Effect of n−3 long-chain polyunsaturated fatty acid supplementation of women with low-risk pregnancies on pregnancy outcomes and growth measures at birth: a meta-analysis of randomized controlled trials

Szajewska, Hania; Horvath, Andrea; Koletzko, Berthold

doi:10.1093/ajcn/83.6.1337

Cited by 233 publications

(184 citation statements)

References 41 publications

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“…A systematic review of omega-3 supplementation in pregnancy found no difference in the rates of GDM (48). The DHA to Optimize Mother Infant Outcome (DOMInO) trial (49) was a multicenter Australian study including 2,399 women allocated to either 800 mg/day of docosahexaenoic acid and 100 mg eicosapentaenoic acid or vegetable oil capsules.…”

Section: Insulinmentioning

confidence: 99%

Normalizing Metabolism in Diabetic Pregnancy: Is It Time to Target Lipids?

et al. 2014

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Outcomes in pregnancies complicated by preexisting diabetes (type 1 and type 2) and gestational diabetes mellitus have improved, but there is still excess morbidity compared with normal pregnancy. Management strategies appropriately focus on maternal glycemia, which demonstrably improves pregnancy outcomes for mother and infant. However, we may be reaching the boundaries of obtainable glycemic control for many women. It has been acknowledged that maternal lipids are important in pregnancies complicated by diabetes. Elevated maternal lipids are associated with preeclampsia, preterm delivery, and large-forgestational-age infants. Despite this understanding, assessment of management strategies targeting maternal lipids has been neglected to date. Consideration needs to be given to whether normalizing maternal lipids would further improve pregnancy outcomes. This review examines the dyslipidemia associated with pregnancy complicated by diabetes, reviews possible therapies, and considers whether it is time to start actively managing this aspect of maternal metabolism.Although rates of adverse outcomes in pregnancies complicated by preexisting diabetes (type 1 and type 2) and gestational diabetes mellitus (GDM) have improved, there is still excess maternal and fetal morbidity compared with normal pregnancy. Current management strategies focus on maternal glycemic control, which demonstrably improves pregnancy outcomes for mother and infant. Truly "normal" glucose levels in pregnancy appear lower than previously thought (1) and achieving currently recommended glucose targets in pregnancy carries a risk of hypoglycemia (2). The challenges in reaching glycemic targets before and after conception raise the question of whether other aspects of maternal metabolism could potentially be addressed to provide benefit to mother and infant.Multiple maternal metabolic, hormonal, and inflammatory factors other than maternal glucose are associated with maternal and fetal outcomes and are altered in pregnancies complicated by prepregnancy diabetes and GDM. These include maternal amino acids, glycerol, ketones, and lipids (3). Lipid management in diabetes is acknowledged as a key therapeutic target in the nonpregnant setting. However, it has not been accorded the same attention in pregnancy. Abnormal maternal lipids in pregnancy have been associated with preeclampsia (4,5), preterm delivery (6), and large-forgestational-age (LGA) infants (7). This review examines the dyslipidemia associated with pregnancy complicated by diabetes, reviews possible therapies, and considers whether there is sufficient evidence to start actively managing lipids in pregnancy. LIPID METABOLISM IN PREGNANCYMaternal metabolism is designed to provide adequate nutrition for fetal growth, in the form of glucose, ketones, lipids, and other fuels. In early pregnancy, maternal

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Section: Insulinmentioning

confidence: 99%

Normalizing Metabolism in Diabetic Pregnancy: Is It Time to Target Lipids?

et al. 2014

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“…The hypothesis has been supported by some (Olsen et al, 1992;Olsen et al, 2000;Smuts et al, 2003) but not all (Bulstra-Ramakers et al, 1995;Onwude et al, 1995;Helland et al, 2001;Knudsen et al, 2006) randomised controlled trials (Olsen 2004;Makrides et al, 2006;Szajewska et al, 2006), and by some (Olsen et al, 1991;Olsen and Secher 2002) but, again, far from all (Olsen 1994;Olsen et al, 1995;Bjerregaard and Hansen 1996;Oken et al, 2004;Rogers et al, 2004;Thorsdottir et al, 2004) observational studies. Two recent meta-analyses of controlled trials concluded that fish oil probably prolongs pregnancy, but that the size of this effect, estimated from the pooled analyses, is most probably too small to be of any clinical significance (Makrides et al, 2006;Szajewska et al, 2006).…”

Section: Introductionmentioning

confidence: 99%

Duration of pregnancy in relation to fish oil supplementation and habitual fish intake: a randomised clinical trial with fish oil

et al. 2007

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Objective: To examine the effect of fish oil supplementation on duration of pregnancy, conditional on the woman's habitual fish intake. Design: Multicentre 1:1 randomised clinical trial of effect of fish oil in a high-risk population of pregnant women in whom habitual fish intake was assessed at randomisation. Setting: Nineteen university delivery wards in seven European countries. Subjects: Pregnant women with preterm delivery, intrauterine growth retardation (IUGR), or pregnancy-induced hypertension (PIH) in a previous pregnancy (group 1, n ¼ 495); with twin pregnancies (group 2, n ¼ 367); or with suspicion of IUGR or threatening preeclampsia in the current pregnancy (group 3, n ¼ 106). Women were stratified into low, middle, or high fish consumers. Methods: The intervention group received fish oil capsules providing 2.7 g long-chain n-3 fatty acids per day (n-3 poly unsaturated fatty acids (PUFA)) from around week 20 (groups 1 and 2) or 6.3 g n-3 PUFA from week 33 (group 3). The control regimen was capsules with olive oil. Effect on timing of spontaneous delivery was examined by Cox regression, assuming elective delivery (occurring in 40%) as a censoring event. Analyses of effect of fish oil were intention to treat, and all analyses were adjusted for maternal smoking, age, and parity. Results: In group 1, fish oil reduced the hazard rate of spontaneous delivery (HR) by 44% (95% confidence interval 14-64%) and 39% (16-56%) in low and middle fish consumers, respectively, with no detectable effect (À56 to 33%) in high fish consumers. In groups 2 and 3, no significant effect of fish oil was detected in any of the sub-strata defined by baseline fish consumption. Conclusions: In pregnant women with previous pregnancy complications, fish oil supplementation delayed onset of delivery in low and middle, but not in high, fish consumers.

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“…Maternal dietary supplementation with n-3 PUFAs has beneficial effects on pregnancy outcomes, including increased gestation length (Szajewska et al 2006), reduced risk of pregnancy complications (Olsen et al 2000, Oken et al 2007, Zhou et al 2012, and increased fetal growth (Olsen et al 1990, Jones et al 2013b. Potentially, n-3 PUFAs may exert beneficial effects via their involvement in several physiological pathways, including anti-oxidative pathways.…”

Section: Introductionmentioning

confidence: 99%

Maternal omega-3 fatty acid intake increases placental labyrinthine antioxidant capacity but does not protect against fetal growth restriction induced by placental ischaemia–reperfusion injury

Jones¹,

Mark²,

Waddell³

2013

Reproduction

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Placental oxidative stress plays a key role in the pathophysiology of several placenta-related disorders. Oxidative stress occurs when excess reactive oxygen species (ROS) damages cellular components, an outcome limited by antioxidant enzymes; mitochondrial uncoupling protein 2 (UCP2) also limits ROS production. We recently reported that maternal dietary omega-3 polyunsaturated fatty acid (n-3 PUFA) supplementation reduced placental oxidative damage and enhanced fetal and placental growth in the rats. Here, we examined the effect of n-3 PUFAs on placental antioxidant defences and whether n-3 PUFA supplementation could prevent growth restriction induced by placental ischaemia-reperfusion (IR), a known inducer of oxidative stress. Rats were fed either standard or high-n-3 PUFA diets from day 1 of pregnancy. Placentas were collected on days 17 and 22 in untreated pregnancies (termZday 23) and at day 22 following IR treatment on day 17. Expression of several antioxidant enzyme genes (Sod1, Sod2, Sod3, Cat, Txn1 and Gpx3) and Ucp2 was measured by quantitative RT-PCR in the placental labyrinth zone (LZ) and junctional zone (JZ). Cytosolic superoxide dismutase (SOD), mitochondrial SOD and catalase (CAT) activities were also analyzed. Maternal n-3 PUFA supplementation increased LZ mRNA expression of Cat at both gestational days (2-and 1.5-fold respectively; P!0.01) and female Sod2 at day 22 (1.4-fold, P!0.01). Cytosolic SOD activity increased with n-3 PUFA supplementation at day 22 (1.3-fold, P!0.05). Sod1 and Txn1 expression decreased marginally (30 and 22%, P!0.05). JZ antioxidant defences were largely unaffected by diet. Despite increased LZ antioxidant defences, maternal n-3 PUFA supplementation did not protect against placental IR-induced growth restriction of the fetus and placental LZ.

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Effect of n−3 long-chain polyunsaturated fatty acid supplementation of women with low-risk pregnancies on pregnancy outcomes and growth measures at birth: a meta-analysis of randomized controlled trials

Abstract: n-3 LC-PUFA supplementation during pregnancy may enhance pregnancy duration and head circumference, but the mean effect size is small. The implications of these findings for later growth and development remain to be elucidated.

Cited by 233 publications

References 41 publications

Normalizing Metabolism in Diabetic Pregnancy: Is It Time to Target Lipids?

Normalizing Metabolism in Diabetic Pregnancy: Is It Time to Target Lipids?

Duration of pregnancy in relation to fish oil supplementation and habitual fish intake: a randomised clinical trial with fish oil

Maternal omega-3 fatty acid intake increases placental labyrinthine antioxidant capacity but does not protect against fetal growth restriction induced by placental ischaemia–reperfusion injury

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