The newly published “Omega-3 fatty acids during pregnancy to reduce preterm birth” statement also noted that a DHA plus EPA dose of 1,000 mg per day is effective at reducing the risk of early birth, with best results when supplementation starts before the 20th week of gestation.
Experts affiliated with the South Australian Health and Medical Research Institute and the University of Adelaide also noted that women with adequate omega-3 intakes in early pregnancy should maintain these intakes.
Credibility
Commenting independently on the study’s findings, Harry Rice, PhD, VP of regulatory & scientific affairs for the Global Organization for EPA and DHA Omega-3s (GOED), told us: “GOED welcomes ISSFAL's formal support for omega-3s reducing the risk of preterm and early preterm birth.
“While a number of global expert scientific organizations and governments recommend EPA/DHA for pregnant women, the recommendations are generally much lower than the current evidence suggests is necessary to reduce the risk of preterm birth. ISSFAL's statement provides additional credibility to the existing strong body of scientific evidence supporting such benefit.
“It is GOED's hope that this statement can be leveraged to help convince policymakers about the benefits of omega-3s for pregnant women.”
Evidence
The ISSFAL statement is underpinned by a 2018 Cochrane systematic review of 70 RCTs that provided data on 19,927 women. The Cochrane review was supported by additional evidence from RCTs completed since 2018, plus other systematic reviews.
“The evidence synthesis confirmed that omega-3 LCPUFA, particularly docosahexaenoic acid (DHA) and eicosapentaenoic acid (EPA), have an important role to play in determining gestational length in singleton pregnancies,” wrote the ISSFAL experts.
“For women with low omega-3 status in early pregnancy, supplements are the most practical way to ensure omega-3 status is restored as effectively as possible,” they stated, before noting that oil fish would also increase omega-3 levels, but factors such as “cost, preference, limitation in food variety, lack of cooking skills, or philosophical and ecological concerns are all potential barriers for women”. For vegan or vegetarian women, omega-3s from micro-algae or plant bioengineered sources may be suitable alternatives.
“An important consideration when recommending omega-3 supplementation to reduce preterm birth is the appropriate regulation of supplement manufacturing to ensure pregnant women can obtain high quality supplements that meet accepted safe international standards for heavy metals, pesticides and oxidation levels,” they added.
The reduction in the risk of pre-term birth also offers significant economic benefits. For example, analysis of data from the Kansas University DHA Outcomes Study (KUDOS) found that this would result in cost savings of $1,678 per infant. Taking out the $166.48 cost of the DHA supplements for 26 weeks and a $26 increase in maternal care costs, the net saving became $1,484.
For the nearly 4 million live births in the US every year this cost saving would become almost $6 million, according to data published in 2016 in Prostaglandins, Leukotrienes and Essential Fatty Acids (Vol. 111, pp. 8–10).
Research gaps
As with all scientific reports, the experts note that more research is needed, with the following areas identified as priorities:
1. Development of an international agreement for specific reference ranges for low and replete status in blood fractions.
2. Developing and validating novel, standardized omega-3 assessment tools that can be widely implemented as a routine part of antenatal care.
3. Evaluation of the minimum effective omega-3 dose, as well as the optimal balance of DHA and EPA for supplementation.
Source: Prostaglandins, Leukotrienes and Essential Fatty Acids
Published online ahead of print, doi: 10.1016/j.plefa.2022.102495
“ISSFAL Statement Number 7 – Omega-3 fatty acids during pregnancy to reduce preterm birth”
Authors: K.P. Best, et al
