Omega-3 fatty acids and pregnancy: current implications for practice.

PURPOSE OF REVIEW: We conducted this review to evaluate the evidence for maternal supplementation with omega-3 fatty acids during pregnancy for the prevention or treatment of common complications of pregnancy including preterm birth, pregnancy-induced hypertension and preeclampsia, as well as perinatal depression. We also evaluated the evidence supporting maternal omega-3 fatty acid supplementation to optimize infant neurocognitive development and for primary prevention of allergic diseases in childhood. RECENT FINDINGS: Omega-3 fatty acids through diet or dietary supplementation may reduce the risk for early preterm birth. Preliminary findings from small randomized controlled trials suggest that maternal omega-3 fatty acid supplementation during pregnancy may reduce the risk for allergic disease in childhood, but this observation requires confirmation by large appropriately powered randomized controlled trials. More research is needed before routine maternal supplementation for this indication can be recommended. SUMMARY: Although it is biologically plausible that maternal omega-3 fatty acid supplementation might prevent a number of pregnancy complications and optimize child health and development, indications for supplementation other than prevention of preterm births are currently investigational.

The mothers, Omega-3 and mental health study.

BACKGROUND: Major depressive disorder (MDD) during pregnancy and postpartum depression are associated with significant maternal and neonatal morbidity. While antidepressants are readily used in pregnancy, studies have raised concerns regarding neurobehavioral outcomes in exposed infants. Omega-3 fatty acid supplementation, most frequently from fish oil, has emerged as a possible treatment or prevention strategy for MDD in non-pregnant individuals, and may have beneficial effects in pregnant women. Although published observational studies in the psychiatric literature suggest that maternal docosahexaenoic acid (DHA) deficiency may lead to the development of MDD in pregnancy and postpartum, there are more intervention trials suggesting clinical benefit for supplementation with eicosapentaenoic acid (EPA) in MDD. METHODS/DESIGN: The Mothers, Omega-3 and Mental Health study is a double blind, placebo-controlled, randomized controlled trial to assess whether omega-3 fatty acid supplementation may prevent antenatal and postpartum depressive symptoms among pregnant women at risk for depression. We plan to recruit 126 pregnant women at less than 20 weeks gestation from prenatal clinics at two health systems in Ann Arbor, Michigan and the surrounding communities. We will follow them prospectively over the course of their pregnancies and up to 6 weeks postpartum. Enrolled participants will be randomized to one of three groups: a) EPA-rich fish oil supplement (1060 mg EPA plus 274 mg DHA) b) DHA-rich fish oil supplement (900 mg DHA plus 180 mg EPA; or c) a placebo. The primary outcome for this study is the Beck Depression Inventory (BDI) score at 6 weeks postpartum. We will need to randomize 126 women to have 80% power to detect a 50% reduction in participants' mean BDI scores with EPA or DHA supplementation compared with placebo. We will also gather information on secondary outcome measures which will include: omega-3 fatty acid concentrations in maternal plasma and cord blood, pro-inflammatory cytokine levels (IL-1ß, IL-6, and TNF-α) in maternal and cord blood, need for and dosage of antidepressant medications, and obstetrical outcomes. Analyses will be by intent to treat. DISCUSSION: This study compares the relative effectiveness of DHA and EPA at preventing depressive symptoms among pregnant women at risk. CLINICAL TRIAL REGISTRATION NUMBER: NCT00711971.