Prenatal Omega‐3 Fatty Acids: Review and Recommendations

Maternal Preconception Omega-6, Omega-3, and Omega-6:Omega-3 Intake and Uterine Artery Indices in Mid-Gestation

OBJECTIVE

 Maternal preconception diet influences pregnancy health and fetal outcomes. We examined the relationship between preconception fatty acid (FA) intake and uterine artery indices in mid-gestation in a large, heterogeneous cohort of nulliparous individuals.

STUDY DESIGN

 This is a secondary analysis of the nuMom2b (Nulliparous Pregnancy Outcomes Study: Monitoring Mothers-to-be) study. Dietary ω-6 and ω-3 FA intake was assessed with food frequency questionnaires and uterine artery indices were obtained via Doppler studies in the second trimester. For our primary outcome of pulsatility index (PI) > 1.6, we compared proportions by each dichotomous FA exposure and tested differences with chi-square test.

RESULTS

 For PI > 1.6, odds ratio for the unfavorable FA quartile compared with remaining quartiles for the exposures were 0.96 to 1.25, p = 0.157 (ω-6 FA); 0.97 to 1.26, p = 0.124 (ω-3 FA); 0.87 to 1.14, p = 1.00 (ω-6:ω-3 FA ratio).

CONCLUSION

 No significant associations between self-reported maternal preconception ω-6 and ω-3 FA intake and uterine artery Doppler indices measured during the second trimester were observed.

KEY POINTS

· Maternal diet impacts pregnancy health/fetal outcomes.. · ω-3 and ω-6 FA intake influences cardiovascular health.. · FA intake may affect blood flow to fetoplacental unit.. · Results are limited by inadequate adherence to dietary recommendations..

Effect of Omega-3 fatty acid supplementation on sexual function of pregnant women: a double blind randomized controlled trial

The aim of this study was to evaluate the effect of omega-3 fatty acid supplementation on female sexual function during pregnancy. The present study was a double-blind randomized controlled clinical trial performed on 124 pregnant women (62 people in each group) at 16-22 weeks of gestation who referred to health centers in Ilam in 2020 to receive prenatal care. The intervention group received 300 mg of omega-3 supplements and the control group received placebo once a day for 8 weeks. Data collection tools in this study included a demographic questionnaire, three 24-h dietary recall (24HR), female sexual function index (FSFI), and Van den Bergh Pregnancy-Related Anxiety Questionnaire (PRAQ). Before intervention, the total score of sexual function in the intervention group and control groups, showed no statistically significant difference (P = 0.123). However, 4 and 8 weeks after intervention, the mean total score of sexual function in the intervention group was significantly higher than that of the control group after intervention (P < 0.0001). Before intervention, the total score of gestational anxiety in the intervention and control groups, showed no statistically significant difference (P = 0.149). However, 4 and 8 weeks after intervention, the mean total score of gestational anxiety in the intervention group was significantly lower than that of the control group (P < 0.0001). Based on three 24-h dietary recall, regardless of daily intake of 300 mg of omega-3 supplement, the percentage of polyunsaturated fatty acid (PUFA) intake from daily energy intake was not statistically significant between the intervention and control groups from baseline to follow-up (P > 0.01). Based on the results of this study, omega-3 supplementation could improve sexual function in pregnant women by preventing increased pregnancy anxiety. However, more studies are needed to prove the effectiveness of omega-3s on female sexual function during pregnancy. This study was approved by the Ethics Committee of Ahvaz Jundishapur University of Medical Sciences (Ref. ID: IR.AJUMS.REC.1398.935) and registered in Iranian Registry of Clinical Trials (Ref. ID: IRCT20200415047078N1).

Nutrition knowledge among pregnant women in Lebanon: A cross-sectional study

BACKGROUND

Women's knowledge of the nutritional guidelines during pregnancy can affect the health and nutritional status of both mother and child. Having good nutritional information related to maternal dietary intake and healthy lifestyles is therefore of great importance. However, there is limited published research that demonstrates pregnant women's knowledge of the nutritional guidelines during pregnancy in Lebanon.

OBJECTIVE

To assess the knowledge on food sources and energy recommendations as well as food safety practices and diet-health relationship among women during pregnancy in Lebanon.

DESIGN

A cross-sectional study.

METHODS

The study was conducted at prenatal care clinics in Lebanon, and all pregnant women present, regardless of nationality, were invited to complete the self-administered nutrition knowledge questionnaire. The study assessed five different nutrition knowledge domains (food sources of nutrients, dietary behaviors, food safety knowledge, micronutrients for fetal development, and energy requirements and weight gain) and the demographic characteristics of pregnant women who completed a multidimensional online survey based on validated and existing measures.

RESULTS

Four-hundred and ten responses were obtained. Approximately half of respondents (47%) held a university degree, for 42% of women this was their first pregnancy, and 71% had a planned pregnancy. Among the different nutrition knowledge domains, the highest levels of knowledge were for the behaviors that can minimize the effect of nausea/vomiting, heartburn, and constipation during pregnancy (63.9%) and the lowest levels of knowledge was for the importance of iodine and omega-3 fatty acids in pregnancy (28.4%). Most of females knew about food safety practices during pregnancy (72.9%) but less than half were knowledgeable about listeriosis contamination (45.9%), and the types of fish that are the safest to select during pregnancy (47.8%).

CONCLUSION

Despite the fact that pregnant women had an adequate level of knowledge in different nutrition-related areas, there was inadequate level of awareness related to critical nutrients and behaviors that can have adverse effects on mother and/or baby. Therefore, there is a need to focus on specific maternal nutrition aspects such as iron-rich foods, listeriosis food contamination, and nutrients that aid in fetal brain and retina development.

Needs Assessment to Inform and Improve Educational Practices Surrounding Omega-3 Consumption during Pregnancy

OBJECTIVES

Adequate dietary consumption of long chain omega-3 fatty acids (n-3 LCPUFA) during pregnancy has been associated with better maternal and infant health outcomes. Given that the primary source of n-3 LCPUFA is fish and fish oils, concerns surrounding contamination and uncertainty of safe fish intake guidelines have negatively affected consumption of fish during pregnancy. Although obstetric healthcare providers are in a unique position to influence dietary intake patterns, a gap exists in their understanding the knowledge and practices surrounding n-3 LCPUFA. This needs assessment investigation evaluated knowledge, attitudes and prescribing/recommending practices of obstetric practitioners surrounding n-3 LCPUFA consumption and/or supplementation to generate evidence supporting the development of targeted educational initiatives.

METHODS

A cross-sectional, needs assessment was conducted using anonymous online-survey of affiliate members of the American College of Nurse Midwives (N = 105). A 24-item, previously validated (α = 0.86) needs assessment survey (Obstetric Clinicians Omega-3 Survey, OCOS) was used to assess attitudes, knowledge, and prescribing practices surrounding n-3 LCPUFA.

RESULTS

The total OCOS score representing attitudes, knowledge and prescribing patterns collectively was 69.48% (Mean = 79.90(± 12.44), score range = 24-115). Scores for the sub-domains included attitude 68.33% (Mean = 20.50(± 3.64), score range = 6-30); knowledge 71.40% (Mean = 30.70(± 5.43), score range = 9-43); and prescribing patterns 68.31% (Mean = 28.69(± 5.39), score range = 9-42).

CONCLUSIONS FOR PRACTICE

Although the majority of respondents had fair-moderate n-3 LCPUFA knowledge, attitudes and prescribing/recommending, our results highlight an opportunity for additional research and educational outreach targeting improved n-3 LCPUFA knowledge and practices. Specific areas of educational interest included associated health outcomes, dosing and safe consumption guidelines.

Importance of n-3 PUFA consumption during pregnancy: perception discrepancies between pregnant women and gynaecologists-obstetricians in Belgium

OBJECTIVE

n-3 PUFA during pregnancy have been subject to intense research interest, but also much controversy, creating a situation of confusion among patients and health-care providers. The present study was carried out to explore knowledge, attitude and practices regarding n-3 PUFA in two independent populations of pregnant women and gynaecologists-obstetricians in Belgium and to assess the relationship between the pregnant women's attributes and their n-3 PUFA status measured by the omega-3 index.

DESIGN

Cross-sectional study. Knowledge, attitude and practices were collected by self-administered questionnaires while laboratory data were available for each pregnant woman.

SETTING

During the first antenatal hospital appointment (for the pregnant women) and by email (for the gynaecologists-obstetricians).ParticipantsWomen in early pregnancy (n 122) and gynaecologists-obstetricians (n 67).

RESULTS

Marked discrepancies in perception were evidenced between the pregnant women and health-care providers. While 82 % of the women attached high importance to n-3 PUFA during pregnancy, only a third of the gynaecologists-obstetricians did. About 35 % of the women declared paying particular attention to their consumption of n-3 PUFA. After adjusting for sociodemographic characteristics, these positive dietary practices were significantly associated with higher omega-3 index (P=0·04). Overall, 43·3 % of professionals did not provide any information about n-3 PUFA to their pregnant patients and 46·3 % did not take any preventive actions.

CONCLUSIONS

Evidence-based guidelines, refreshment training and communication tools are needed to improve awareness and clinical practices among caregivers regarding n-3 PUFA to benefit both mothers and their children.

Omega-3 Consumption During Pregnancy to Support Optimal Outcomes

Long-chain omega-3 polyunsaturated fatty acids (n-3 LCPUFA), including docosahexaenoic acid, are components of cellular membranes that affect biological functioning. Most pregnant women consume inadequate amounts of n-3 LCPUFA and inadequately convert linolenic acid into docosahexaenoic acid. The purpose of this article is to educate nursing professionals on the importance of n-3 LCPUFA consumption during pregnancy and highlight the critical role of nursing professionals in supporting optimal consumption for improved metabolic, antioxidant, and anti-inflammatory potential.

Reduced DHA transfer in diabetic pregnancies: mechanistic basis and long-term neurodevelopmental implications

Infants born to diabetic mothers have a higher frequency of impaired neurodevelopment. The omega-3 or n-3 fatty acid docosahexaenoic acid (DHA) is an important structural component of neural tissue and is critical for fetal brain development. Maternal DHA supplementation during pregnancy is linked to better infant neurodevelopment; however, maternal-fetal transfer of DHA is reduced in women with diabetes. Evidence of mechanisms explaining altered maternal-fetal DHA transfer in this population is limited. This review explores existing evidence underpinning reduced maternal-fetal DHA transfer in maternal fuel metabolism in this population. Further research is necessary to evaluate the role of peroxisome proliferator-activated receptors in modulating placental fatty acid binding and maternal-fetal DHA transfer. Considerations for clinical practice include a diet high in DHA and/or provision of supplemental DHA to obstetric diabetic patients within minimum guidelines.

Amniotic fluid metabolomic analysis in spontaneous preterm birth

OBJECTIVE

To identify metabolic changes associated with early spontaneous preterm birth (PTB; <34 weeks) and term births, using high-throughput metabolomics of amniotic fluid (AF) in African American population.

METHOD

In this study, AF samples retrieved from spontaneous PTB (<34 weeks [n = 25]) and normal term birth (n = 25) by transvaginal amniocentesis at the time of labor prior to delivery were subjected to metabolomics analysis. Equal volumes of samples were subjected to a standard solvent extraction method and analyzed using gas chromatography/mass spectrometry (MS) and liquid chromatography/MS/MS. Biochemicals were identified through matching of ion features to a library of biochemical standards. After log transformation and imputation of minimum observed values for each compound, t test, correlation tests, and false discovery rate corrections were used to identify differentially regulated metabolites. Data were controlled for clinical/demographic variables and medication during pregnancy.

RESULTS

Of 348 metabolites measured in AF samples, 121 metabolites had a gestational age effect and 116 differed significantly between PTB and term births. A majority of significantly altered metabolites could be classified into 3 categories, namely, (1) liver function, (2) fatty acid and coenzyme A (CoA) metabolism, and (3) histidine metabolism. The signature of altered liver function was apparent in many cytochrome P450-related pathways including bile acids, steroids, xanthines, heme, and phase II detoxification of xenobiotics with the largest fold change seen with pantothenol, a CoA synthesis inhibitor that was 8-fold more abundant in PTB.

CONCLUSION

Global metabolic profiling of AF revealed alteration in hepatic metabolites involving xenobiotic detoxification and CoA metabolism in PTB. Maternal and/or fetal hepatic function differences may be developmentally related and its contribution PTB as a cause or effect of PTB is still unclear.

Ingestão de energia e de nutrientes e baixo peso ao nascer: estudo de coorte com gestantes adolescentes

OBJETIVO: Avaliar a ingestão de energia, de macro e de micronutrientes por adolescentes no primeiro e no segundo trimestres de gestação e estimar sua associação com o peso do concepto ao nascer. MÉTODOS: Estudo longitudinal, incluindo 139 gestantes adolescentes atendidas em serviço de pré-natal de maternidade pública, acompanhadas desde o primeiro trimestre gestacional até o puerpério imediato. Aplicou-se um questionário de frequência de consumo alimentar no primeiro e no segundo trimestres de gestação. O peso e a idade gestacional ao nascer dos recém-nascidos foram coletados dos prontuários hospitalares. Foram estimados médias e intervalo de confiança de 95%. O método dos resíduos foi utilizado para ajustar o consumo de nutrientes pelo consumo energético total. Modelos de regressão linear múltipla foram desenvolvidos para identificar os fatores associados ao peso ao nascer. RESULTADOS: O consumo médio de proteínas (p=0,02), lipídeos (p=0,02), ácidos graxos saturados (p=0,02) e monoinsaturados (p=0,05), colesterol (p=0,01), cálcio (p<0,01), potássio (p=0,01) e fósforo (p<0,01) foi mais elevado entre gestantes que tiveram filhos com peso ao nascer acima de 2500g. Idade gestacional ao parto (β=105,8; p<0,01), número de consultas de pré-natal (β=34,1; p=0,04), consumo de ácidos graxos poli-insaturados (β=7,5; p=0,04) e de ômega-3 (β=74,3; p=0,05) e de colesterol (β=0,4; p=0,04) foram variáveis preditoras do peso ao nascer em modelos de regressão linear múltipla. CONCLUSÃO: O perfil lipídico da dieta da mãe foi o principal preditor do peso do concepto ao nascer, e os resultados sugerem que o acompanhamento nutricional deva ser incluído na rotina dos serviços de atenção pré-natal.

Estimation of eicosapentaenoic acid and docosahexaenoic acid intakes in pregnant Japanese women without nausea by using a self-administered diet history questionnaire

Eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) intakes during pregnancy affect fetal development and maternal mental health; therefore, an accurate assessment of EPA and DHA intakes is required. We hypothesized that a self-administered diet history questionnaire (DHQ) that was developed for non-pregnant adults could be used for estimating EPA and DHA intakes in pregnant Japanese women; thus, we evaluated the validity and reproducibility of the DHQ during pregnancy. We recruited 262 healthy participants with singleton pregnancies during their second trimester at a university hospital in Tokyo between June 2010 and July 2011. Plasma concentrations of EPA and DHA were measured as reference values. Fifty-eight women completed the DHQ twice, within a 4- to 5-week period to assess the reproducibility of the results. Among the participants without pregnancy-associated nausea (n = 180), significantly positive correlations were observed between energy-adjusted intakes and plasma concentrations of EPA (r(s) = 0.388), DHA (r(s) = 0.264), and EPA + DHA (r(s) = 0.328). More than 60% of the participants without nausea fell into the same or adjacent quintiles according to energy-adjusted intakes and plasma concentrations of EPA, DHA, and EPA + DHA. Meanwhile, among the participants with nausea, a low correlation for EPA and no correlation for DHA and EPA + DHA were found. Intraclass correlation coefficients for the 2-time DHQ measurements were 0.691 (EPA) and 0.663 (DHA). The results indicate that the DHQ has an acceptable level of validity and reproducibility for assessing EPA, DHA, and EPA + DHA intakes in pregnant Japanese women without nausea.

DHA supplementation: current implications in pregnancy and childhood

Dietary supplementation with ω-3 long chain fatty acids including docosahexaenoic acid (DHA) has increased in popularity in recent years and adequate DHA supplementation during pregnancy and early childhood is of clinical importance. Some evidence has been built for the neuro-cognitive benefits of supplementation with long chain polyunsaturated fatty acids (LCPUFA) such as DHA during pregnancy; however, recent data indicate that the anti-inflammatory properties may be of at least equal significance. Adequate DHA availability in the fetus/infant optimizes brain and retinal maturation in part by influencing neurotransmitter pathways. The anti-inflammatory properties of LCPUFA are largely mediated through modulation of signaling either directly through binding to receptors or through changes in lipid raft formation and receptor presentation. Our goal is to review the current findings on DHA supplementation, specifically in pregnancy and infant neurodevelopment, as a pharmacologic agent with both preventative and therapeutic value. Given the overall benefits of DHA, maternal and infant supplementation may improve neurological outcomes especially in vulernable populations. However, optimal composition of the supplement and dosing and treatment strategies still need to be determined to lend support for routine supplementation.

Fetal and neonatal levels of omega-3: effects on neurodevelopment, nutrition, and growth

Nutrition in pregnancy, during lactation, childhood, and later stages has a fundamental influence on overall development. There is a growing research interest on the role of key dietary nutrients in fetal health. Omega-3 polyunsaturated fatty acids (n-3 LCPUFAs) play an important role in brain development and function. Evidence from animal models of dietary n-3 LCPUFAs deficiency suggests that these fatty acids promote early brain development and regulate behavioral and neurochemical aspects related to mood disorders (stress responses, depression, and aggression and growth, memory, and cognitive functions). Preclinical and clinical studies suggest the role of n-3 LCPUFAs on neurodevelopment and growth. n-3 LCPUFAs may be an effective adjunctive factor for neural development, growth, and cognitive development, but further large-scale, well-controlled trials and preclinical studies are needed to examine its clinical mechanisms and possible benefits. The present paper discusses the use of n-3 LCPUFAs during different developmental stages and the investigation of different sources of consumption. The paper summarizes the role of n-3 LCPUFAs levels during critical periods and their effects on the children's neurodevelopment, nutrition, and growth.

Perinatal manipulation of α-linolenic acid intake induces epigenetic changes in maternal and offspring livers

Previous studies indicated that the intake of α-linolenic acid (ALA) can alter the concentration of both ω-6 and ω-3 fatty acids in both mother and offspring, with consequences on postnatal brain development. This study describes the association between maternal ALA availability during gestation and lactation, and alterations in the Fads2 DNA methylation in both maternal and offspring livers, at the end of lactation period. Both Fads2 promoter and intron 1 DNA methylation were increased in the groups receiving postnatal flaxseed oil containing 50% ALA (mothers or pups), while bivariate analysis indicated a significant association of the Fads2 epigenetic status in the liver between each mother and its offspring. In addition, Fads2 expression was negatively correlated with promoter methylation at the individual level in maternal livers (P<0.05). This study also indicated that the interplay between ALA availability during gestation and lactation can differentially alter the expression of desaturases and elongases involved in ω-6 and ω-3 metabolic pathways. In summary, when considering the perinatal dietary ALA requirements in mice, both gestation and lactation periods should be considered as having distinct roles in modulating the metabolism of ω-6 and ω-3 fatty acids in maternal mouse livers.

The Role of Endocrine Disruptors in the Epigenetics of Reproductive Disease and Dysfunction: Potential Relevance to Humans

In a murine model, we have linked early life toxicant exposure to reduced uterine sensitivity to progesterone, a phenotype we had previously associated with inflammation in endometriosis patients. Subsequent studies revealed that developmental toxicant exposure not only reduces fertility in male and female mice but also negatively impacts pregnancy leading to spontaneous preterm birth (PTB). An epigenetic alteration of the progesterone receptor gene correlated with reduced fertility and adverse pregnancy outcomes and persisted in multiple generations of mice in the absence of an additional toxicant exposure. Gene-environment interactions in women may explain why some patients "at risk" for PTB deliver at term while others without known risks deliver early. Our model provides a unique system to unravel the interactive influences of inflammation and reduced progesterone responsiveness on PTB and suggests that therapy needs to begin prior to pregnancy (and involve both partners) rather than once the inflammatory cascade has been initiated.

The evaluation of antioxidant activity of milling fractions of selected cereals grown in the year 2010

Cereals are good source of biologically active compounds that contribute to reducing the risk of coronary heart disease and also inhibit oxidation in human plasma. The aim of this study was to evaluate of antioxidant potential of four milling fractions of selected cereals grown in the year 2010. Methanol was used to extract the antioxidant compounds from cereals. Free radical scavenging activity of samples was measured using DPPH assay and reducing power was determined using FRAP assay. Secondary was evaluated of total phenolic and flavonoid content of cereal extracts. We found that flour fractions (break flour and reduction flour) showed the lower proportion of the total antioxidant potential than bran fractions (fine bran and coarse bran). Extract from barley had the highest values of antioxidant activity and phenolic content.

Preconception omega-3 fatty acid supplementation of adult male mice with a history of developmental 2,3,7,8-tetrachlorodibenzo-p-dioxin exposure prevents preterm birth in unexposed female partners

We have recently reported that adult male C57BL/6 mice exposed in utero to the environmental toxicant 2,3,7,8-tetrachlorodibenzo-p-dioxin (TCDD) confer an increased risk of preterm birth (PTB) to unexposed females. Risk of PTB was coincident with decreased placental progesterone receptor (Pgr) mRNA expression and increased toll-like receptor 4 (Tlr4) mRNA expression, suggesting that toxicant exposure induced a heightened inflammatory response at the maternal-fetal interface. Since omega-3 fatty acids exhibit anti-inflammatory activity, in this study, we provided TCDD-exposed males a fish oil-enriched diet prior to mating. Although PTB was common in control females mated to TCDD-exposed males on the standard diet, fish oil supplementation of TCDD-exposed males eliminated PTB in unexposed partners. We also determined the influence of preconception, paternal fish oil supplementation on the placental inflammatory response in late pregnancy (E18.5) by examining the expression of Pgr and Tlr4 mRNA as well as the expression of 15-hydroxyprostaglandin dehydrogenase (PGDH). PGDH catabolizes the inflammatory PGE2 to an inactive form; thus, reduced expression of this enzyme would promote tissue inflammation. Compared with control pregnancies, examination of E18.5 placentas arising from TCDD-exposed males on the standard diet revealed a significant increase in Tlr4 mRNA expression corresponding to a reduction in Pgr mRNA and PGDH protein expression. In contrast, fish oil supplementation of toxicant-exposed males led to normalization of placental expression of both Pgr and Tlr4 mRNA and a marked increase in PGDH expression. These studies suggest that a paternal preconception diet that includes omega-3 fatty acids prevents the toxicant-associated increase in the placental inflammatory response at late gestation, preventing PTB.

Maternal nutrition and perinatal outcomes

Diet and patterns of eating during pregnancy can affect perinatal outcomes through direct physiologic effects or by stressing the fetus in ways that permanently affect phenotype. Supplements are not a magic nutritional remedy, and evidence of profound benefit for most supplements remains inconclusive. However, research supports calcium supplements to decrease preeclampsia. Following a low glycemic, Mediterranean-type diet appears to improve ovulatory infertility, decrease preterm birth, and decrease the risk of gestational diabetes. Although women in the United States have adequate levels of most nutrients, subpopulations are low in vitamin D, folate, and iodine. Vitamin D has increasingly been shown to be important not only for bone health, but also for glucose regulation, immune function, and good uterine contractility in labor. To ensure adequate vitamin and micronutrient intake, especially of folate before conception, all reproductive age women should take a multivitamin daily. In pregnancy, health care providers need to assess women's diets, give them weight gain recommendations based on their body mass index measurement, and advise them to eat a Mediterranean diet rich in omega-3 fatty acids (ingested as low-mercury risk fatty fish or supplements), ingest adequate calcium, and achieve adequate vitamin D levels through sun exposure or supplements. Health care providers should continue to spend time on nutrition assessment and counseling.

Prenatal nutrition: a practical guide for assessment and counseling

Adequate nutrition during the periconceptional and prenatal periods is important for healthy pregnancy outcomes. By enhancing maternal nutritional status, health care providers can help pregnant women lower their risk of certain pregnancy complications and decrease their children's risk of adverse birth outcomes and later chronic disease. Use of evidence-based tools and recommendations will assist in the assessment of pregnant women's diets and streamline the counseling session to optimize their nutritional status. This article contains a review of the literature related to nutrition intervention studies during pregnancy that were designed to improve habits or achieve target weight gains and nutrition recommendations specific for the pregnancy state, as well as tools/resources for the health care provider for implementation of these recommendations into their busy practices.

Long-chain omega-3 fatty acids and women's mental health in the perinatal period and beyond

Recent research has shown that depression and a range of physical illnesses, including heart disease, metabolic syndrome, and type 2 diabetes, have an inflammatory etiology. The long-chain omega-3 fatty acids (omega-3s) eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA), which are found in fish and fish-oil products, may protect against these illnesses, in part because they lower inflammation. This article reviews the recent research on omega-3s and women's mental health, with a particular focus on the perinatal period. These studies include population studies examining fish consumption and studies testing the efficacy of EPA and DHA as treatments for depression. Although the findings are mixed, the majority of studies indicate that EPA has efficacy in treating depression either alone or in combination with DHA and/or antidepressant medications. The role of DHA alone in mental health is less clear, but it is generally combined with EPA and appears to have a beneficial effect. In moderate doses, EPA and DHA appear safe for pregnant and postpartum women, and they are well tolerated by patients.

Essentials of healthy eating: a guide

Enough solid evidence now exists to offer women several fundamental strategies for healthy eating. They include emphasizing healthful unsaturated fats, whole grains, good protein "packages," and fruits and vegetables; limiting consumption of trans and saturated fats, highly refined grains, and sugary beverages; and taking a multivitamin with folic acid and extra vitamin D as a nutritional safety net. A diet based on these principles is healthy through virtually all life stages, from young adulthood through planning for pregnancy, pregnancy, and on into old age.