Women who take n-3 long-chain polyunsaturated fatty acid supplements during pregnancy and lactation meet the recommended intake

Erythrocyte membrane and breast milk fatty acid profile in lactating mothers: relationship with infant erythrocyte membrane fatty acid profile

During the first thousand days of life, fetus and infant's nutrition depends on mother's diet. Polyunsaturated fatty acids (PUFA) are important substrates in infant neurogenesis. We related erythrocyte membrane (EM) and breast milk fatty acids (FA) profile in lactating mothers with the EM FA profile in exclusively breastfed infants and evaluated maternal fat consumption. We conducted an observational, cross-sectional analytical study. During the 2016-2019 period, milk and blood samples from adult mothers 90 days post-partum and infant's blood were analysed, and FA were determined by GC. A frequency of consumption survey of fatty acids precursor foods and sources was conducted. The sample included forty-five mother-infant EM and forty-five milk samples donated by the same mothers. A low percentage of DHA (0·14 (0·12-0·2)) was found in milk, consistent with mother's low consumption of DHA-rich foods. A significant positive correlation between infant's EM DHA percentage and milk DHA percentage (r = 0·39; P value 0·008), as well as between infant's EM ω-3 fatty acids sum and milk DHA percentage (r = 0·39; P value 0·008), was found. When milk had a DHA percentage greater than or equal to 0·20 %, infants had a significant increase in DHA in their EM. Mother's consumption of DHA precursors and sources was NS. The relation between the DHA percentage distribution found in maternal milk, and the DHA percentage distribution found in infant's and mother's EM was proven in this population. Dietary fatty acid intake is associated with the maternal milk lipid distribution and with mothers' and infant's EM fatty acids percentage.

Maternal co-exposure to mercury and perfluoroalkyl acid isomers and their associations with child neurodevelopment in a Canadian birth cohort

BACKGROUND

Perfluoroalkyl acids (PFAAs) within the broader class of per- and polyfluoroalkyl substances (PFAS) are present in human serum as isomer mixtures, but epidemiological studies have yet to address isomer-specific associations with child development and behavior.

OBJECTIVES

To examine associations between prenatal exposure to 25 PFAAs, including perfluorooctane sulfonate (PFOS) and perfluorooctanoate (PFOA) isomers, and child neurodevelopment among 490 mother-child pairs in a prospective Canadian birth cohort, the Alberta Pregnancy Outcomes and Nutrition (APrON) study. To consider the influence of a classic neurotoxicant, total mercury (THg), based on its likelihood of co-exposure with PFAAs from common dietary sources.

METHODS

Maternal blood samples were collected in the second trimester and child neurodevelopment was assessed at 2 years of age using the Bayley Scales of Infant and Toddler Development, 3rd Edition (Bayley-III). Linear or curvilinear multiple regression models were used to examine associations between exposures and neurodevelopment outcomes.

RESULTS

Select PFAAs were associated with lower Cognitive composite scores, including perfluoroheptanoate (PFHpA) (β = -0.88, 95% confidence interval (CI): -1.7, -0.06) and perfluorododecanoate (PFDoA) (β = -2.0, 95% CI: -3.9, -0.01). Non-linear relationships revealed associations of total PFOS (β = -4.4, 95% CI: -8.3, -0.43), and linear-PFOS (β = -4.0, 95% CI: -7.5, -0.57) and 1m-PFOS (β = -1.8, 95% CI: -3.3, -0.24) isomers with lower Language composite scores. Although there was no effect modification, including THg interaction terms in PFAA models revealed negative associations between perfluorononanoate (PFNA) and Motor (β = -3.3, 95% CI: -6.2, -0.33) and Social-Emotional (β = -3.0, 95% CI: -5.6, -0.40) composite scores.

DISCUSSION

These findings reinforce previous reports of adverse effects of maternal PFAA exposure during pregnancy on child neurodevelopment. The unique hazards posed from isomers of PFOS justify isomer-specific analysis in future studies. To control for possible confounding, mercury co-exposure may be considered in studies of PFAAs.

The Programming Effect of Plant-Based DHA, Along with Equivalent AA, on Immune System and Oral Tolerance Development in Six-Week Allergy Prone BALB/c Pups

BACKGROUND

Docosahexaenoic acid (DHA) and arachidonic acid (AA) on oral tolerance (OT) development in allergy-prone infants is less known.

OBJECTIVES

We aim to determine the effects of early life DHA supplementation (1% of total fat, from novel canola oil), along with AA, on OT toward ovalbumin (ova, egg protein) in allergy-prone BALB/c pups at 6-wk.

METHODS

Breastfeeding dams (n ≥ 10/diet) were fed DHA+AA (1% DHA, 1% AA wt/wt of total fat) or control (0% DHA, 0% AA) suckling period diet (SPD) during which pups consumed dam's milk. At 3-wk, pups from each SPD group were assigned to either the control or DHA+AA weaning diet. For OT, pups from each diet group were either orally fed ova or placebo daily from 21-25 d. Systemic immunization to ova was induced through intraperitoneal injections before euthanizing 6-wk pups. Ova-specific immunoglobulin (ova-Ig) and splenocytes ex-vivo cytokine response to different stimuli were analyzed using a 3-factor analysis of variance.

RESULTS

OT-induced suppression was seen in ova-stimulated splenocyte ex-vivo response, where ova-tolerized pups showed significantly lower total immunoglobulin (Ig)G, IgG1, interleukin (IL)-2 and IL-6 production than sucrose (placebo) pups. DHA+AA SPD was associated with 3 times lower plasma concentrations of ova-IgE (P = 0.03) than controls. DHA+AA weaning diet resulted in lower T helper type-2 cytokines (IL-4 and IL-6) with ova stimulation than controls, which may benefit OT. DHA+AA SPD resulted in significantly higher T cell cytokine response [IL-2, interferon-gamma, (IFNγ) and IL-1β] to anti-CD3/CD28 stimulation than controls. The splenocytes stimulated with lipopolysaccharide produced lower inflammatory cytokines (IFNγ, tumor necrosis factor-alpha, IL-6, and C-X-C motif ligand 1), which may be because of lower CD11b+CD68+ splenocytes proportion in pups from DHA+AA SPD than control (all P < 0.05).

CONCLUSIONS

DHA and AA in early life may influence OT in allergy-prone BALB/c mouse offspring, as they effectively promote T helper type-1 immune responses.

Association between Adherence to the Healthy Food Pyramid and Breast Milk Fatty Acids in the First Month of Lactation

In lactating women, breast milk (BM) fatty acids may come from the diet or stored adipose tissue. Our objective was to evaluate the influence of the adherence to the healthy food pyramid (HFP), the dietary pattern in the Mediterranean region, and the maternal body composition on the BM fatty acids pattern. Fifty breastfeeding women answered a socioeconomic survey and the adherence to the HFP questionnaire (AP-Q). In addition, they provided a BM sample at 7 ± 1, 14 ± 1, and 28 ± 1 days postpartum. The body's composition was analyzed at days 7 and 28 by bioimpedance. The BM fatty acids were analyzed by gas chromatography-mass spectroscopy. We found a negative association between the consumption of olive oil and the BM palmitic acid levels (β = -3.19 ± 1.40; p = 0.030), and the intake of cereals and legumes was positively associated with the BM saturated fatty acids (β = 11.48 ± 3.87; p = 0.005). The intake of proteins and vegetables was positively associated with the omega-3 fatty acids and negatively with the omega-6:omega-3 ratio in BM. A negative association between the maternal age (β = -0.43 ± 0.11; p = 0.001) and the α-linolenic acid (ALA) levels was observed, being overall AP-Q positively associated with the ALA levels (β = 0.39 ± 0.15; p = 0.016). Physical activity reduced both the omega-3 and omega-6 fatty acids in BM. Diet had a larger influence than the maternal body's composition on BM fatty acids during the first month of lactation, demonstrating a better adherence to the HFP and positively impacting on the omega-3 content in BM, a fact that is modulated by one's maternal age.

Breastmilk PUFA strongly associated with maternal dietary intake but not anthropometric parameters and breastmilk carotenoids

BACKGROUND

Long chain polyunsaturated fatty acids (PUFA) and the optimal n-6/n-3 fatty acids ratio are essential for proper neurodevelopment in infancy. This study aimed to evaluate the association between breastmilk fatty acid intake and maternal dietary intake, anthropometrics and breastmilk carotenoid levels.

METHODS

This observational, prospective study included 44 women in the first, third, and sixth month of lactation. At each study visit, maternal anthropometric measures were assessed and breastmilk samples were collected and assessed for fatty acids and carotenoids. At the third and sixth month, maternal diet was evaluated by three-day foods record.

RESULTS

Mean breastmilk docosahexaenoic (DHA) was 0.58%, 0.47%, and 0.49%, respectively at the 1, 3, and 6 month (p ≤ 0.05). Mean DHA intake were higher in month 3 compared to 6: 357 vs. 169 mg/day. Pre-pregnancy BMI was associated with SFA, PUFA, and n-6 PUFA at 1 month, whereas current BMI to SFA at months 1 and 3. DHA was correlated with lycopene, total carotenoids at 1 month and total carotenoids at month 3, whereas n-3 PUFA to lycopene at 1 month. DHA, n-3 PUFA, n-6 PUFA and saturated (SFA) levels were associated with its dietary intake both at months 3 and 6, AA/DHA and LA/ALA ratios only at month 3.

CONCLUSIONS

Maternal intake of PUFA and n-6/n-3 ratios were a good predictor of its breastmilk composition, whereas pre-pregnancy and current BMI, as well as breastmilk carotenoids had a limited influence.

Maternal Dietary Fatty Acids and Their Relationship to Derived Endocannabinoids in Human Milk

BACKGROUND

Dietary long-chain polyunsaturated fatty acids are known to benefit infant development. After birth, human milk provides arachidonic, eicosapentaenoic, and docosahexaenoic acids to the infant. Endocannabinoids are endogenous lipid mediators derived from the long-chain polyunsaturated fatty acids. Although the roles and the mechanisms of action are not fully understood, previous researchers have suggested that endocannabinoids might play a role in infant feeding behavior.

RESEARCH AIMS

To assess (i) maternal dietary intake of long-chain polyunsaturated fatty acids and (ii) their relationship to concentrations of fatty acids and derived endocannabinoids in human milk.

METHODS

For this exploratory-longitudinal study, participants (N = 24) provided dietary intake data and milk samples. Fatty acids and derived endocannabinoids: Arachidonylethanolamide, arachidonoylglycerol, docosahexaenoyl glycerol, eicosapentaenoyl ethanolamide, and eicosapenaenoyl glycerol were identified in their milk by liquid chromatography-mass spectrometry and correlations to dietary fatty acids were assessed.

RESULTS

Participants were not consuming recommended amounts of docosahexaenoic acid. Significant correlations (p ≤ .05) were only found between dietary docosahexaenoic and eicosapentaenoic acids and the concentrations of these in human milk. Moreover, only dietary docosahexaenoic acid was correlated (p = .031) with its corresponding endocannabinoid, docosahexaenoyl glycerol.

CONCLUSIONS

To the best of our knowledge, this may be one of the first studies evaluating relationships between dietary long-chain polyunsaturated fatty acids and multiple endocannabinoids in human milk. Our findings suggest that endocannabinoid concentrations could be modulated by dietary precursors. Future research studies can be designed based on these data to better elucidate the roles of endocannabinoids in human milk for infant health and development.

Sex-specific associations of human milk long-chain polyunsaturated fatty acids and infant allergic conditions

BACKGROUND

Polyunsaturated fatty acids (PUFAs) may influence immune development. We examined the association of PUFAs in human milk with food sensitization and atopic dermatitis among breastfed infants.

METHODS

In a selected subgroup of 1109 mother-infant dyads from the CHILD Cohort Study, human milk was analyzed by gas-liquid chromatography to quantify PUFAs including arachidonic acid (ARA) and docosahexaenoic acid (DHA). At 1 year of age, food sensitization was determined by skin-prick testing for egg, peanut, cow's milk, and soybean, and atopic dermatitis was diagnosed by pediatricians. Logistic regression analyses controlled for breastfeeding exclusivity, family history of atopy, and other potential confounders.

RESULTS

Overall, 184 infants (17%) were sensitized to one or more food allergens and 160 (14%) had atopic dermatitis. Sex-specific associations were observed between these conditions and milk PUFAs. Girls receiving human milk with lower proportions of DHA had lower odds of food sensitization (aOR 0.35; 95% CI 0.12, 0.99 for lowest vs highest quintile), and a clear dose-dependent association was observed for the ARA/DHA ratio (aOR 2.98; 95% CI 1.10, 8.06 for lowest vs highest quintile). These associations were not seen in boys. Similar sex-specific tendencies were observed for atopic dermatitis.

CONCLUSIONS

Human milk PUFA proportions and their ratios are associated with infant atopic conditions in a sex-specific manner. In female infants, a higher ratio of ARA/DHA may reduce the risk of food sensitization and atopic dermatitis. Further research is needed to determine the underlying mechanisms and clinical relevance of this sex-specific association.

The role of maternal nutrition during pregnancy in the intergenerational transmission of childhood adversity

Adverse childhood experiences (ACEs) of a woman can lead to dysregulated hypothalamus-pituitary-adrenal (HPA) axis during pregnancy, which can in turn adversely affect her offspring HPA axis function. Choline and docosahexaenoic acid (DHA) are dietary factors with the potential to favorably modify the stress response system. The current study aimed to investigate whether maternal choline intake and DHA status moderate the effects of maternal ACEs exposure on maternal and infant HPA axes function. Participants were a sub-sample of the prospective longitudinal Alberta Pregnancy Outcomes and Nutrition (APrON) study consisting of 340 mothers and 238 infants. We collected data on maternal ACEs, maternal choline intake (24-hour dietary recall) and serum phospholipid DHA concentrations (at each trimester). Women self-collected saliva samples on two consecutive days (at waking, +30 min, 1100 h, and 2100 h) in each trimester to calculate the cortisol awakening response (CAR) and total daytime cortisol. Infants' salivary cortisol was measured before and after (20, and 40 min) exposure to a blood draw stressor 3 months postpartum. During pregnancy, choline intake moderated (reduced) the association between maternal ACEs and CAR (β = -0.003; 95% CI -0.006, -0.003), but not total daytime cortisol. DHA status did not moderate the association between ACEs and CAR or total daytime cortisol. Choline intake also moderated (reduced) the association between maternal CAR and infant cortisol during a stress task (β = -0.0001; 95% CI -0.0002, -0.00003). Maternal DHA status revealed no modifying effects on these associations. Our findings suggest that maternal choline intake, but not DHA status, can buffer the associations between ACEs and maternal HPA axis, as well as maternal and infant HPA axes function.

Short-term supplementation of DHA as phospholipids rather than triglycerides improve cognitive deficits induced by maternal omega-3 PUFA deficiency during the late postnatal stage

Cognitive deficiencies, which are caused by maternal omega-3 PUFA deficiency (O-3 Def), are likely to be more rapidly and easily reversed at younger ages with quicker DHA reversal. This study aims to compare the efficiency of short-term supplementation of DHA in the form of phospholipids (PL) and triglycerides (TG) and improve cognitive deficiency in the O-3 Def model during different periods of brain development (3-week and 7-week old). The animal's spatial task performance, brain PUFA concentration, histopathology, and expression of synapse-associated proteins in the hippocampus were then analyzed. We demonstrate here that DHA-PL shows improved efficiency in improving cognitive deficiency compared to DHA-TG, particularly for adult O-3 Def offspring. The superiority of DHA-PL also correlates with the specific elevation of synapse-associated proteins, including BDNF, DCX, GAP-43, Syn, and PSD95, except to higher brain DHA accretion. This work highlights the DHA-PL as a better DHA supplement for inferior brain development caused by maternal O-3 Def, especially regarding those who missed the optimal time window of neurodevelopment.

Docosahexaenoic Acid: Outlining the Therapeutic Nutrient Potential to Combat the Prenatal Alcohol-Induced Insults on Brain Development

Brain development is markedly affected by prenatal alcohol exposure, leading to cognitive and behavioral problems in the children. Protecting neuronal damage from prenatal alcohol could improve neural connections and functioning of the brain. DHA, a n-3 (ω-3) long-chain PUFA, is involved in the development of neurons. Insufficient concentrations of DHA impair neuronal development and plasticity of synaptic junctions and affect neurotransmitter concentrations in the brain. Alcohol consumption during pregnancy decreases the maternal DHA status and reduces the placental transfer of DHA to the fetus, resulting in less DHA being available for brain development. It is important to know whether DHA could induce beneficial effects on various physiological functions that promote neuronal development. This review will discuss the current evidence for the beneficial role of DHA in protecting against neuronal damage and its potential in mitigating the teratogenic effects of alcohol.

Fatty acids of human milk - a review

The composition of human milk is the result of the evolution of mammals over millions of years. Among the most important components of milk are fatty acids. Approximately 85% are saturated and monounsaturated fatty acids - the rest are polyunsaturated one. Their role is to provide energy and immunity and to serve as buildings blocks, as well as assisting the hormonal system and the metabolism of fats, carbohydrates and proteins. The structural differences between fatty acids determine their biodiversity and give them particular physiological importance. Correct development of the nervous system, retina and other structures depend on an adequate supply of both these fatty acids during intrauterine development and in the newborn and infant stages. The fats present in milk form milk fat globules - structures that do not appear in milk formula prepared using vegetable oils. Apart from the mother's diet, other sources of fatty acids are endogenous biosynthesis in the mammary gland and the fat deposits from which the fatty acids are released. Evolution of the mother's body has also created adaptive mechanisms that adjust the amount of fatty acids in milk to the state of health and needs of the child. These mechanisms go some way to creating a buffer with regard to dietary shortages experienced by pregnant/breastfeeding women, and optimalise the composition of milk fatty acids depending on the age of the pregnant woman, the birth weight of the infant and the efficiency of the placenta during pregnancy.

Human milk fatty acid composition is associated with dietary, genetic, sociodemographic, and environmental factors in the CHILD Cohort Study

BACKGROUND

Fatty acids are a vital component of human milk. They influence infant neurodevelopment and immune function, and they provide ∼50% of milk's energy content.

OBJECTIVES

The objectives of this study were to characterize the composition of human milk fatty acids in a large Canadian birth cohort and identify factors influencing their variability.

METHODS

In a subset of the CHILD cohort (n = 1094), we analyzed milk fatty acids at 3-4 mo postpartum using GLC. Individual and total SFAs, MUFAs, and n-3 and n-6 PUFAs were analyzed using SD scores and principal component analysis (PCA). Maternal diet, sociodemographic, health, and environmental factors were self-reported. Single-nucleotide polymorphisms were assessed in the fatty acid desaturase 1 (FADS1-rs174556) and 2 (FADS2-rs174575) genes.

RESULTS

Fatty acid profiles were variable, with individual fatty acid proportions varying from 2- to >30-fold between women. Using PCA, we identified 4 milk fatty acid patterns: "MUFA and low SFA," "high n-6 PUFA," "high n-3 PUFA," and "high medium-chain fatty acids." In multivariable-adjusted analyses, fish oil supplementation and fatty cold water fish intake were positively associated with DHA and the "high n-3 PUFA" pattern. Mothers carrying the minor allele of FADS1-rs174556 had lower proportions of arachidonic acid (ARA; 20:4n-6). Independent of selected dietary variables and genetic variants, Asian ethnicity was associated with higher linoleic acid (18:2n-6) and total n-3 PUFAs. Ethnic differences in ARA were explained by FADS1 genotype. Maternal obesity was independently associated with higher total SFAs, the "high medium-chain fatty acid" pattern, and lower total MUFAs. Lactation stage, season, study site, and maternal education were also independently associated with some milk fatty acids. No associations were observed for maternal age, parity, delivery mode, or infant sex.

CONCLUSIONS

This study provides unique insights about the "normal" variation in the composition of human milk fatty acids and the contributing dietary, genetic, sociodemographic, health, and environmental factors. Further research is required to assess implications for infant health.

The Concentration of Omega-3 Fatty Acids in Human Milk Is Related to Their Habitual but Not Current Intake

This study determined fatty acid (FA) concentrations in maternal milk and investigated the association between omega-3 fatty acid levels and their maternal current dietary intake (based on three-day dietary records) and habitual dietary intake (based on intake frequency of food products). Tested material comprised 32 samples of human milk, coming from exclusively breastfeeding women during their first month of lactation. Milk fatty acids were analyzed as fatty acid methyl ester (FAME) by gas chromatography using a Hewlett-Packard 6890 gas chromatograph with MS detector 5972A. We did not observe any correlation between current dietary intake of omega-3 FAs and their concentrations in human milk. However, we observed that the habitual intake of fatty fish affected omega-3 FA concentrations in human milk. Kendall’s rank correlation coefficients were 0.25 (p = 0.049) for DHA, 0.27 (p = 0.03) for EPA, and 0.28 (p = 0.02) for ALA. Beef consumption was negatively correlated with DHA concentrations in human milk (r = −0.25; p = 0.046). These findings suggest that current omega-3 FA intake does not translate directly into their concentration in human milk. On the contrary, their habitual intake seems to markedly influence their milk concentration.

Docosahexaenoic Acid in Mature Breast Milk of Low-income Mothers

Docosahexaenoic acid (DHA) is among the main components of synaptosomal membranes and myelin sheaths. Because DHA is essential for child neurodevelopment, breast milk DHA levels should be improved by optimizing maternal nutrition. We determined DHA percentage levels in breast milk of low-income mothers receiving care at the public healthcare sector. We performed a descriptive, cross-sectional study in breast milk samples from 39 exclusively breast-feeding adult mothers with normal fetal and neonatal history. Samples were collected 90 ± 7 days after delivery. Breast milk fatty acid composition was determined by gas chromatography. The cut-off value of DHA was 0.3% of total fatty acids in milk according to recommendations. Median DHA in milk was 0.14% (0.12-0.21). Breast milk DHA levels were lower than the minimum recommended in 92% of samples. The analysis of breast milk samples from low-income exclusively breast-feeding mothers showed that they did not reach the minimum recommended DHA percentage.

Very low inadequate dietary intakes of essential n-3 polyunsaturated fatty acids (PUFA) in pregnant and lactating French women: The INCA2 survey

BACKGROUND

The French National survey INCA2 pointed out that the majority of the French population (children, adolescents, adults and elderly) ingest low quantities of n-3 polyunsaturated fatty acid (PUFA) in the form of both precursor (alpha-linolenic acid, ALA) and long-chain (mainly docosahexaenoic acid, DHA). However, we don't know whether such inadequate n-3 PUFA consumption is also found again in pregnant and lactating women.

METHODS

Dietary lipid and PUFA intakes were determined from 28 pregnant and 21 lactating French women by using the most recent set of national robust data on food (National Survey INCA2 performed in 2006 and 2007), and compared with that of 742 women of childbearing age.

RESULTS

Main results showed that mean daily intakes of n-3 PUFA were very low in this French woman population because no pregnant and lactating women met recommended dietary intakes (RDIs). Moreover, some of them ingested quantities 4 times (ALA) to 10 times (DHA) lower than RDIs. Very similar dietary intakes were observed in women of childbearing age.

CONCLUSION

French pregnant and lactating women did not change their dietary habits to favor ALA and n-3 long-chain PUFA consumption via rich-ALA vegetable oils and fish and oily fish consumption, and have low n-3 PUFA dietary consumption typical of French women of childbearing age. Such PUFA intakes could have adverse impact on long-chain n-3 PUFA incorporation in brain membranes of fetus and infants, but also on cognitive and visual development of infants during the first years of life.

Omega-3 polyunsaturated fatty acid supplementation in prevention and treatment of maternal depression: Putative mechanism and recommendation

BACKGROUND

Women are vulnerable to depression during their childbearing years, and giving birth to a child precipitates postpartum depression (PPD) in some women. This review focuses on comparing the effectiveness of omega-3 polyunsaturated fatty acid supplementation on depression during pregnancy or PPD after childbirth.

METHODS

MEDLINE, PubMed, PsycINFO, and the Cochrane Collaboration Registry of Controlled Trials etc. through July 2017 were searched. Studies of dietary intake and plasma and/or milk levels of omega-3 fatty acids and trials of benefits and effects of omega-3 fatty acids supplements on pregnant or postpartum women with depression were specifically selected.

RESULTS

Omega-3 fatty acid deficiency, due to inadequate intake, fast depletion during pregnancy and lactation, is one of the risk factors of PPD. Associations between neuroinflammation (elevated pro-inflammatory cytokines) and aberrant neurotransmission (low serotonergic transmission activity) and risk of PPD have also been reported by numerous studies. Supplementation with eicosapentaenoic acid (EPA)-rich oil can effectively reduce depression during pregnancy and PPD after childbirth. Long term treatment with docosahexaenoic acid (DHA)-rich oil can be effective in reducing the risk of PPD in healthy women, but not in lactating women. Supplementation of DHA-rich oil to women begun at pregnancy and continued after childbirth exerts no beneficial effect on depression.

CONCLUSIONS

Dietary supplementation with omega-3 fatty acids rich in EPA during pregnancy or postpartum reduces some symptoms associated with depression. DHA supplementation to healthy pregnant women can also reduce the risk of PPD.

Impact of n-3 Docosapentaenoic Acid Supplementation on Fatty Acid Composition in Rat Differs Depending upon Tissues and Is Influenced by the Presence of Dairy Lipids in the Diet

The n-3 docosapentaenoic acid (n-3 DPA) could be a novel source of n-3 long-chain polyunsaturated fatty acids (LCPUFA) with beneficial physiological effects. Following the supplementation of 0.5% purified n-3 DPA for 3 weeks from weaning, the n-3 DPA content increased in one-half of the 18 studied tissues (from +50% to +110%, p < 0.05) and mostly affected the spleen, lung, heart, liver, and bone marrow. The n-3 DPA was slightly converted into DHA (+20% in affected tissues, p < 0.05) and mostly retroconverted into EPA (35-46% of n-3 DPA intake in liver and kidney) showing an increased content of these LCPUFA in specific tissues. The partial incorporation of dairy lipids in the diet for 6 weeks increased overall n-3 PUFA status and brain DHA status. Furthermore, the n-3 DPA supplementation and dairy lipids had an additive effect on the increase of n-3 PUFA tissue contents. Moreover, n-3 DPA supplementation decreased plasma cholesterol.

Qualitative Assessment of Key Messages about Nutrition and Weight Gain in Pregnancy in Printed Educational Materials in Alberta

Printed educational materials are a common source of health information, although their effectiveness in improving women's knowledge or self-care in pregnancy has been questioned. This study describes the information in printed educational materials that address healthy eating during pregnancy and gestational weight gain (GWG) that are currently used in Alberta, Canada. Content of 6 resources was analyzed using a constant comparison qualitative approach. Resources emphasized healthy eating, prenatal supplements, folate supplementation, and healthy weight gain. More resources discussed the importance of "eating enough" than provided guidance on avoiding excessive GWG. Themes identified were: "everything is important" meaning that all healthy behaviours are important, making prioritization difficult; "more is more" emphasized eating more over moderation; "everyone is individual" suggests women seek individualized care through the care provider; and "contradictions" describes differences in content and recommendations within and between resources. New or revised versions of resources should provide congruent information with up-to-date recommendations that are easily prioritized. Care providers should be aware of contradictory information or information that does not align with current recommendations within printed educational materials and be ready to help women address the areas important for her personal behaviour change.

Dietary Intake of DHA and EPA in a Group of Pregnant Women in the Moncton Area

Purpose: To compare docosahexaenoic acid (DHA), eicosapentaenoic acid (EPA), and fish intake of pregnant women at 30 weeks of gestation to current recommendations and to determine the factors associated with omega-3 (ω-3) intake.

Methods: A food frequency questionnaire was completed by 54 women (54/131 = 41%) at 30 ± 0.8 weeks gestation. Supplement intake, sociodemographic characteristics, and ω-3 food habits were evaluated.

Results: Among this high socioeconomic status (SES) group, 66.7% and 64.8% met the Food and Agriculture Organization of the United Nations (FAO)/World Health Organization (WHO) recommendation of 200 mg/d DHA and 300 mg/d DHA + EPA, respectively, and only 48.1% met the Academy of Nutrition and Dietetics (Academy) recommendation of 500 mg/d DHA + EPA. Eighteen of the 54 women took a ω-3 supplement during the third trimester. This significantly improved their total intake to meet the FAO/WHO (88.9% ≥200 mg/d DHA and 94.4% ≥300 mg/d DHA + EPA) and the Academy (77.8% ≥500 mg/d DHA + EPA) recommendations. Among nonsupplement users (36/54), 50% met the FAO/WHO recommendations and only 33.3% met the Academy recommendations.

Conclusions: Results suggest that the majority of high SES women did not meet ω-3 recommendations from food alone. Continued prenatal education on the importance of fish intake and on the addition of ω-3 prenatal supplement is essential.

Breast milk fatty acid composition and fatty acid intake of lactating mothers in South Korea

The aim of this study was to determine the fatty acid (FA) composition of breast milk, and its association with mothers' FA intake. Milk samples were obtained from 238 healthy lactating women who volunteered to participate in the Human Milk Micronutrients Analysis Research. Dietary intake during lactation was assessed using a 3-d food record, and fat content and FA composition of the breast milk samples were analysed by IR spectrometry using MilkoScan FT2 and GC flame ionisation detector, respectively. The fat content was 3·31 (sd 1·41) g/100 ml breast milk. The concentrations of arachidonic acid (20 : 4 n-6), EPA (20 : 5 n-3) and DHA (22 : 6 n-3) in breast milk were 0·48 (sd 0·13), 0·15 (sd 0·12) and 0·67 (sd 0·47) % of total FA, respectively. Fat content and FA composition of breast milk were associated with maternal age, BMI, supplement use and infant age. Dietary intakes of EPA, DHA, n-3 FA, n-6 FA, SFA and PUFA were positively correlated with the corresponding FA in the milk samples. FA levels in breast milk and maternal diet are highly correlated. Further studies are warranted to explore factors that may be associated with changes in FA composition in human milk.

Opportunities for probiotics and polyunsaturated fatty acids to improve metabolic health of overweight pregnant women

Overweight during pregnancy predisposes both the mother and foetus to health complications. Maternal complications include gestational diabetes, obstetric problems and type 2 diabetes later in life. Complications for the offspring are not only restricted to the foetal period or birth, such as prematurity and foetal macrosomia, but may also have long-term metabolic health implications through the mechanism of early nutrition programming. One of the key metabolic components characterising overweight in the non-pregnant state is low-grade inflammation manifested by elevated levels of circulatory pro-inflammatory cytokines. In pregnancy, in addition to adipose tissue and placenta, inflammatory response may originate from the gut. The extent to which overweight induces metabolic maladaptation during pregnancy and further compromises maternal and child health is currently poorly understood. In this review, we evaluate recent scientific literature and describe the suggested links between overweight, gut and low-grade inflammation associated metabolic disorders. We focus on overweight pregnant women and gestational diabetes, and discuss how specific dietary factors, probiotics and long-chain polyunsaturated fatty acids (fish oil), might confer health benefits in combatting against metabolic risk factors.

Docosahexaenoic acid supplementation during pregnancy as phospholipids did not improve the incorporation of this fatty acid into rat fetal brain compared with the triglyceride form

Prenatal docosahexaenoic acid (DHA) supply is important to ensure an adequate infant neurodevelopment. Several fat supplements with DHA under different chemical structures are available. There is an increased placental phospholipase activity at the end of pregnancy. The hypothesis of this study was to discern whether DHA consumption during pregnancy as phospholipids (PLs) could be more available for placental DHA uptake and fetal accretion than triglycerides (TGs) form. We aimed to evaluate maternofetal DHA status in pregnant rats fed with DHA as PL from egg yolk or TG from algae oil to determine which source might be most effective during pregnancy. Three experimental diets were tested: 2.5% DHA-TG (n = 10), 2.5% DHA-PL (n = 9), and 9% DHA-PL (n = 9). The total PL content of these diets was 2%, 12%, and 38%, respectively. We determined dietary fat absorption and quantified fatty acids by gas chromatography in maternal and fetal tissues. Dietary PL enhanced significantly dietary fat absorption. However, animals fed the highest PL-content diet (38% PL and 9% DHA-PL) stored most of the absorbed fat in maternal liver, promoting hepatic steatosis, which was not observed in the lower PL-content diets (12% and 2%). Despite higher fat absorption of PL-containing diets, maternal and fetal tissues (including fetal brain) did not show major differences in DHA content between the 2.5% DHA-PL and 2.5% DHA-TG-fed groups. We conclude that the chemical form of DHA consumed by the rat during gestation (PL or TG) does not differentially affect DHA accretion into fetal brain, and both lipid sources can be equally used for maternal DHA supplementation during pregnancy.

Simple dietary criteria to improve serum n-3 fatty acid levels of mothers and their infants

OBJECTIVE

Sufficient maternal dietary intake of n-3 fatty acids (FA) supports offspring development. We aimed to construct simple criteria for dietary counselling to improve intake of n-3 FA.

DESIGN

Serum phospholipid FA from mothers and infants were analysed by GC one month after delivery. Dietary intake of foods during pregnancy and one month after delivery were recorded using 3 d food diaries and an index for healthy eating was calculated. Fish consumption was established by questionnaires. Dietary consumption of foods resulting in an increase in serum n-3 FA was defined.

SETTING

A mother-child follow-up study in Southwest Finland.

SUBJECTS

Mothers (n 90) and 1-month-old infants (n 63).

RESULTS

After delivery, the mother's consumption of fish at least three times per week resulted in an increase in total serum n-3 FA (mean difference (95 % CI): 1·7 (0·7, 2·8) % of total FA, P<0·001) and DHA (1·1 (0·5, 1·8) % of total FA, P<0·001) compared with non-consumers. Persistent fish intake once weekly throughout pregnancy increased total serum n-3 FA (P=0·001) and DHA (P<0·001). Overall, a healthy diet (middle and highest tertiles of healthy eating index score v. the lowest tertile) resulted in higher total serum n-3 FA (P=0·004) and DHA (P=0·008). Mother's diet along with higher serum levels of n-3 FA were related to serum FA levels in 1-month-old infants.

CONCLUSIONS

An overall healthy diet and persistent consumption of fish at least once weekly throughout pregnancy or more frequent fish intake three times per week increases n-3 FA in serum phospholipids of both mothers and their infants.

A Correlation Study of DHA Dietary Intake and Plasma, Erythrocyte and Breast Milk DHA Concentrations in Lactating Women from Coastland, Lakeland, and Inland Areas of China

We aimed to assess the correlation between docosahexaenoic acid (DHA) dietary intake and the plasma, erythrocyte and breast milk DHA concentrations in lactating women residing in the coastland, lakeland and inland areas of China. A total of 408 healthy lactating women (42 ± 7 days postpartum) were recruited from four hospitals located in Weihai (coastland), Yueyang (lakeland) and Baotou (inland) city. The categories of food containing DHA, the average amount consumed per time and the frequency of consumption in the past month were assessed by a tailored DHA food frequency questionnaire, the DHA Intake Evaluation Tool (DIET). DHA dietary intake (mg/day) was calculated according to the Chinese Food Composition Table (Version 2009). In addition, fasting venous blood (5 mL) and breast milk (10 mL) were collected from lactating women. DHA concentrations in plasma, erythrocyte and breast milk were measured using capillary gas chromatography, and were reported as absolute concentration (μg/mL) and relative concentration (weight percent of total fatty acids, wt. %). Spearman correlation coefficients were used to assess the correlation between intakes of DHA and its concentrations in biological specimens. The study showed that the breast milk, plasma and erythrocyte DHA concentrations were positively correlated with DHA dietary intake; corresponding correlation coefficients were 0.36, 0.36 and 0.24 for relative concentration and 0.33, 0.32, and 0.18 for absolute concentration (p < 0.05). The median DHA dietary intake varied significantly across areas (p < 0.05), which was highest in the coastland (24.32 mg/day), followed by lakeland (13.69 mg/day), and lowest in the inland (8.84 mg/day). The overall relative and absolute DHA concentrations in breast milk were 0.36% ± 0.23% and 141.49 ± 107.41 μg/mL; the concentrations were significantly lower in inland women than those from coastland and lakeland. We conclude that DHA dietary intake is positively correlated with DHA concentrations in blood and breast milk in Chinese lactating women, suggesting that the tailored DHA food frequency questionnaire, DIET, is a valid tool for the assessment of DHA dietary intake.

The effect of fish oil supplementation on serum phospholipid fatty acids profile during pregnancy: A double blind randomized controlled trial

Omega-3 fatty acids (FAs) are essential unsaturated long-chain FAs necessary for proper health and growth. The objective of the authors in this study was to evaluate the effect of fish oil supplementation in pregnancy on maternal serum FA profiles. Participants (n = 150 pregnant women aged 18-35 years in Tabriz, Iran) were randomly assigned to receive either 1,000 mg fish oil supplements daily containing 120 mg docosahexanoic acid (DHA) and 180 mg eicosapentaenoic acid (EPA), or placebo from week 21 of pregnancy to delivery. The primary outcome measures were mean serum DHA and EPA proportion of total FAs at weeks 35-37 of pregnancy. Analyses were based on intention-to-treat. No significant differences were observed between the groups in consumption of fish and serum FAs levels at baseline. Fish oil supplementation significantly increased the mean DHA proportion of total FAs in the intervention compared to the placebo group at weeks 35-37 [adjusted Mean Difference (aMD) = 0.15; 95% CI 0.08-0.23]. The mean EPA proportion of total FAs also increased in the intervention group, but the difference between the groups was not significant (aMD = 0.04; 95% CI -0.01 to 0.08). The dietary recommendation for consumption of 1,000 mg/day fish oil supplements during pregnancy seems beneficial for better serum FA composition.

Could gestational diabetes mellitus be managed through dietary bioactive compounds? Current knowledge and future perspectives

Gestational diabetes mellitus (GDM) is a serious problem growing worldwide that needs to be addressed with urgency in consideration of the resulting severe complications for both mother and fetus. Growing evidence indicates that a healthy diet rich in fruit, vegetables, nuts, extra-virgin olive oil and fish has beneficial effects in both the prevention and management of several human diseases and metabolic disorders. In this review, we discuss the latest data concerning the effects of dietary bioactive compounds such as polyphenols and PUFA on the molecular mechanisms regulating glucose homoeostasis. Several studies, mostly based on in vitro and animal models, indicate that dietary polyphenols, mainly flavonoids, positively modulate the insulin signalling pathway by attenuating hyperglycaemia and insulin resistance, reducing inflammatory adipokines, and modifying microRNA (miRNA) profiles. Very few data about the influence of dietary exposure on GDM outcomes are available, although this approach deserves careful consideration. Further investigation, which includes exploring the ‘omics’ world, is needed to better understand the complex interaction between dietary compounds and GDM.

Polyunsaturated Fatty Acid (PUFA) Status in Pregnant Women: Associations with Sleep Quality, Inflammation, and Length of Gestation

Mechanistic pathways linking maternal polyunsaturated fatty acid (PUFA) status with gestational length are poorly delineated. This study examined whether inflammation and sleep quality serve as mediators, focusing on the antiinflammatory ω-3 docosahexaenoic acid (DHA; 22:6n3) and proinflammatory ω-6 arachidonic acid (AA; 20:4n6). Pregnant women (n = 135) provided a blood sample and completed the Pittsburgh Sleep Quality Index (PSQI) at 20–27 weeks gestation. Red blood cell (RBC) fatty acid levels were determined by gas chromatography and serum inflammatory markers [interleukin (IL)-6, IL-8, tumor necrosis factor-α, IL-1β, and C-reactive protein] by electrochemiluminescence using high sensitivity kits. Both higher serum IL-8 (95% CI = 0.10,3.84) and poor sleep (95% CI = 0.03,0.28) served as significant mediators linking lower DHA:AA ratios with shorter gestation. Further, a serial mediation model moving from the DHA:AA ratio → sleep → IL-8 → length of gestation was statistically significant (95% CI = 0.02, 0.79). These relationships remained after adjusting for depressive symptoms, age, BMI, income, race, and smoking. No interactions with race were observed in relation to length of gestation as a continuous variable. However, a significant interaction between race and the DHA:AA ratio in predicting preterm birth was observed (p = 0.049); among African Americans only, odds of preterm birth decreased as DHA:AA increased (p = 0.048). These data support a role for both inflammatory pathways and sleep quality in linking less optimal RBC PUFA status with shorter gestation in African American and European American women and suggest that African-Americans have greater risk for preterm birth in the context of a low DHA:AA ratio.