For family members and healthcare providers, ensuring pregnancies reach full term is a priority. Evidence indicates that every week of pregnancy matters, as the baby’s brain, liver, and lungs still develop until 39 weeks. Now called “full term,” carrying a baby until the end of 39 weeks gives the baby the best chance to start a healthy life. Yet, according to data provided by the CDC for 2022, one out of every ten infants born in the United States was born preterm.

Furthermore, the rate of preterm birth among African American women was about 50% higher than their white or Hispanic counterparts. Preterm birth (<37 weeks) and early preterm birth (<34 weeks) are associated with an increased risk of infant death, breathing problems, feeding difficulties, developmental delays, vision problems, and more. Given the impact of preterm birth on health, as well as the economic costs, healthcare providers and families are looking for safe, effective, and affordable approaches to reduce the risk of going into labor too early.

 

2024 Experts Review Current Research on the Effects of Omega-3 Intake in Pregnant Women

While there are several etiologic reasons for preterm/early preterm birth, up to half may be spontaneous and may occur in women with no known risk factors. Furthermore, even if pregnancies at risk are identified, the options for preventing preterm/early preterm birth are minimal based on the cause.

It’s generally understood that nutrition can impact pregnancy outcomes, but more data is emerging to clarify how much proper nutrition can affect preterm birth risk. A 2018 Cochrane Review, including 70 randomized controlled trials, concluded that pregnant women assigned to increase omega-3 intake, either through food or supplementation, had an 11% risk reduction of all-cause preterm birth and a 42% risk reduction of all-cause early preterm birth compared to controls/placebos. In 2022, an update to this review was published and included additional trials that reported a 12% reduction in preterm births and a 35% reduction in early preterm births.

BLOG: Choline and DHA Uptake During Pregnancy

Most recently, in an Expert Review paper, Cetin et al. dug deeper into recent trials. Unlike the 2018 Cochrane Review trials, the more recent trials were conducted after prenatal supplements, including DHA, were widely used. Therefore, these studies often included high-dose omega-3 intake compared to low-dose omega-3 intake, which was already included in the standard prenatal multivitamin.

The results demonstrated that the women who benefited the most from additional omega-3 supplementation were those with lower baseline DHA or total omega-3 fatty acid status. More specifically, women with red blood cell phospholipid DHA content <6% of total fatty acids experienced risk reduction of preterm/early preterm birth with omega-3 supplementation.

 

Pregnant Women Are Not Hitting Omega-3 Intake Targets

Omega-3 fatty acid DHA is found naturally in a limited number of foods. Fish is an excellent source of DHA, whereas egg yolks, liver, and poultry provide small amounts. Traditional recommendations for pregnant women are to consume at least 200-250mg/d, requiring pregnant women to consume 224-336 g (8-12 oz) of fish per week. Yet evidence indicates that most women are not meeting these targets.

A 2016 study investigating a global overview of dietary intake of DHA, which included 47 developed and 128 developing countries, found that 64% of the populations measured have a dietary DHA intake of <200 mg/day. Furthermore, data indicate that only 10-20% of US women eat as much as 8 oz of fish per week, pregnant women consume an average of 1.8 oz per week, and 10-20% of pregnant women consume no fish at all.

BLOG: How DHA Affects the Intelligence of Preterm Babies

Moreover, the rationale behind many of the organizational recommendations for omega-3 intake in the pregnant population does not make those recommendations to reduce preterm or early preterm birth. According to the review, currently, only two countries link DHA recommendations in pregnant individuals with the reduction of preterm birth. The Australian National Health and Medical Research Council and the Polish Society of Gynecologists and Obstetricians recommend higher intakes (800-1000 mg/d) of DHA for pregnant women who are low in omega-3 fatty acids or at risk of preterm birth.

Although dietary intake of DHA should be considered, the best way to measure status is through laboratory analysis of blood lipids. Regarding the pregnant population, earlier evidence led scientists to propose a threshold level of 5% red blood cell (RBC) DHA content since the risk of early preterm birth seemed to increase below this level.

BLOG: Omega-3 for Kids

However, the more up-to-date consensus in the Expert Review agreed on a threshold of 6%. In the US, the average RBC DHA level in women between the ages of 20-40 is much lower than this recommended threshold at about 3.7%. Furthermore, since omega-3 requirements likely increase throughout pregnancy to support normal fetal growth, assessing RBC DHA levels throughout pregnancy and acting on the results may be beneficial.

VIDEO: Why Omega-3 DHA is Important for a Baby’s Brain Development

 

New Position Paper Establishes Clinical Practice Guidelines for Omega-3 Intake in Pregnant Women 

It remains true that strategies to prevent preterm births are limited, and identifying women at risk for preterm birth is a challenge. Yet, today’s evidence demonstrates that increasing omega-3 fatty acid intake protects against spontaneous and early preterm birth at very little cost or risk.

After reviewing the current evidence, lead authors of the 2024 Expert Review developed clinical practice guidelines. Then, they invited other renowned experts and medical-scientific organizations from around the globe to contribute and vote on the final recommendations.

Conclusions supported by >95% of the guideline group members were considered “strong consensus,” >75-95% a “consensus,” >50-75% a “majority approval,” and <50% as “not supported.” The final draft, which the leading authors wrote, was then shared with all members and supporting organizations for suggestions and approval.

BLOG: Does Taking a Supplement Increase DHA Concentrations in Breast Milk?

The paper includes 11 conclusions and five recommendations for further research. While more details can be found in the paper itself, what is clear is the experts on this paper believe both healthcare providers and pregnant individuals can do more to increase omega-3 intake and decrease unnecessary risk of spontaneous preterm birth.

The authors of the paper suggest that by assessing DHA levels either through blood work or through a structured questionnaire applied at the first obstetrical visit, it is possible to identify women who could effectively lower their risk of early premature birth and preterm birth by increasing intake of DHA through food or supplementation.

The summary of consensus recommendations from the expert panel includes the following DHA intakes:

  • ≥ 250 mg/d of DHA + EPA from foods or supplements for the general population, including women of childbearing age.
  • ≥ 250 mg/d of DHA + EPA and an additional intake of ≥ 100-200 mg/d of DHA for all pregnant women
  • 600-1000 mg/d of DHA + EPA, or DHA alone, no later than 20 weeks gestation for pregnant women with low DHA intakes or blood levels at the beginning of pregnancy

 

Conclusion

A brand-new position paper was published that provides clinical practice guidelines developed by experts around the globe advising omega-3 intakes for pregnant women to prevent and reduce the incidence of early preterm (before 34 weeks) and preterm (before 37 weeks) birth rates. The paper summarized the relevant research demonstrating that improving omega-3 status in pregnant women, especially in those with low baseline omega-3 status, is a safe and effective way to significantly reduce spontaneous preterm and early preterm birth. Those who are pregnant or considering pregnancy would benefit from understanding their current omega-3 status and determining, with their healthcare provider, whether they would benefit from increasing omega-3 intake.

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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