The effect of prenatal docosahexaenoic acid supplementation on infant outcomes in African American women living in low-income environments: A randomized, controlled trial

Abstract

Importance African American women living in urban, low-income environments are at high risk for poor nutrition during pregnancy and birth complications. Objective To test the effectiveness of prenatal docosahexaenoic acid (DHA) supplementation on birth outcomes and infant development in a sample of African American women with Medicaid insurance and living in the city of Pittsburgh. Design The Nutrition and Pregnancy Study (NAPS) is a double-blind, randomized controlled trial of prenatal DHA supplementation conducted between 2012 and 2014. Setting Participants were recruited from obstetric clinics at the University of Pittsburgh Medical Center. Participants Sixty-four pregnant, African American women were enrolled at 16–21 weeks of gestation and randomized to either 450 mg/day of DHA (22:6n-3)(n=43) or a soybean placebo (n=21). Four women (6.3%) withdrew from the study: two participants from each study arm; complete data were obtained for 49 infants (76.5%) at the 3-month assessment. Interventions Supplementation with DHA or placebo continued from the beginning of enrollment through delivery. Main Outcome and Measures Data on birth outcomes were collected from medical records. At approximately 3 months post-partum, mothers brought their infants to the laboratory where the Bayley Scales of Infant Development (BSID-III) were administered and cortisol response to the Face-to-Face Still-Face (FFSF) paradigm was assessed. Results Infants of mothers who received DHA supplementation had higher birth weight (3,174 grams versus 2,890 grams) than infants of mothers receiving placebo (F [2,40] = 6.09, p = .018, eta = .36), and were more likely to have a 1-minute Apgar score greater than 8 (OR = 5.99 [95% CI = 1.25–28.75], p = .025). Infants of mothers who received DHA compared with infants of mothers receiving placebo had lower levels of cortisol in response to the FFSF paradigm (F [1,32] = 5.36, p = .018, eta = .36). None of the scores on the BSID-III differed as a function of active supplement versus placebo. Conclusions Infants of women living in urban, low-income environments who received DHA supplementation had more optimal birth outcomes and more modulated cortisol response to a stressor. DHA supplementation may be effective in attenuating the negative effects of prenatal stress on offspring development.

The role of glucocorticoid, interleukin-1β, and antioxidants in prenatal stress effects on embryonic microglia

“…Intriguingly, our results demonstrating alterations of embryonic microglia with IL-1β also support redox mechanisms, based on the importance of reactive oxygen species for IL-1β’s activation of microglia [ 30 , 31 ]. These convergent findings support the importance of redox dysregulation in the effects of prenatal stress [ 32 , 33 ].…”

Effect of Prenatal Docosahexaenoic Acid Supplementation on Blood Pressure in Children With Overweight Condition or Obesity

“…We cannot know the biological mechanism, but evidence from 2 trials of DHA supplementation during pregnancy suggests 2 plausible mechanisms: intrauterine DHA resulted in more mature fetal autonomic nervous system 22 and reduced cortisol response to a stressor in infancy. 23 If these effects were prolonged after birth, either one could affect childhood BP.…”

Early environmental influences on the development of children's brain structure and function

“…52 Emerging evidence suggests that long-chain polyunsaturated fatty acids intake may attenuate maternal psychosocial stress during pregnancy. 54 In rodents, gestational docosahexaenoic acid supplementation prevents prenatal stress-induced impairment of learning and memory and normalizes the biomarkers of oxidative damage and apoptosis in the offspring's hippocampus. 54 In rodents, gestational docosahexaenoic acid supplementation prevents prenatal stress-induced impairment of learning and memory and normalizes the biomarkers of oxidative damage and apoptosis in the offspring's hippocampus.…”

“…53 Prenatal docosahexaenoic acid supplementation, an unsaturated omega-3 fatty acid, is associated with better birth outcomes and modulation of the cortisol response to a stressor in infants living in a low socio-economic status environment. 54 In rodents, gestational docosahexaenoic acid supplementation prevents prenatal stress-induced impairment of learning and memory and normalizes the biomarkers of oxidative damage and apoptosis in the offspring's hippocampus. 55 The supplementation with n-3 polyunsaturated fats directly to the offspring exposed to prenatal adversity also seems to be associated with less brain oxidative damage in rodents.…”