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PEDIATRICS Vol. 114 No. 1 July 2004, pp. 325

Nutritional Implications of Observed Neurobehavioral Disturbances and Reduced Gestation Length in Infants of Mothers Using Selective Serotonin Reuptake Inhibitors During Pregnancy

Elizabeth Vavasour, MSc
Health Canada
Ottawa, Ontario, Canada K1A 0L2

To the Editor. —

The nutritional implications of the observations of neurobehavioral disturbances and reduced gestation length in the infants of mothers using selective serotonin reuptake inhibitors for treatment of depression during pregnancy1 may be cause for concern, inasmuch as these results suggest that maternal dietary status of {omega}-3 long-chain polyunsaturated fatty acids (LCPUFAs) in the individuals receiving treatment was inadequate for the support of optimal fetal development. Information concerning the increased demand for {omega}-3 LCPUFAs on the expectant mother during pregnancy and breastfeeding,2–4 the importance of these fatty acids for the developing nervous system of the infant,5 the relationship of the depleted state of {omega}-3 LCPUFAs with depression,6,7 the effects of these fatty acids on central nervous system serotonin receptor density and on peripheral serotonin function,8 and the generally inadequate intakes of these fatty acids by the North American population9 have been well documented in the scientific literature. In addition, maternal plasma docosahexaenoic acid concentration has been positively associated with more mature neonatal sleep-state patterning,10 and daily intake of a fish oil supplement containing {omega}-3 LCPUFAs has been shown to prolong gestation and increase birth weight.11 Treatment with selective serotonin reuptake inhibitors, although alleviating the symptoms of depression in the expectant mother, does not address the enhanced nutritional needs of the infant for {omega}-3 LCPUFAs. The results described in this article support the need for investigation of depression as a possible indicator of inadequate maternal {omega}-3 LCPUFA status.

REFERENCES

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  2. Al MDM, van Houwelingen AC, Kester ADM, Hasaart TH, De Jong AEP, Hornstra G. Maternal essential fatty acid patterns during normal pregnancy and their relationship to the neonatal essential fatty acid status. Br J Nutr. 1995;74 :55 –68[CrossRef][ISI][Medline]
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  7. Naes N, Smith R, Christophe A, Cosyns P, Desnyder R, Meltzer H. Fatty acid composition in major depression: decreased ù3 fractions in cholesteryl esters and increased C20: 4?6/C20:5?3 ratio in cholesteryl esters and phospholipids. J Affect Disord. 1996;38 :35 –36[CrossRef][ISI][Medline]
  8. Locke CA, Stoll AL. Omega-3 fatty acids in major depression. World Rev Nutr Diet. 2001;89 :173 –185[Medline]
  9. Kris-Etherton PM, Taylor DS, Yu-Poth S, et al. Polyunsaturated fatty acids in the food chain of the United States. Am J Clin Nutr. 2000;71(1 suppl) :179S –188S
  10. Cheruku SR, Montgomery-Downs HE, Farkas SL, Thoman EB, Lammi-Keefe, CJ. Higher maternal plasma docosahexaenoic acid during pregnancy is associated with more mature neonatal sleep-state patterning. Am J Clin Nutr. 2002;76 :608 –661[Abstract/Free Full Text]
  11. Olsen SF, Sørenson JD, Secher NJ, et al. Randomised controlled trial of effect of fish-oil supplementation on pregnancy duration. Lancet. 1992;339 :1003 –1007[CrossRef][ISI][Medline]
PEDIATRICS (ISSN 1098-4275). ©2004 by the American Academy of Pediatrics



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