DHA is an omega-3 fatty acid that plays a crucial role in the growth and development of an infant’s brain, eyes, and central nervous system. DHA is found in breast milk, but its levels can vary depending on a mother’s diet. As a result, many mothers consider taking DHA supplements to ensure their breast milk contains an adequate amount of this essential nutrient.

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However, the effectiveness of these supplements in increasing DHA concentrations in breast milk is still a topic of debate among experts. If you are a new mother considering taking a DHA supplement to enhance the nutritional value of your breast milk, understanding the current research can help you make an informed decision about whether to incorporate supplementation into your breastfeeding routine. In this article, we will explore the evidence and shed light on the potential impact of DHA supplementation on breast milk composition.

 

Breast Milk Composition Matters

Breast milk is optimal for infant feeding because it contains essential nutrients, antibodies, and other factors vital for infant growth and development. The composition of maternal breast milk may vary based on environmental factors, maternal dietary intake, and across different stages of lactation. Since the composition of milk changes over time, the nutritional and bioactive components of human breast milk are typically discussed as averages. According to recent studies, human breast milk contains about 87-88% water, 7% (60-70 g/L) carbohydrates, 1% (8-10 g/L) protein, and 3.8% (35-40 g/L) fat, along with other health promoting properties like micronutrients and immunologic factors.

While some factors impacting breastmilk composition cannot be modified, such as stage of lactation, maternal dietary intake is one factor that can be manipulated to optimize infant growth and health. For example, the fatty acid profile of human milk varies with the maternal diet. Studies show that long-chain polyunsaturated fatty acids in human milk, including the omega-3 fatty acid DHA, are particularly low in North American populations.

To make matters worse, DHA is found in a minimal number of foods, such as fatty fish, most of which are not consumed in substantial amounts. Therefore, it is challenging for breastfeeding mothers to obtain the recommended 200-300mg/day of DHA, which provides roughly 100mg/day of DHA to the breastfeeding infant, keeping in line with current recommendations for at least the first 6 months of life. Other researchers recommend infant DHA intake around 10mg/kg/day for at least the first six months of life.

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Not only are breastfeeding mothers challenged by limited food options when striving to meet DHA recommendations, evidence indicates that DHA concentrations in mothers decrease during pregnancy and postpartum periods, reaching a minimum at six months after birth and returning to prepregnancy levels within one year. The decrease in maternal DHA is attributed to the offspring’s transfer to and accretion of DHA without adequate maternal intakes. Furthermore, evidence has found that maternal DHA status becomes further reduced after each following pregnancy, which may result in a lower DHA status in the newborns and may also be reduced by smoking.

Lastly, if breastfeeding is not viable, infant formula supplemented with omega-3 fatty acids DHA and ARA is recommended. Evidence indicates that infant development appears to be similar in infants receiving DHA + ARA supplemented infant formula as those who are breastfed. Furthermore, studies show that adding DHA + ARA when supplementing infant formulas with long-chain polyunsaturated fatty acids supports visual and cognitive development through 39 months of age.

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The Importance of DHA for Growing Minds

The transfer of fatty acids from mother to fetus during pregnancy and in the early years of life, either through breastfeeding, infant formula, or supplementation, is required for optimal infant growth and development. Long-chain polyunsaturated fatty acids, particularly DHA, play structural roles in cellular membranes and act as precursors for signaling molecules.

Yet, the essentiality of DHA in infant growth and development is mainly attributed to its incorporation into tissues of the central nervous system, brain, and eyes. The period from birth to 2 years of age is considered the primary growth phase for the human brain and DHA supply is believed to be critically important during this time.

Evidence demonstrating the impact of omega-3s early in life has grown in recent years. In human studies, DHA supply during gestation and infancy appears to impact brain and visual development and may play a role in the prevention and treatment of several neuropsychiatric conditions, including depression.

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DHA is a principal fatty acid highly concentrated in the prefrontal cortex and gray matter of the brain, which is essential for association and short-term memory function. Additionally, DHA metabolites have strong antioxidant capacities that protect tissues and neural cells from oxidative injury and stress.

DHA levels in infants have been linked with differential functional outcomes later in life and several studies have demonstrated that maternal intake of omega-3 fatty acids during pregnancy and lactation may be favorable for children’s long-term development.

One study found that the DHA content of infant red blood cells is related to visual acuity at two and twelve months of age and verbal activity at nine months of age. Another study found that children’s mental processing scores at four years of age correlated significantly with maternal intake of DHA and EPA. Although some individual studies and reviews demonstrate improvements in infant cognitive and visual outcomes with maternal omega-3 supplementation, other reviews and meta-analyses (1,2,3) have not reported conclusive evidence.

 

Does Evidence Demonstrate Supplementation Increases DHA in Breast Milk?

Since the composition of human breast milk reflects the nutritional status and dietary intake of the lactating mother, the amount of DHA in breast milk can also be influenced by the maternal diet. Many U.S. women, including those who are pregnant, do not consume the recommended 8-12 oz of seafood per week, resulting in inadequate consumption of DHA during pregnancy and lactation. Therefore, supplementation may be a safe and easy way to ensure adequate maternal dietary intake.

Several lines of evidence (1, 2, 3, 4, 5, 6, 7) demonstrate that DHA supplementation in lactating mothers increases breast milk circulating DHA. Furthermore, research has found that increasing breast milk DHA levels leads to a dose-dependent increase in infant plasma and erythrocyte phospholipid DHA.

A September 2023 study was the first to assess longitudinal changes in DHA and the changes within the context of DHA supplementation during pregnancy through one year postpartum across four different categories of samples (maternal blood, cord blood, breast milk, and infant blood). Designed as a randomized, double-blinded, placebo-controlled trial, the researchers set out to test the effect of DHA supplementation with 400mg/day DHA compared with placebo from <20 weeks of gestation through 6 months postpartum.

While  there was no difference in mean DHA concentration between the DHA and placebo groups at baseline, the researchers found that maternal DHA supplementation from mid-pregnancy through 6 months postpartum increased maternal and infant erythrocyte and breast milk DHA concentrations that persisted through 1 year of age.

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Furthermore, the researchers observed a decrease in the omega-6:omega-3 ratio of mother’s blood, cord blood, infant’s blood, and breast milk in the DHA-supplemented group compared to the placebo group. However, the ratio did not approach optimal values, and the authors noted that even higher dosages of DHA may be required for breastfeeding mothers to achieve more ideal Omega-3 Index values and omega-6:omega-3 ratios.

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Summary

Omega-3 fatty acids, particularly DHA, play essential roles in central nervous system development in the early years of life. Even though results are inconclusive on the long-term cognitive impact of DHA supplementation on offspring, the importance of adequate intake for normal growth and development is well established.

While numerous studies recommend at least 200 mg per day of DHA for pregnant and lactating women, data demonstrates that many lactating women are only receiving around 25% of this recommended amount.

Furthermore, more recent evidence suggests that higher levels, such as 400 mg/d, from early pregnancy through 6 months postpartum may be required to significantly increase circulating DHA in breast milk and infant erythrocyte levels. Adequate evidence exists to support the use of DHA supplementation in lactating women to increase the DHA concentration of breast milk and increase availability for breastfeeding infants. Maternal DHA supplementation may be a safe and effective way to increase infant DHA supply to a level that beneficially impacts infant brain and central nervous system development.

These statements have not been evaluated by the Food and Drug Administration. This test is not intended to diagnose, treat, cure, prevent or mitigate any disease. This site does not offer medical advice, and nothing contained herein is intended to establish a doctor/patient relationship. OmegaQuant, LLC is regulated under the Clinical Laboratory improvement Amendments of 1988 (CLIA) and is qualified to perform high complexity clinical testing. The performance characteristics of this test were determined by OmegaQuant, LLC. It has not been cleared or approved by the U.S. Food and Drug Administration.

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