RETERM BIRTH IS THE MOST COMmon cause of neonatal morbidity and mortality worldwide. Almost 75% of perinatal deaths occur in infants born before 37 weeks' gestation. 1 Consequently, pre-term birth is associated with a large burden of disease, high costs for medical care, special education, and institutionalized care for disabled infants. 2 In threatened preterm labor before 34 weeks, delay of delivery for 48 hours allows antenatal corticosteroid treatment to improve fetal maturity and transfer of the pregnant woman to a center with a neonatal intensive care unit. 3 For initial tocolysis, nifedipine is comparable with magnesium sulfate 4 and superior to ritodrine 5 and atosiban. 6 Because perinatal morbidity and Author Affiliations are listed at the end of this article.
In women with threatened preterm labour who are fetal fibronectin positive, maintenance tocolysis with nifedipine does not seem to prolong pregnancy, nor reduce length of NICU admission.
Objective: Several randomized controlled trials (RCTs) investigated omega-3 polyunsaturated fatty acids (PUFAs) (ie, fish oil) in perinatal depression, but their efficacy remains unclear. We performed a meta-analysis of RCTs on omega-3 PUFAs for perinatal depression, comparing a priori defined subgroups: pregnant women vs postpartum women and prevention vs treatment of perinatal depression. Methods: We searched Web of Science, Embase, PsycINFO, and the Cochrane Library, combining omega-3 PUFAs and perinatal depression terms and including publications up to February 18, 2019, for RCTs on omega-3 PUFAs compared to placebo or any active comparator. Results: Data from 18 RCTs on 4,052 participants showed an overall significant small beneficial effect of omega-3 PUFAs on depressive symptoms compared to placebo (−0.236 standardized difference in means [SDM]; 95% CI = −0.463 to −0.009; P = .042). Heterogeneity was considerable (I 2 = 88.58; P < .001), with significant subgroup differences explaining 55% of between-study variance (P = .001). In depressed women, omega-3 PUFAs showed a medium effect (SDM = −0.545; 95% CI = −1.182 to 0.093; P = .094) vs no effect in nondepressed women (SDM = −0.073). Moreover, the effect was medium to large in postpartum women (SDM = −0.656; 95% CI = −1.690 to 0.378; P = .214) compared to a negligible effect during pregnancy (SDM = −0.071). RCTs specifically studying postpartum depression showed the largest effect (SDM = −0.886; 95% CI = −2.088 to 0.316; P = .149). Conclusions: Omega-3 PUFAs have an overall significant small beneficial effect on perinatal depression, with important subgroup differences. We advise against prescribing omega-3 PUFAs for the treatment or prevention of depressive symptoms during pregnancy, given a lack of effect with low heterogeneity. In contrast, omega-3 PUFA supplementation may be a promising (add-on) treatment for postpartum depression.
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