The effect of fish oil supplementation on maternal and neonatal outcomes: a triple-blind, randomized controlled trial

Alireza Ostadrahimi; Sakineh Mohammad-Alizadeh; Mojgan Mirghafourvand; Shadi Farshbaf-Khalili; Nayyer Jafarilar-Agdam; Azizeh Farshbaf-Khalili

doi:10.1515/jpm-2016-0037

Article

The effect of fish oil supplementation on maternal and neonatal outcomes: a triple-blind, randomized controlled trial

Alireza Ostadrahimi , Sakineh Mohammad-Alizadeh , Mojgan Mirghafourvand , Shadi Farshbaf-Khalili , Nayyer Jafarilar-Agdam and Azizeh Farshbaf-Khalili

Published/Copyright: January 31, 2017

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From the journal Journal of Perinatal Medicine Volume 45 Issue 9

Abstract

Objective:

To evaluate the effect of fish oil supplementation on pregnancy outcomes in mother and newborn.

Methods:

This randomized, triple-blind, placebo-controlled trial was conducted on 150 pregnant women aged 18–35 years from Feburary 2014 to April 2015 in Tabriz, Iran. Participants were assigned to receive either 1000 mg fish oil supplements containing 180 mg eicosapentaenoic acid (EPA) and 120 mg docosahexanoic acid or placebo from week 20 of gestation to birth. The primary outcome measure was birth weight. Gestational duration, preterm labor low birth weight (LBW), length, head circumference, and maternal serum docosahexaenoic acid (DHA) and EPA level at 35–37 weeks were also examined. The statistical analysis was on an intention-to-treat basis.

Results:

Demographic characteristics were similar in both groups (P>0.05). The mean (SD) birth weight values in the fish oil and placebo groups were 3256 (362) g and 3172 (447) g, respectively (adjusted mean difference (MD)=84.1 g, 95% confidence interval [CI]=−24.8 to 193.2). Five (7.6%) neonates in the placebo versus no case in the fish oil group were born with LBW (P=0.02). The rate of preterm labor was lower in the fish oil group (adjusted OR=0.74, 95% CI=0.16–3.42). However, there were no statistically significant differences in the maternal outcomes (P>0.05) with the exception of the proportion of maternal serum DHA fatty acid at 35–37 weeks (P<0.001).

Conclusion:

Although low dose fish oil supplementation increased birth weight, its effect was not statistically significant. The frequency of LBW was significantly reduced in the intervention group, but the observed reduction needs to be confirmed in future larger investigations using different doses of omega-3.

Keywords: fish oil supplemention; mothers; neonates; nutritional status; omega-3; pregnancy

Acknowledgments

This study resulted from a PhD thesis that has been approved by the Tabriz Health Services Management Research Center (grant no. 5/77/5241). The authors would like to appreciate the research deputy of the Chromatography Laboratory, Faculty of Medicine, Tabriz University of Medical Sciences; the Zahravi Pharmacy Company; the Health Department of Tabriz; the authorities and staff of health centers; and all women who patiently assisted us in collecting data. They also thank Dr Masoud Darabi from the Faculty of Medicine, Tabriz University of Medical Sciences, Iran, for analysis of fatty acids.

Author’s statement

Conflict of interest: Authors state no conflict of interest.
Material and methods: Informed consent has been obtained from all individuals included in this study.
Ethical approval: The research related to human use has been complied with all the relevant national regulation, and institutional policies, is in accordance the tenets of the Helsinki Declaration, and has been approved by the authors’ institutional review board or equivalent committee.
Source of funding: This study was supported by Tabriz University of Medical Sciences.

References

[1] World Health Organization. Marine oil supplementation to improve pregnancy outcomes. e-Library of Evidence for Nutrition Actions (eLENA). 2011.Search in Google Scholar

[2] Coletta JM, Bell SJ, Roman A. Omega-3 fatty acids and pregnancy. Rev Obstet Gynecol. 2010;3:163–11.Search in Google Scholar PubMed

[3] Olafsdottir AS, Magnusardottir AR, Thorgeirsdottir H, Hauksson A, Skuladottir GV, Steingrimsdottir L. Relationship between dietary intake of cod liver oil in early pregnancy and birthweight. Br J Obstet Gynaecol. 2005;112:424–9.10.1111/j.1471-0528.2005.00477.xSearch in Google Scholar

[4] Ramakrishnan U, Stein AD, Parra-Cabrera S, Wang M, Imhoff-Kunsch B, Juarez-Marquez S, et al. Effects of docosahexaenoic acid supplementation during pregnancy on gestational age and size at birth: randomized, double-blind, placebo-controlled trial in Mexico. Food Nutr Bull. 2010;31:S108–16.10.1177/15648265100312S203Search in Google Scholar PubMed

[5] Borja-Hart NL, Marino J. Role of omega-3 fatty acids for prevention or treatment of perinatal depression. Pharmacotherapy. 2010;30:210–6.10.1592/phco.30.2.210Search in Google Scholar PubMed

[6] Olsen SF, Hansen HS. Marine fat, birthweight, and gestational age: a case report. Agents Actions. 1987;22:373–4.10.1007/BF02009084Search in Google Scholar

[7] Olsen SF, Sørensen JD, Secher NJ, Hedegaard M, Henriksen TB, Hansen HS, et al. Randomized controlled trial of effect of fish-oil supplementation on pregnancy duration. Lancet. 1992;339:1003–7.10.1016/0140-6736(92)90533-9Search in Google Scholar PubMed

[8] Morris MC, Sacks F, Rosner B. Does fish oil lower blood pressure? A meta-analysis of controlled trials. Circulation. 1993;88:523–33.10.1161/01.CIR.88.2.523Search in Google Scholar PubMed

[9] Olsen SF. Is supplementation with marine omega-3 fatty acids during pregnancy a useful tool in the prevention of preterm birth? Clin Obstet Gynecol. 2004;47:768–74. discussion 881–2.10.1097/01.grf.0000141430.57412.56Search in Google Scholar PubMed

[10] Roman AS, Schreher J, Mackenzie AP, Nathanielsz PW. Omega-3 fatty acids and decidual cell prostaglandin production in response to the inflammatory cytokine IL-1beta. Am J Obstet Gynecol. 2006;195:1693–9.10.1016/j.ajog.2006.04.009Search in Google Scholar PubMed

[11] Makrides M, Duley L, Olsen SF. Marine oil, and other prostaglandin precursor, supplementation for pregnancy uncomplicated by pre-eclampsia or intrauterine growth restriction. Cochrane Database Syst Rev. 2006;19:CD003402.10.1002/14651858.CD003402.pub2Search in Google Scholar PubMed

[12] Harper M, Thom E, Klebanoff MA, Thorp J Jr, Sorokin Y, Varner MW, et al. Omega-3 fatty acid supplementation to prevent recurrent preterm birth. Obstet Gynecol. 2010;115:234–42.10.1097/AOG.0b013e3181cbd60eSearch in Google Scholar PubMed PubMed Central

[13] Williams MA, Zingheim RW, King IB, Zebelman AM. Omega-3 fatty acids in maternal erythrocytes and risk of preeclampsia. Epidemiology. 1995;6:232–7.10.1097/00001648-199505000-00007Search in Google Scholar PubMed

[14] World Health Organization. Marine oil supplementation during pregnancy. e-Library of Evidence for Nutrition Actions (eLENA). 2012.Search in Google Scholar

[15] World Health Organization. Marine oil supplementation in pregnancy and maternal and neonatal health outcomes. e-Library of Evidence for Nutrition Actions (eLENA). 2011.Search in Google Scholar

[16] Mandagarana. 2015. Fish markets in the cities of East Azerbaijan. Avalable at: http://www.mandagarana.ir/News/7042.Search in Google Scholar

[17] Memari AM, Ramim T, Amini M, Mehran A, Ajorlo A, Shakibaie P. The effect of aerobic exercises on pregnancy outcomes. Hayat 2006;12:35–41. (persian)Search in Google Scholar

[18] Farshbaf-Khalili A, Mohamad-Alizadeh S, Darabi M, Hematzadeh S, Mehdizadeh A, Shaaker M, et al. The effect of fish oil supplementation on serum phospholipid fatty acids profile during pregnancy: a double blind randomized controlled trial. Women Health. 2016;24:1–17.10.1080/03630242.2016.1159269Search in Google Scholar PubMed

[19] Saccone G, Berghella V. Omega-3 supplementation to prevent recurrent preterm birth: a systematic review and metaanalysis of randomized controlled trials. Am J Obstet Gynecol. 2015;213:135–40.10.1016/j.ajog.2015.03.013Search in Google Scholar PubMed

[20] Larque E, Gil-Sanchez A, Prieto-Sanchez MT, Koletzko B. Omega 3 fatty acids, gestation and pregnancy outcomes. Br J Nutr. 2012;107(Suppl 2):S77–84.10.1017/S0007114512001481Search in Google Scholar PubMed

[21] Carlson SE, Colombo J, Gajewski BJ, Gustafson KM, Mundy D, Yeast J, et al. DHA supplementation and pregnancy outcomes. Am J Clin Nutr. 2013;97:808–15.10.3945/ajcn.112.050021Search in Google Scholar PubMed PubMed Central

[22] Salvig JD, Lamont RF. Evidence regarding an effect of marine n-3 fatty acids on preterm birth: a systematic review and meta-analysis. Acta Obstet Gynecol Scand. 2011;90:825–38.10.1111/j.1600-0412.2011.01171.xSearch in Google Scholar PubMed

[23] Szajewska H, Horvath A, Koletzko B. 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;83:1337–44.10.1093/ajcn/83.6.1337Search in Google Scholar PubMed

[24] Imhoff-Kunsch B, Briggs V, Goldenberg T, Ramakrishnan U. Effect of n-3 long-chain polyunsaturated fatty acid intake during pregnancy on maternal, infant, and child health outcomes: a systematic reviewppe. Paediatr Perinat Epidemiol. 2012;26(Suppl. 1):91–107.10.1111/j.1365-3016.2012.01292.xSearch in Google Scholar PubMed

[25] Helland IB, Saugstad OD, Smith L, Saarem K, Solvoll K, Ganes T, et al. Similar effects on infants of n-3 and n-6 fatty acids supplementation to pregnant and lactating women. Pediatrics. 2001;108:E82.10.1542/peds.108.5.e82Search in Google Scholar PubMed

[26] Grieger JA, Clifton VL. A review of the impact of dietary intakes in human pregnancy on infant birth weight. Nutrients. 2014;7:153–78.10.3390/nu7010153Search in Google Scholar PubMed PubMed Central

[27] Larqué E, Krauss-Etschmann S, Campoy C, Hartl D, Linde J, Klingler M, et al. Docosahexaenoic acid supply in pregnancy affects placental expression of fatty acid transport proteins. Am J Clin Nutr. 2006;84:853–61.10.1093/ajcn/84.4.853Search in Google Scholar PubMed

[28] Smuts CM, Huang M, Mundy D, Plasse T, Major S, Carlson SE. A randomized trial of docosahexaenoic acid supplementation during the third trimester of pregnancy. Obstet Gynecol. 2003;101:469–79.10.1097/00006250-200303000-00011Search in Google Scholar PubMed

[29] De Giuseppe R, Roggi C, Cena H. n-3 LC-PUFA supplementation: effects on infant and maternal outcomes. Eur J Nutr. 2014;53:1147–54.10.1007/s00394-014-0660-9Search in Google Scholar PubMed

[30] Mozurkewich EL, Klemens C. Omega-3 fatty acids and pregnancy: current implications for practice. Curr Opin Obstet Gynecol. 2012;24:72–7.10.1097/GCO.0b013e328350fd34Search in Google Scholar PubMed

[31] Ranjkesh F, Laluha F, Pakniat H, Kazemi H, Golshahi T, Esmaeili S. Effect of omeg-3 supplementation on preeclampsia in high risk pregnant women. JQUMS 2011;15:28–33.Search in Google Scholar

[32] Fereidooni B, Jenabi E. The use of omega 3 on pregnancy outcomes: a single-center study. J Pak Med Assoc. 2014;64:1363–5.Search in Google Scholar

Received: 2016-1-30

Accepted: 2016-12-9

Published Online: 2017-1-31

Published in Print: 2017-12-20

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Articles in the same Issue

https://doi.org/10.1515/jpm-2016-0037

Keywords for this article

fish oil supplemention; mothers; neonates; nutritional status; omega-3; pregnancy