PEDIATRICS Vol. 108 No. 5 November 2001, p. e82
ELECTRONIC ARTICLE:
Similar Effects on Infants of n-3 and n-6 Fatty Acids
Supplementation to Pregnant and Lactating Women
Received Jan 29, 2001; accepted Jun 13, 2001.
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From the * Institute for Nutrition Research, Objective. There have been
indications that high intake of n-3 long-chain polyunsaturated fatty
acids (PUFAs) during pregnancy may increase birth weight and
gestational length. In addition, n-3 long-chain PUFAs may be important
for the neurobiological development of the infants. High levels of
docosahexaenoic acid (DHA, 22:6 n-3) are found in the gray matter of
the cerebral cortex and in the retina, and it seems as if the
availability of long-chain PUFAs may be limiting cerebral development.
The fetus and the newborn are dependent on a high supply from their
mothers, either via the placenta or via breast milk. We supplemented
pregnant and lactating women with n-3 or n-6 long-chain PUFAs to
evaluate the effect on birth weight, gestational length, and infant
development.
Design. We performed a double-blind, randomized study
recruiting 590 pregnant, healthy, nulli- or primiparous women
(19-35 years old) in weeks 17 to 19 of pregnancy. The women were
provided 10 mL of either cod liver oil or corn oil daily until 3 months
after delivery.
Main outcome measures. Primary outcomes were gestational
length and birth weight. Electroencephalography (EEG) was done on the
second day of life and at 3 months of age. Novelty preference (Fagan
test) was used as an indicator of cognitive function at 6 and 9 months
of age. The fatty acid pattern in umbilical plasma phospholipids and in breast milk was measured, and dietary assessments were performed, both
on the mothers during pregnancy and on the infants at 3 months of age.
The growth of the infants was followed up to 1 year of age.
Results. Three hundred forty-one mothers took part in the
study until delivery. There were no significant differences in maternal
body mass index before pregnancy and at birth, or parity between the 2 groups. Smoking habits and parental education were also similar in the
2 groups. The mean age of the mothers receiving cod liver oil was, by
chance, 1 year higher than the age of the mothers receiving corn oil
(28.6 [3.4] vs 27.6 [3.2] years). The maternal dietary intake in
the 2 groups receiving cod liver oil or corn oil was similar, except
for the supplementation. There were no differences in gestational
length or birth weight between the cod liver oil group and the corn oil
group (279.6 [9.2] vs 279.2 [9.3] days; 3609 [493] vs 3618 [527] g, respectively). Birth length, head circumference, and
placental weight were also similar in the 2 groups. The concentrations
of the n-3 fatty acids eicosapentaenoic acid (20:5 n-3),
docosapentaenoic acid (22:5 n-3), and DHA in umbilical plasma
phospholipids were higher in the cod liver oil group compared with the
corn oil group (10.8 [7.6] vs 2.5 [1.8] µg/mL, 5.0 [2.6] vs 2.9 [1.3] µg/mL, 55.8 [20.6] vs 45.3 [12.8] µg/mL, respectively).
Neonates with high concentration of DHA in umbilical plasma
phospholipids (upper quartile) had longer gestational length than
neonates with low concentration (lower quartile; 282.5 [8.5] vs 275.4 [9.3] days). No differences in EEG scores or Fagan scores were found,
but neonates with mature EEG (N = 70) had a higher
concentration of DHA in umbilical plasma phospholipids than neonates
with immature EEG (N = 51) on the second day of
life. Dietary information from 251 infants at 3 months of age was
collected and 85% of these infants were exclusively breastfed, in
addition to 12% who were partly breastfed. The breast milk of mothers
supplemented with cod liver oil contained more n-3 long-chain PUFAs and
less n-6 long-chain PUFAs than breast milk of mothers supplemented with
corn oil. There were no significant differences in infant growth during
the first year of life between the 2 groups.
Conclusions. This study shows neither harmful nor
beneficial effects of maternal supplementation of long-chain n-3 PUFAs
regarding pregnancy outcome, cognitive development, or growth, as
compared with supplementation with n-6 fatty acids. However, it
confirms that DHA concentration may be related to gestational length
and cerebral maturation of the newborn.
Department of
Pediatric Research, and § Institute of Psychology, University of Oslo,
Oslo; Peter Möller, Avd Orkla ASA; and ¶ Department of
Neurology, The National Hospital, Oslo, Norway.
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