Research Highlights: The Benefits of DHA During Pregnancy and While Breastfeeding
Docosahexaenoic acid, DHA, is a long chain omega-3 fatty acid that is found throughout the body. More specifically, it is a major structural fat in the brain and the retina of the eye and is a key component of the heart. A growing body of research continues to support the important role that DHA plays for both mother and baby. Specifically, DHA is important for optimal infant brain, eye and nervous system development, and has been shown to support a healthy pregnancy. Below are research highlights from studies examining the role of DHA in health and development during pregnancy and while nursing. (Please refer to the list of references.)
  • DHA is the most abundant fatty acid in the brain and eyes (retina). DHA represents about 97% and 93% of all omega-3 fatty acids in the brain and eyes, respectively.1-2
  • DHA is important for healthy visual and mental development of the infant in utero and throughout infancy.1-4
  • Breast milk is the optimal method for infant feeding. DHA is always present in human breast milk.5
  • The developing infant receives DHA from the mother through the placenta during pregnancy and in breast milk after birth.5-7
  • Expert panels recommend that DHA intake be 200-300mg per day for pregnant and nursing women.8,9
  • On average, pregnant and nursing women in North America consume 60-80mg of DHA a day, only 20-40% of the recommended intake.10,11
  • Breast milk DHA levels are dependent on the mother's diet.12-24 Because of a low DHA dietary intake, American women reportedly have lower DHA levels in their breast milk than their international counterparts.5
  • Maternal DHA supplementation was shown to increase the mother's blood and breast milk DHA levels. This, in turn, elevated the blood DHA levels of both the fetus and breast-feeding infant. 12-13, 24-30
  • Higher levels of DHA in breast milk were associated with an infant‘s ability to easily adjust to changes in surroundings (measured using Brazelton Neonatal Behavioral Assessment scale).31
  • Maternal DHA supplementation during lactation resulted in mental development advantages in children 32-35 including:
    • Improved psychomotor development (such as eye-hand coordination) at 2.5 years of age.34
    • Improved attention skills at 5 years of age.35
  • A study using a statistical model of risk-benefit analysis, designed by Harvard Center for Risk Analysis, estimated that increasing maternal DHA intake by 1 g/day increases child IQ by 1.3 points.36
  • Supplementation with DHA during pregnancy benefits both mother and baby by extending the length of gestational age. Meta-analyses of studies conducted to date show that maternal DHA supplementation was associated with a greater length of pregnancy averaging 1.6 to 2.6 days closer to term. 37-39 One study demonstrated a 6 day increase in the length of gestational age.39
References
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1. Martinez M. Tissue levels of polyunsaturated fatty acids during early human development. Pediatr, 1992.120:S129-38.
2. Lauritzen L, et al. The essentiality of long chain n-3 fatty acids in relation to development and function of the brain and retina. Prog Lipid Res, 2001. 40:1-94. (Calculated using Table 1 data. 22:6n-3/Total n-3)
3. Salem, N Jr, et al. Mechanisms of action of docosahexaenoic acid in the nervous system. Lipids, 2001. 36:945-59.
4. Crawford MA. The role of essential fatty acids in neural development: implications for perinatal nutrition. Am J Clin Nutr, 1993. 57:703S- 709S.
5. Yuhas R, et al. Human milk fatty acid composition from nine countries varies most in DHA. Lipids 2006;41:851-8.
6. Koletzko B, et al. Placental transfer of long-chain polyunsaturated fatty acids (LC-PUFA).J Perinat Med. 2007 Feb;35 Suppl 1:S5-S11.
7. Innis SM. Essential fatty acid transfer and fetal development. Placenta. 2005 Apr;26 Suppl A:S70-5. Review.
8. Simopoulos AP, et al. Workshop on the essentiality of and recommended dietary intakes for omega-6 and omega-3 fatty acids. J Am Coll Nutr, 1999. 18(5): 487-9.
9. Influence of Dietary Fatty Acids on the Pathophysiology of Intrauterine Foetal Growth and Neonatal Development. Consensus Conference: Dietary fat intake during the perinatal period, 11-14 September 2005, Wildbad Kreuth/Germany. Dietary Recommendations for Pregnant Women http://www.perilip.org/PERILIPRecommendations.html
10. Denomme J, et al. Directly quantitated dietary (n-3) fatty acid intakes of pregnant Canadian women are lower than current dietary recommendations. J Nutr, 2005. 135:206-11.
11. Benisek D, et al. Dietary intake of polyunsaturated fatty acids by pregnant or lactating women in the United States. Obstet Gynecol, 2000. 95:S77-S78.
12. Makrides M, et al. Effect of maternal docosahexaenoic acid (DHA) supplementation on breast milk composition. Eur J Clin Nutr, 1996. 50:352-7.
13. Smit EN, et al. Effect of supplementation of arachidonic acid (AA) or a combination of AA plus docosahexaenoic acid on breastmilk fatty acid composition. Prostaglandins Leukot Essent Fatty Acids, 2000. 62:335-40.
14. Bitman J, et al. Comparison of the lipid composition of breast milk from mothers of term and preterm infants. Am J Clin Nutr, 1983. 38:300-12.
15. Dotson KD, et al. High-performance liquid chromatography of human milk triacylglycerols and gas chromatography of component fatty acids. Lipids, 1992. 27:933-9.
16. Specker B, et al. Differences in fatty acid composition of human milk in vegetarian and nonvegetarian women: long-term effect of diet. J Pediatr Gastroent Nutr, 1987. 6:764-8.
17. Auestad N, et al. Visual acuity, erythrocyte fatty acid composition, and growth term infants fed formulas with long chain polyunsaturated fatty acids for one year. Pediatr Res, 1997. 41:1-10.
18. Finley D, et al. Breast milk composition: fat content and fatty acid composition in vegetarians and non-vegetarians. Am J Clin Nutr, 1985. 41:787-800.
19. Francois CA, et al. Acute effects of dietary fatty acids on the fatty acids of milk. Am J Clin Nutr, 1998. 67:301-8.
20. Harris WS, et al. Will dietary n-3 fatty acids change the composition of human milk? Am J Clin Nutr, 1984. 40:780-5.
21. Henderson TR, et al. Effect of pasteurization on long chain polyunsaturated acid levels and enzyme activities of human milk. J Pediatr, 1998. 132:876-8.
22. Spear ML, et al. Milk and blood fatty acid composition during two lactations same woman. Am J Clin Nutr, 1992. 56:65-70.
23. Henderson RA, et al. Effect of fish oil on the fatty acid composition of human milk and maternal and infant erythrocytes. Lipids, 1992. 27:863-9.
24. FAO/WHO Expert Committee. "Fats and oils in human nutrition," Food and Nutrition Paper. FAO, Rome, Italy. 1994. No.57. 49-55.
25. Connor WE, et al. Increased docosahexaenoic acid levels in human newborn infants by administration of sardines and fish oil during pregnancy. Lipids, 1996. 31:S183-7.
26. Otto SJ, et al. The effect of different supplements containing docosahexaenoic acid on plasma and erythrocyte fatty acids of healthy nonpregnant women. Nutr Res, 2000. 20:917-927.
27. Otto SJ, et al. The effect of supplementation with docosahexaenoic and arachidonic acid derived from single cell oils on plasma and erythro cyte fatty acids of pregnant women in the second trimester. Prostaglandins Leukot Essent Fatty Acids, 2000. 63:323-8.
28. Jensen CL, et al. Effect of docosahexaenoic acid supplementation of lactating women on the fatty acid composition of breast milk lipids and maternal and infant plasma phospholipids. Am J Clin Nutr, 2000. 71:292S-9S.
29. van Houwelingen AC, et al. Essential fatty acid status in neonates after fish-oil supplementation during late pregnancy. Br J Nutr, 1995. 74:723-31.
30. Gibson RA, et al. Effect of increasing breast milk docosahexaenoic acid on plasma and erythrocyte phospholipid fatty acids and neural indices of exclusively breast fed infants. Eur J Clin Nutr, 1997. 51:578-84.
31. Hart SL, et al. Brief report: newborn behavior differs with docosahexaenoic acid levels in breast milk. J Pediatr Psychol, 2005. 31:221-6.
32. Decsi T, and Koletzko B. N-3 fatty acids and pregnancy outcomes. Curr Opin Clin Nutr Metab Care, 2005. 8:161-6.
33. Helland IB, et al. Maternal supplementation with very-long-chain n-3 fatty acids during pregnancy and lactation augments children's IQ at 4 years of age. Pediatrics, 2003. 111:e39-44.
34. Jensen CL, et al., Effects of maternal docosahexaenoic acid intake on visual function and neurodevelopment in breastfed term infants. Am J Clin Nutr, 2005. 82:125-32.
35. Jensen CL, et al. Effect of Maternal Docosahexaenoic Acid (DHA) Supplementation on Neuropsychological and Visual Status of Former Breast-fed Infants at Five Years of Age (abstr.). Pediatric Research, 2004. 49:181A.
36. Cohen JT, et al. A quantitative analysis of prenatal intake of n-3 polyunsaturated fatty acids and cognitive development. Am J Prev Med, 2005. 29:366-374.
37. Szajewska H, et al. 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. Am J Clin Nutr 2006. 83:1337-44.
38. Makrides M, et al. Marine oil, and other prostaglandin precursor, supplementation for pregnancy uncomplicated by pre-eclampsia or intrauterine growth restriction. Cochrane Database Syst Rev 2006. 3:CD003402.
39. Smuts CM, et al. A randomized trial of docosahexaenoic acid supplementation during the third trimester of pregnancy. Obstet Gynecol, 2003. 101: 469-79.


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