inflammatory conditions

AIM

The aim of the present experimental study was to assess the tocolytic effect of eicosanoids on myometrium from non-pregnant and pregnant rats with or without an induced inflammatory condition.

METHODS

Three hundred myometrial rings were obtained by median laparotomy from 50 Sprague-Dawley rats divided into three groups: (i) non-pregnant (n = 15); (ii) pregnant in absence (n = 20); or (iii) pregnant in presence (n = 15) of lipopolysaccharide treatment, timed at 22 days of pregnancy. Spontaneous contractile activities were compared by isometric tension measurements. The effects of epoxy- and hydroxyeicosanoids derived from arachidonic acid as well as specific enzyme inhibitors were assessed. Changes were expressed as percentage of basal activity by calculating the area under the curve as a function of drug concentration and compared to the effect of the vehicle.

RESULTS

A decrease in contractile activity ranging 10-25% was observed upon addition of epoxy- and hydroxyeicosanoids. Increasing epoxyeicosanoid bioavailability by inhibiting their degradation induced a tocolytic effect in the non-pregnant group (20%) and in inflammation-induced condition (40%). There was a significant difference in reactivity between groups and pregnancy condition. Semiquantification of metabolic enzymes that produce (cytochrome P-450 epoxygenase) and degrade (soluble epoxide hydrolase) epoxyeicosanoids by western blot analysis revealed that these enzymes were mainly detected in the non-pregnant group.

CONCLUSION

Eicosanoids can modify myometrial reactivity and their presence and effects are amplified in non-pregnant and in inflammation-induced condition. Our data suggest that in contrast to prostaglandins, epoxyeicosatrienoic acids are likely involved in the quiescence phase of parturition because they reduce the rhythmic contractile activity of uterine tissues in pregnant rats.

Exposure to organochlorines and mercury through fish and marine mammal consumption: associations with growth and duration of gestation among Inuit newborns

BACKGROUND

Several studies have reported negative associations of polychlorinated biphenyls (PCBs), hexachlorobenzene (HCB) and mercury (Hg) with duration of gestation and fetal growth in fish eating populations. Docosahexaenoic acid (DHA) from fish, seafood and marine mammal intake has been reported to be positively related with pregnancy duration and fetal growth. So far, it remains unclear, however, if the associations of environmental contaminants (ECs) with growth are direct or mediated through their relation with the duration of gestation and the degree to which DHA intake during pregnancy attenuates the negative association of ECs with fetal growth.

OBJECTIVES

To investigate direct and indirect associations of in utero exposure to ECs with fetal growth and pregnancy duration while taking into account the possible positive effects of DHA.

METHODS

Pregnant Inuit women (N=248) from Arctic Quebec were recruited and cord blood samples were analyzed for PCBs, HCB, Hg and DHA. Anthropometric measurements were assessed at birth. Path models were used to evaluate direct and indirect associations.

RESULTS

Cord concentrations of PCB 153, HCB and Hg were significantly associated with shorter duration of pregnancy (β varying from -0.17 to -0.20, p<0.05). Path models indicated that the associations of PCBs, HCB and Hg with reduced fetal growth (β varying from -0.09 to -0.13, p<0.05) were mediated through their relations with shorter gestation duration. Cord DHA was indirectly related to greater growth parameters (β varying from 0.17 to 0.20, p<0.05) through its positive association with gestation duration.

CONCLUSION

Prenatal exposure to ECs was associated with reduced gestation duration, which is a recognized determinant of fetal growth. DHA intake during pregnancy appeared to have independent positive association with fetal growth by prolonging gestation. Whether these associations are causal remains to be elucidated.

Effect of dietary intervention to reduce the n-6/n-3 fatty acid ratio on maternal and fetal fatty acid profile and its relation to offspring growth and body composition at 1 year of age

BACKGROUND/OBJECTIVE

Evidence is accumulating that the long-chain PUFA (LCPUFA) are associated with offspring growth and body composition. We investigated the relationship between LCPUFAs in red blood cells (RBCs) of pregnant women/breastfeeding mothers and umbilical cord RBCs of their neonates with infant growth and body composition ≤ 1 year of age.

SUBJECTS/METHODS

In an open-label randomized, controlled trial, 208 healthy pregnant women received a dietary intervention (daily supplementation with 1200 mg n-3 LCPUFAs and dietary counseling to reduce arachidonic acid (AA) intake) from the 15th week of gestation until 4 months of lactation or followed their habitual diet. Fatty acids of plasma phospholipids (PLs) and RBCs from maternal and cord blood were determined and associated with infant body weight, body mass index (BMI), lean body mass and fat mass assessed by skinfold thickness measurements and ultrasonography.

RESULTS

Dietary intervention significantly reduced the n-6/n-3 LCPUFA ratio in maternal and cord-blood plasma PLs and RBCs. Maternal RBCs docosahexaenoic acid (DHA), n-3 LCPUFAs and n-6 LCPUFAs at the 32nd week of gestation were positively related to birth weight. Maternal n-3 LCPUFAs, n-6 LCPUFAs and AA were positively associated with birth length. Maternal RBCs AA and n-6 LCPUFAs were significantly negatively related to BMI and Ponderal Index at 1 year postpartum, but not to fat mass.

CONCLUSION

Maternal DHA, AA, total n-3 LCPUFAs and n-6 LCPUFAs might serve as prenatal growth factors, while n-6 LCPUFAs also seems to regulate postnatal growth. The maternal n-6/n-3 LCPUFA ratio does not appear to have a role in adipose tissue development during early postnatal life.

Effects of dietary fish oil and corn oil on rat mammary tissue

The effects, on the maternal mammary gland, of diets containing similar lipid percentages but differing in composition of polyunsaturated fatty acids (PUFA) have been assessed in rats during pregnancy and lactation. For this purpose, tuna fish oil (an n-3-PUFA-enriched oil) and corn oil (an n-6-PUFA-enriched oil) were included in diets at ratios such that the caloric inputs were the same as that of the control diet. As expected, the maternal diet affected the tissue composition of dams. Unexpectedly, only the tuna fish oil diet had an effect on pup growth, being associated with the pups being underweight between the ages of 11 and 21 days. The maternal mammary gland of rats fed the tuna fish oil diet displayed two main modifications: the size of cytoplasmic lipid droplets was increased when compared with those in control rats and the mammary epithelium showed an unusual formation of multilayers of cells. These results show that the tuna fish oil diet, during pregnancy and lactation, exerts specific effects on mammary cells and on the formation of lipid droplets. They suggest that this maternal diet affects the functioning of the mammary tissue.

Long-term child follow-up after large obstetric randomised controlled trials for the evaluation of perinatal interventions: a systematic review of the literature

BACKGROUND

Although the hope is that many perinatal interventions are performed with an ultimate aim to improve the long-term health and development of the child, long-term outcome is rarely used as a primary end-point in perinatal randomised controlled trials (RCTs).

OBJECTIVE

To evaluate how often and with which tools long-term follow-up is performed after large obstetric RCTs.

SEARCH STRATEGY

We searched the Cochrane Library for Cochrane reviews published by the Cochrane Pregnancy and Childbirth Group for reviews on interventions that aimed to improve neonatal outcome. Selection criteria  Reviews on perinatal interventions that were not performed to improve the condition of the neonate were excluded. We limited our review to RCTs with more than 350 participating women. For each included study, we checked in Web of Science as to whether the researchers had reported on follow-up in subsequent publications.

DATA COLLECTION AND ANALYSIS

Relevant information was extracted from these RCTs by two reviewers using a predefined data collection sheet. All information was analysed using SPSS 17.0 (SPSS Inc., Chicago, IL, USA).

MAIN RESULTS

We studied 212 reviews including 1837 RCTs on perinatal interventions, 249 (14%) of which included 350 participants. Only 40 of 249 RCTs (16%) followed the children after discharge from the hospital to evaluate the effect of a specific perinatal intervention. The number of RCTs with long-term follow-up remained stable, with 10 of 67 RCTs (15%) reporting follow-up before 1990, 17 of 115 (15%) between 1990 and 2000, and 13 of 67 (19%) after 2000 (P = 0.68).

CONCLUSIONS

Only a small minority of large perinatal RCTs report the long-term follow-up of the child. Future obstetric RCTs should consider performing long-term follow-up at the start of the trial.

The fetal origins of the metabolic syndrome: can we intervene?

Epidemiological studies have suggested that metabolic programming begins during fetal life and adverse events in utero are a critical factor in the etiology of chronic diseases and overall health. While the underlying molecular mechanisms linking impaired fetal development to these adult diseases are being elucidated, little is known about how we can intervene early in life to diminish the incidence and severity of these long-term diseases. This paper highlights the latest clinical and pharmaceutical studies addressing how dietary intervention in fetal and neonatal life may be able to prevent aspects of the metabolic syndrome associated with IUGR pregnancies.

Long chain polyunsaturated fatty acids alter oxytocin signaling and receptor density in cultured pregnant human myometrial smooth muscle cells

Epidemiological studies and interventional clinical trials indicate that consumption of long chain n-3 polyunsaturated fatty acids (LC n-3 PUFA) such as docosahexaenoic acid (DHA) lengthen gestational duration. Although the mechanisms are not well understood, prostaglandins (PG) of the 2-series are known to play a role in the initiation and progress of labor. In animal studies, modest DHA provision has been shown to reduce placental and uterine PGE(2) and PGF(2α), matrix metalloproteinase (MMP)-2 and MMP-9 expression, and placental collagenase activity. However, modulation of PG biosynthesis may not account for all the effects of LC n-3 PUFAs in labor. We investigated one potential PG-independent mechanism of LC PUFA action using cultured pregnant human myometrial smooth muscle cells. Our goal was to characterize the effect of LC PUFA treatment on oxytocin signaling, a potent uterotonic hormone involved in labor. The addition of 10 µM-100 µM DHA or arachidonic acid (AA) to the culture media for 48 h resulted in dose dependent enrichment of these fatty acids in membrane lipid. DHA and AA significantly inhibited phosphatidylinositol turnover and [Ca(2+)](i) mobilization with oxytocin stimulation compared to bovine serum albumin control and equimolar oleic acid. DHA and AA significantly reduced oxytocin receptor membrane concentration without altering binding affinity or rate of receptor internalization. These findings demonstrate a role for LC n-3 PUFAs in regulation of oxytocin signaling and provide new insight into additional mechanisms pertaining to reports of dietary fish and fish oil consumption prolonging gestation.

Omega 3 polyunsaturated fatty acids and body weight

In animal studies, n-3 PUFA have been shown to influence body composition and to reduce the accumulation of body fat, thereby affecting body weight homeostasis. In addition, it has been suggested that an additional supply of n-3 PUFA during pregnancy or lactation, or both, would have a beneficial effect on birth weight and infant growth and development. The purpose of the present study was to systematically review interventional clinical trials on the effects of dietary n-3 PUFA supplementation on body weight in adult subjects and in infants whose mothers were supplemented with these fatty acids during pregnancy and/or lactation. A systematic search, focused on n-3 PUFA and body weight, and limited to controlled clinical trials, was performed in different databases. The quality of all included studies was assessed against set criteria, and results of eligible trials were compared. There were few studies targeting this topic. In adults, all of the five studies included, except for one, show no change in body weight by dietary supplementation with n-3 PUFA. Within those trials conducted in pregnant and/or lactating women in which a main outcome was birth weight or growth in infancy, two showed a modest increase in birth weight and the rest showed no effect. None of the trials showed an effect of maternal n-3 PUFA supplementation on infant's weight at the short term. However, it should be noted that a number of limitations, including a variety of experimental designs, type and doses of n-3 PUFA, and high attrition rates, among others, make impossible to draw robust conclusions from this review.

Effect of n-3 long-chain polyunsaturated fatty acid intake during pregnancy on maternal, infant, and child health outcomes: a systematic review

Evidence from observational studies and randomised trials has suggested a potential association between intake of n-3 long-chain polyunsaturated fatty acids (LCPUFA) during pregnancy and certain pregnancy and birth outcomes. Marine foods (e.g. fatty sea fish, algae) and select freshwater fish contain pre-formed n-3 LCPUFA, which serve as precursors for bioactive molecules (e.g. prostaglandins) that influence a variety of biological processes. The main objective of this analysis was to summarise evidence of the effect of n-3 LCPUFA intake during pregnancy on select maternal and child health outcomes. Searches were performed in PubMed, EMBASE, and other electronic databases to identify trials where n-3 LCPUFA were provided to pregnant women for at least one trimester of pregnancy. Data were extracted into a standardised abstraction table and pooled analyses were conducted using RevMan software. Fifteen randomised controlled trials were eligible for inclusion in the meta-analysis, and 14 observational studies were included in the general review. n-3 LCPUFA supplementation during pregnancy resulted in a modest increase in birthweight (mean difference = 42.2 g; [95% CI 14.8, 69.7]) and no significant differences in birth length or head circumference. Women receiving n-3 LCPUFA had a 26% lower risk of early preterm delivery (<34 weeks) (RR = 0.74; [95% CI 0.58, 0.94]) and there was a suggestion of decreased risk of preterm delivery (RR = 0.91; [95% CI 0.82, 1.01]) and low birthweight (RR = 0.92; [95% CI 0.83, 1.02]). n-3 LCPUFA in pregnancy did not influence the occurrence of pre-eclampsia, high blood pressure, infant death, or stillbirth. Our review of observational studies revealed mixed findings, with several large studies reporting positive associations between fish intake and birthweight and several reporting no associations. In conclusion, n-3 LCPUFA supplementation during pregnancy resulted in a decreased risk of early preterm delivery and a modest increase in birthweight. More studies in low- and middle-income countries are needed to determine any effect of n-3 LCPUFA supplementation in resource-poor settings, where n-3 PUFA intake is likely low.

Fish-oil supplementation in pregnancy does not reduce the risk of gestational diabetes or preeclampsia

BACKGROUND

There is uncertainty regarding the efficacy of increasing n-3 long-chain PUFA (LCPUFA) intake during pregnancy in reducing the risk of gestational diabetes mellitus (GDM) and preeclampsia.

OBJECTIVES

The objective was to determine whether n-3 LCPUFA supplementation in pregnancy reduces the incidence of GDM or preeclampsia. A secondary objective was to assess the effect of n-3 LCPUFA supplementation on perinatal complications.

DESIGN

This was a double-blind, multicenter randomized control trial-the DHA to Optimize Mother Infant Outcome (DOMInO) trial. Pregnant women (n = 2399) of <21 wk gestation were randomly assigned to receive DHA-enriched fish oil (800 mg/d) or vegetable oil capsules without DHA from trial entry to birth. The presence of GDM or preeclampsia was assessed through a blinded audit of medical records. Birth outcomes and prenatal complications were also assessed.

RESULTS

The overall incidences of GDM and preeclampsia were 8% and 5%, respectively, based on clinical diagnosis. The RR of GDM was 0.97 (95% CI: 0.74, 1.27) and of preeclampsia was 0.87 (95% CI: 0.60, 1.25), and they did not differ significantly between the groups. Birth weight, length, and head circumference z scores also did not differ between the groups. There were 12 perinatal deaths and 5 neonatal convulsions in the control group compared with 3 perinatal deaths and no neonatal convulsions in the DHA group (P = 0.03 in both cases).

CONCLUSION

DHA supplementation of 800 mg/d in the second half of pregnancy does not reduce the risk of GDM or preeclampsia. Whether supplementation reduces the risk of perinatal death and neonatal convulsions requires further investigation. The DOMInO trial was registered with the Australian New Zealand Clinical Trials Registry as TRN12605000569606.

Omega 3 fatty acids on child growth, visual acuity and neurodevelopment

The aim of this review is to evaluate the effects of omega-3 long chain polyunsaturated fatty acids (n-3 LCPUFA) supplementation in pregnant and lactating women and infants during postnatal life, on the visual acuity, psychomotor development, mental performance and growth of infants and children. Eighteen publications (11 sets of randomized control clinical trial [RCTs]) assessed the effects of the n-3 LCPUFA supplementation duringpregnancyon neurodevelopment and growth, in the same subjects at different time points; 4 publications (2 data sets from RCTs) addressed physiological responses to n-3 LCPUFA supplementation duringpregnancy & lactationand 5 publications (3 data sets from RCTs) exclusively duringlactation. Some of these studies showed beneficial effects of docosahexaenoic acid (DHA) supplementation during pregnancy and/or lactation especially on visual acuity outcomes and some on long-term neurodevelopment; a few, showed positive effects on growth. There were also 15 RCTs involving term infants who received infant formula supplemented with DHA, which met our selection criteria. Many of these studies claimed a beneficial effect of such supplementation on visual, neural, or developmental outcomes and no effects on growth. Although new well designed and conducted studies are being published, evidence from RCTs does not demonstrate still a clear and consistent benefit of n-3 LCPUFA supplementation during pregnancy and/or lactation on term infants growth, neurodevelopment and visual acuity. These results should be interpreted with caution due to methodological limitations of the included studies.

Omega 3 fatty acids, gestation and pregnancy outcomes

Pregnancy is associated with a reduction in maternal serum docosahexaenoic acid (DHA, 22:6 n-3) percentage and its possible depletion in the maternal store. Since the synthesis of long chain polyunsaturated fatty acids (LCPUFA) in the fetus and placenta is low, both the maternal LCPUFA status and placental function are critical for their supply to the fetus. Maternal supplementation with DHA up to 1 g/d or 2·7 g n-3 LCPUFA did not have any harmful effect. DHA supplementation in large studies slightly the enhanced length of gestation (by about 2 days), which may increase the birth weight by about 50 g at delivery. However no advice can be given on their general using to avoid preterm deliveries in low or high risk pregnancies. Several studies, but not all, reported improvements of the offspring in some neurodevelopmental tests as a result of DHA supplementation during gestation, or, at least, positive relationships between maternal or cord serum DHA percentages and cognitive skills in young children. The effect seems more evident in children with low DHA proportions, which raises the question of how to identify those mothers who might have a poor DHA status and who could benefit from such supplementation. Most studies on the effects of n-3 LCPUFA supplementation during pregnancy on maternal depression were judged to be of low-to-moderate quality, mainly due to small sample sizes and failure to adhere to Consolidated Standards of Reporting Trials guidelines. In contrast, the effects of n-3 LCPUFA supplementation on reducing allergic diseases in offspring are promising.

Dietary (n-6 : n-3) fatty acids alter plasma and tissue fatty acid composition in pregnant Sprague Dawley rats

The objective of this paper is to study the effects of varying dietary levels of n-6 : n-3 fatty acid ratio on plasma and tissue fatty acid composition in rat. The treatment groups included control rats fed chow diet only, rats fed 50% soybean oil (SBO): 50% cod liver oil (CLO) (1 : 1), 84% SBO: 16% CLO (6 : 1), 96% SBO: 4% CLO (30 : 1). Blood samples were taken at day 15 of pregnancy, and the plasma and tissue were analyzed for fatty acid profile. The n-3 PUFA in plasma of Diet 1 : 1 group was significantly higher than the other diet groups, while the total n-6 PUFA in plasma was significantly higher in Diet 30 : 1 group as compared to the control and Diet 1 : 1 groups. The Diet 1 : 1 group showed significantly greater percentages of total n-3 PUFA and docosahexaenoic acid in adipose and liver tissue, and this clearly reflected the contribution of n-3 fatty acids from CLO. The total n-6 PUFA, linoleic acid, and arachidonic acid were significantly difference in Diet 30 : 1 as compared to Diet 1 : 1 and control group. These results demonstrated that the dietary ratio of n-6 : n-3 fatty acid ratio significantly affected plasma and tissue fatty acids profile in pregnant rat.

The effect of maternal fish oil supplementation during the last trimester of pregnancy on blood pressure, heart rate and heart rate variability in the 19-year-old offspring

Studies in experimental animals and human subjects have suggested that intake of n-3 fatty acids in early life can affect cardiovascular risk factors in adult life. Therefore, the aim of the present study was to investigate the effect of fish oil (FO) supplementation during the third trimester of pregnancy on blood pressure (BP), heart rate (HR) and HR variability (HRV) in the 19-year-old offspring. The study was based on follow-up of a randomised, controlled trial from 1990, in which 533 pregnant women were randomised to FO, olive oil (OO) or no oil (NO) during the last trimester of pregnancy. The offspring was invited to a physical examination including BP, HR and HRV measurements. A subgroup consisting of the offspring of mothers with a low baseline fish intake also had 24 h HRV determined. The OO group was used as reference and multiple linear regression modelling was used to compare the FO and OO groups. A total of 180 of the offspring from the FO and OO groups agreed to participate in the study (45 %). The adjusted difference between the FO and OO groups was 2 (95 % CI − 1, 4) mmHg in systolic and 1 (95 % CI 0, 3) mmHg in diastolic BP. The difference in HR was 1 (95 % CI − 2, 4). Also, HRV indices did not differ significantly between groups. Hence, FO supplementation during late pregnancy was not associated with offspring BP, HR and HRV during adolescence.

Prevention of preterm birth

Preterm birth (delivery before 37 completed weeks of gestation) is common and rates are increasing. In the past, medical efforts focused on ameliorating the consequences of prematurity rather than preventing its occurrence. This approach resulted in improved neonatal outcomes, but it remains costly in terms of both the suffering of infants and their families and the economic burden on society. Increased understanding of the pathophysiology of preterm labor has altered the approach to this problem, with increased focus on preventive strategies. Primary prevention is a limited strategy which involves public education, smoking cessation, improved nutritional status and avoidance of late preterm births. Secondary prevention focuses on recurrent preterm birth which is the most recognisable risk factor. Widely accepted strategies include cervical cerclage, progesterone and dedicated clinics. However, more research is needed to explore the role of antibiotics and anti-inflammatory treatments in the prevention of this complex problem.

The Salmon in Pregnancy Study: study design, subject characteristics, maternal fish and marine n-3 fatty acid intake, and marine n-3 fatty acid status in maternal and umbilical cord blood

BACKGROUND

Oily fish provides marine n-3 (omega-3) fatty acids that are considered to be important in the growth, development, and health of the fetus and newborn infant.

OBJECTIVES

The objectives were to increase salmon consumption among pregnant women and to determine the effect on maternal and umbilical cord plasma marine n-3 fatty acid content.

DESIGN

Women (n = 123) with low habitual consumption of oily fish were randomly assigned to continue their habitual diet or were provided with 2 portions of farmed salmon/wk to include in their diet from week 20 of pregnancy until delivery.

RESULTS

Median weekly consumption frequency of study salmon in the salmon group was 1.94 portions, and total fish consumption frequency was 2.11 portions/wk in the salmon group and 0.47 portions/wk in the control group (P < 0.001). Intakes of eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) from the diet, from seafood, and from oily fish were higher in the salmon group (all P < 0.001). Percentages of EPA and DHA in plasma phosphatidylcholine decreased during pregnancy in the control group (P for trend = 0.029 and 0.008, respectively), whereas they increased in the salmon group (P for trend for both < 0.001). EPA and DHA percentages were higher in maternal plasma phosphatidylcholine at weeks 34 and 38 of pregnancy and in umbilical cord plasma phosphatidylcholine in the salmon group (P < 0.001 for all).

CONCLUSION

If pregnant women, who do not regularly eat oily fish, eat 2 portions of salmon/wk, they will increase their intake of EPA and DHA, achieving the recommended minimum intake; and they will increase their and their fetus' status of EPA and DHA. This trial was registered at clinicaltrials.gov as NCT00801502.

Effect of maternal dietary intake on the weight of the newborn in Aligarh city, India

BACKGROUND

This study aimed (1) To record the nutrient intake of the respondents and compare the same with the available recommended dietary allowances (RDA). (2) To assess the correlation between maternal dietary intake and the weight of newborn.

MATERIALS AND METHODS

Two hundred and ninety two pregnant women.

STUDY AREA

Five hospitals of Aligarh city, Uttar Pradesh. Study Tool and Data Collection: Interview schedule was administered to record information regarding dietary intake and weight of newborn. The data collection was initiated in April 2009 and was completed in March' 2010.

DATA ANALYSIS

Statistical analysis was done by using version SPSS 17. Frequency distributions were calculated for all variables. Univariate and multivariate analysis were performed to determine the influence of the dietary intake on the birth weight of newborn.

RESULTS

Results revealed that the nutrient intake in all trimesters of pregnancy was lower as compared to RDA. There were significant correlations between the nutrient intake of the mothers and the weight of newborn in all trimesters of pregnancy (P=0.01).

CONCLUSION

It was found that the dietary intake during all trimesters of pregnancy were significantly associated with the birth weight.

The effect of perinatal omega-3 fatty acid supplementation on inflammatory markers and allergic diseases: a systematic review

BACKGROUND

Maternal supplementation with omega-3 polyunsaturated fatty acids (n-3 PUFA) may modulate immune responses and allergy in neonates and children.

OBJECTIVE

To determine if n-3 PUFA supplementation during pregnancy and lactation reduces risk for childhood allergic disease.

SEARCH STRATEGY

We searched Medline and all evidence-based medicine reviews for randomised controlled trials comparing the effects of n-3 PUFA and placebo supplementation during pregnancy and/or lactation on childhood allergic diseases and inflammatory cytokines.

SELECTION CRITERIA

We included studies reporting on food allergy, response to the egg skin prick test (SPT), atopy and asthma in infancy and childhood as well as production of interleukin-13 and interferon-gamma, two cytokines involved in the pathogenesis of asthma. For assessment of inclusion, two authors reviewed all abstracts for suitability and independently extracted data.

DATA COLLECTION AND ANALYSIS

Two-by-two tables were constructed and odds ratios (OR) were calculated for the outcomes: response to the SPT, food allergy, atopy and asthma in childhood. The assays differed so data on inflammatory markers were reported in narrative form.

MAIN RESULTS

Five randomised controlled trials (n = 949) were included. n-3 PUFA supplementation during pregnancy reduced 12-month prevalence of positive egg SPT (two trials, 12/87 versus 32/100, OR 0.33, 95% CI 0.16, 0.70) and childhood asthma (two trials, 10/303 versus 17/179, OR 0.349, 95% CI 0.154, 0.788) and significantly reduced cord blood interleukin-13 levels. Supplementation during lactation did not prevent asthma, food allergy or atopy.

CONCLUSION

n-3 PUFA supplementation during pregnancy decreases childhood asthma and response to SPT.

Trans fats-sources, health risks and alternative approach - A review

Trans fatty acids have the presence of one or more double bonds in the trans configuration instead of the usual cis configuration. They are desired by Vanaspati industry as they impart firmness to margarines and plasticity as well as emulsion stability to shortenings. Research has proved the direct connection of trans fatty acids with cardiovascular diseases, breast cancer, shortening of pregnancy period, risks of preeclampsia, disorders of nervous system and vision in infants, colon cancer, diabetes, obesity and allergy. In light of these new findings trans fatty intake should be zero and new technology of hydrogenation of oils is to be developed which produce zero trans fatty acids at the same time preserve the desirable properties contributed by trans fatty acids to the hydrogenated oils. Presently in India there is no system to monitor and regulate the amount of trans fats in processed foods and hence a stringent food law is immediately required.

Intake of fish oil during pregnancy and adiposity in 19-y-old offspring: follow-up on a randomized controlled trial

BACKGROUND

It is well established that obesity tends to track from early childhood into adult life. Studies in experimental animals have suggested that changes in the peri- and early postnatal intake of n-3 (omega-3) polyunsaturated acids can affect the development of obesity in adult life.

OBJECTIVE

The aim of the current study was to investigate the effect of daily supplementation with 2.7 g long-chain n-3 fatty acids during the third trimester of pregnancy on adiposity in 19-y-old offspring.

DESIGN

The study was based on follow-up of a randomized controlled trial from 1990, in which 533 pregnant women were randomly assigned to receive fish oil, olive oil, or no oil. At ≈19 y of age, the offspring of subjects from the randomized controlled trial were invited to undergo a physical examination, including anthropometric measurements and fasting blood sampling. The blood sample was analyzed for insulin, glucose, glycated hemoglobin, leptin, adiponectin, insulin-like growth factor I, and high-sensitivity C-reactive protein. Multiple linear regression modeling, adjusted for sex, smoking, and parental overweight, was used to estimate the effect of fish oil relative to that of olive oil on BMI (in kg/m(2)), waist circumference, and biochemical measures.

RESULTS

A total of 243 of the offspring were followed up. We found no difference between the fish-oil and olive oil groups in BMI (0.13; -0.92, 1.17) or waist circumference (0.7 cm; -2.1, 3.4 cm). Overall, results of the biochemical analyses supported the finding of no difference between the groups.

CONCLUSION

We detected no effect of fish-oil supplementation during pregnancy on offspring adiposity in adolescence.

Fish oil supplementation during late pregnancy does not influence plasma lipids or lipoprotein levels in young adult offspring

Nutritional influences on cardiovascular disease operate throughout life. Studies in both experimental animals and humans have suggested that changes in the peri- and early post-natal nutrition can affect the development of the various components of the metabolic syndrome in adult life. This has lead to the hypothesis that n-3 fatty acid supplementation in pregnancy may have a beneficial effect on lipid profile in the offspring. The aim of the present study was to investigate the effect of supplementation with n-3 fatty acids during the third trimester of pregnancy on lipids and lipoproteins in the 19-year-old offspring. The study was based on the follow-up of a randomized controlled trial from 1990 where 533 pregnant women were randomized to fish oil (n = 266), olive oil (n = 136) or no oil (n = 131). In 2009, the offspring were invited to a physical examination including blood sampling. A total of 243 of the offspring participated. Lipid values did not differ between the fish oil and olive oil groups. The relative adjusted difference (95% confidence intervals) in lipid concentrations was -3% (-11; 7) for LDL cholesterol, 3% (-3; 10) for HDL cholesterol, -1% (-6; 5) for total cholesterol,-4% (-16; 10) for TAG concentrations, 2%(-2; 7) for apolipoprotein A1, -1% (-9; 7) for apolipoprotein B and 3% (-7; 15) in relative abundance of small dense LDL. In conclusion, there was no effect of fish oil supplementation during the third trimester of pregnancy on offspring plasma lipids and lipoproteins in adolescence.

Diet in pregnancy and risk of small for gestational age birth: results from a retrospective case-control study in Italy

This study aims to analyse the association between selected dietary indicators during pregnancy and the risk of small for gestational age (SGA) births in a South European population. This is a case-control study. Cases were 555 women who delivered SGA babies at the Luigi Mangiagalli Clinic of Milan and the Obstetric and Gynecology Clinic of the University of Verona. The controls were women who gave birth at term (≥37 weeks of gestation) to healthy infants with normal weight in the same clinics. Dietary information was collected with a food frequency questionnaire. Women with SGA babies reported a more frequent consumption of meat and olive oil, and a less frequent consumption of fish and eggs. Women with high consumption of olive oil had an increased risk of delivering an SGA baby [odds ratio (OR) 1.6, 95% confidence interval (CI) 1.0-2.5]. The multivariate OR for high meat consumption was 1.4 (95% CI 1.1-1.9); for fish 0.8 (95% CI 0.6-1.0, χ² for trend 4.0, P = 0.045 ) and for egg 0.7 (95% CI 0.5-0.9). After allowing for factors generally known to be associated with SGA, we have shown that eating more fish and eggs, and less meat and possibly olive oil, are associated with a lower risk of delivering an SGA baby.

Inflammatory bowel disease and pregnancy: an update

Women with inflammatory bowel disease have similar rates of conception to the general population unless they have had pelvic surgery. Once pregnant, regardless of disease activity, they have an increased risk of adverse pregnancy outcome and should be followed as high-risk obstetric patients. Most medications are compatible with pregnancy and lactation, as described in this article. Ideally, women should discuss their plans for pregnancy with their physician prior to conception so that risks and benefits can be reviewed, medications adjusted and healthcare maintenance updated. Once pregnant, a multidisciplinary team of gastroenterologists, obstetricians and pediatricians should help to ensure the best care for the mother and child.

Omega-3 supplements in pregnancy: are we too late to identify the possible benefits?

OBJECTIVE

Postpartum depression (PPD) is a common and recurring illness. Most women who experience PPD do not seek professional help; for those who do, the available treatment options are not supported by extensive research evidence. Several lines of research have linked omega-3 fatty acids (omega-3) supplementation with a reduced risk of PPD. Although it has been suggested that women in the perinatal period consume sufficient omega-3 to potentially prevent PPD, there is a lack of definitive research evidence. This pilot study surveyed pregnant women's current use of omega-3, multivitamin, and other supplements, as well as their attitudes toward omega-3 research during pregnancy, to assess the feasibility of pregnant women's participation in a large randomized controlled trial evaluating omega-3 supplementation.

METHODS

Women attending prenatal clinics over a three-week period were invited to participate in a survey. The survey contained an information letter that was followed by a brief questionnaire assessing the use of nutritional supplements and opinions regarding the likelihood of participating in a clinical trial during pregnancy.

RESULTS

Of the 176 women who completed the survey, six women were in the first trimester of pregnancy, 82 were in the second trimester, and 87 were in the third trimester. One hundred fifty-nine respondents (90.3%) reported taking a multivitamin supplement but none were taking a supplement that contained omega-3; only 20 (11.4%) were taking omega-3. Seventy-eight women (44.4%) responded that they would participate in a clinical study evaluating the effects of fish oil on their health.

CONCLUSION

The results of our study indicate that many pregnant women take prenatal multivitamins and nutritional supplements, that there are currently few pregnant women attending clinics at our hospitals who are supplementing with omega-3, and that pregnant women would be willing to participate in a clinical trial evaluating the effects of omega-3.

Prenatal mercury contamination: relationship with maternal seafood consumption during pregnancy and fetal growth in the 'EDEN mother-child' cohort

Maternal seafood intake is of great health interest since it constitutes an important source of n-3 fatty acids, but provides also an important pathway for fetal exposure to Hg. The objective of the present study was to determine associations between Hg contamination and both maternal seafood consumption and fetal growth in French pregnant women. Pregnant women included in the 'EDEN mother-child' cohort study answered FFQ on their usual diet in the year before and during the last 3 months of pregnancy, from which frequencies of seafood intake were evaluated. Total hair-Hg level was determined for the first 691 included women. Associations between Hg level, seafood intake and several neonatal measurements were studied using linear regressions adjusted for confounding variables. The median Hg level for mothers was 0.52 μg/g. Maternal seafood intake was associated with Hg level (r 0.33; P < 0.0001). There was no association between Hg level and fetal growth in the whole sample of women, except for an early negative relationship with biparietal diameter. A positive association was found between seafood intake and fetal growth in overweight women only which remained unchanged after adjustment for Hg level (birth weight: +101 g for a difference of 1 sd in seafood consumption; P = 0.008). Although seafood intake was associated with Hg contamination in French pregnant women, the contamination level was low. There was no consistent association between Hg level and fetal growth. Taking into account Hg level did not modify associations between seafood intake and fetal growth.

Do pregnant women and those at risk of developing post-natal depression consume lower amounts of long chain omega-3 polyunsaturated fatty acids?

The aims were to compare intakes of long chain omega-3 polyunsaturated fatty acid (LC n-3 PUFA) in pregnant and non-pregnant women in Australia and to compare these intakes to the Australian National Nutrition Survey of 1995 (NNS95) [1] and to determine if the LC n-3 PUFA intakes differed in women who may be ‘at risk’ compared with women ‘not at risk’ of developing post-natal depression (PND). A validated LC n-3 PUFA food frequency questionnaire and pregnant women’s Edinburgh Postnatal Depression Scale (EPDS) scores were used. LC n-3 PUFA intakes were comparable to the NNS95 but did not differ due to pregnancy or whether or not a woman is at risk of developing PND.

Omega-3 fatty acid supplementation to prevent recurrent preterm birth: a randomized controlled trial

OBJECTIVE

To assess whether the addition of an omega-3 long-chain polyunsaturated fatty acid supplement would reduce preterm birth in women with at least one prior spontaneous preterm birth receiving 17alpha-hydroxyprogesterone caproate.

METHODS

We conducted a randomized, double-masked, placebo-controlled trial in 13 centers. Women with a history of prior spontaneous singleton preterm birth and a current singleton gestation were assigned to either a daily omega-3 supplement (1,200 mg eicosapentaenoic acid and 800 mg docosahexaenoic acid) or matching placebo from 16-22 through 36 weeks of gestation. All participants received weekly intramuscular 17alpha-hydroxyprogesterone caproate (250 mg). The primary study outcome was delivery before 37 weeks of gestation. A sample size of 800 was necessary to have 80% power to detect a 30% reduction in the primary outcome from 30%, assuming a type I error two-sided of 5%.

RESULTS

A total of 852 women were included, and none was lost to follow up. Delivery before 37 weeks of gestation occurred in 37.8% (164/434) of women in the omega-3 group and 41.6% (174/418) in the placebo group (relative risk 0.91, 95% confidence interval 0.77-1.07).

CONCLUSION

Omega-3 long-chain polyunsaturated fatty acid supplementation offered no benefit in reducing preterm birth among women receiving 17alpha-hydroxyprogesterone caproate who have a history of preterm delivery.

CLINICAL TRIAL REGISTRATION

ClinicalTrials.gov, www.clinicaltrials.gov, NCT00135902.

LEVEL OF EVIDENCE

I.

Pregnancy and inflammatory bowel disease

This review covers important questions that arise for physicians caring for women with inflammatory bowel disease. Fertility, pregnancy outcomes and the safety of medications in pregnancy and lactation are discussed.

Pregnancy and inflammatory bowel disease

This review covers important questions that arise for physicians caring for women with inflammatory bowel disease. Fertility, pregnancy outcomes and the safety of medications in pregnancy and lactation are discussed.