- The Importance of DHA in a Prenatal Vitamin
- Making DHA a Priority
- What Is DHA in Prenatal Vitamins?
- DHA Before and After Conception
- Effects in Fetal Development
- Fishy Problems in the Diet
- Where to Find DHA Supplements
- Other Important Prenatal Vitamin Features
- DHA in Pregnancy: Should You Supplement?
- 5 Ways Pregnant Women Can Get More DHA in Their Diets
- Vitamins and other nutrients during pregnancy
- Pregnant Women Need DHA — But Diet Beats Supplements
- 5 Key Benefits of DHA During Pregnancy
- Health Benefits For Baby
- Health Benefits For Mom
- How to Get Enough DHA During Pregnancy
- The Importance of DHA for Babies
- What is DHA?
- Natural Sources of DHA
- Supplemental Sources
- So, what to do?
The Importance of DHA in a Prenatal Vitamin
04/24/2015 – Contributed by: Dr. Michael C. Bartfield, M.D., F.A.C.OG.
Over the past several years, docosahexaenoic acid (DHA) has become a standard nutrient in the majority of prenatal vitamins.
DHA is an omega-3 essential fatty acid (EFA). Although EFAs are important in promoting overall health, they are not produced by the body, and therefore must be consumed though diet and/or supplementation. DHA, along with another omega-3, eicosapentaenoic acid (EPA), act as an anti-inflammatory agent in the body, counterbalancing the effects of Omega-6 series. In the United States, omega-6 fatty acid consumption far outweighs that of omega-3, leading to increased risks of diseases such as hypertension, arthritis, atherosclerosis, depression, adult-onset diabetes mellitus, myocardial infarction, thrombosis, and some cancers. A more balanced diet including DHA may lead to decreased risk for adults.
Making DHA a Priority
At preconception planning and initial pregnancy visits, I always have a discussion with my patients regarding adequate diet and make a recommendation for them to take a quality prenatal vitamin, one that includes DHA. There are decades of research that have debated DHA’s influence on many things including a newborn’s IQ, motor development, coordination, and eyesight. One thing that is not debated is that DHA is a main building block for a growing baby’s or infant’s brain and nervous system, especially in the third trimester of pregnancy and during the first several years of life. If mom’s diet and supplementation are deficient, her baby may have a deficiency as well.
I highly recommend that my pregnant and non-pregnant patients seek out foods and supplements with DHA to ensure an adequate daily amount of omega-3 fatty acids.
The views expressed herein are solely the views of Dr. Michael C. Bartfield, M.D., F.A.C.OG. and do not necessarily reflect the views of TherapeuticsMD, Inc. or any of its affiliates. This information is for informational and educational purposes only, and is not intended as a substitute for professional medical advice. Always consult a qualified healthcare provider for medical advice.
What Is DHA in Prenatal Vitamins?
Docosahexaenoic acid (DHA) is a type of omega-3 fatty acid. Found primarily in fish, DHA is important for a variety of health functions in adults. Pregnant women depend on this fatty acid to promote healthy fetal development. According to the Academy of Nutrition and Dietetics, the average woman only eats 2 ounces of the recommended 8 to 12 ounces of fish per week during pregnancy. This is why prenatal vitamin manufacturers are increasingly putting DHA in their products.
DHA Before and After Conception
Omega-3’s, like DHA, are called essential fatty acids because you can only get them from diet or supplements. Fetal development is dependent on a mother’s health, which is why it’s important to obtain the recommended amount of DHA before conception and during pregnancy. The American Pregnancy Association recommends taking a DHA supplement providing between 300 and 600 milligrams per day for at least six weeks before conception and throughout the pregnancy. Supplementation should also continue through nursing.
Effects in Fetal Development
When you think of fish oil, you might think of its benefits for the heart. DHA is heart-healthy, but it does much more for fetuses. The fatty acid ensures proper brain development and promotes better attention and learning habits later in life. DHA is also responsible for healthy eyes, nervous system development and proper immune function.
Fishy Problems in the Diet
Two main challenges can get in the way of getting enough DHA from eating fish. First is the fact that most Americans don’t eat enough healthy seafood, whether it’s due to a lack of access or money. Another problem is the misconception that eating fish will harm your baby. Certain types of seafood, such as swordfish and shark, have high levels of mercury that can adversely affect your pregnancy outcome. But there are healthier choices that are both high in DHA and low in mercury. The Academy of Nutrition and Dietetics recommends eating 12 ounces a week of anchovies, salmon, freshwater bass or trout. You can also eat 6 ounces of tuna per week. DHA supplements can still help you get this essential nutrient without eating fish.
Where to Find DHA Supplements
Many name and generic brands of prenatal vitamins already contain DHA. If a particular supplement lacks DHA, or has under 300 milligrams, you may consider buying a separate DHA supplement designed for pregnant women. Your doctor may even prescribe a prenatal vitamin with DHA in it. Choices in supplements are numerous, so if you do choose an over-the-counter version, you might ask your physician for a brand recommendation.
Other Important Prenatal Vitamin Features
DHA is just one component to consider in a supplement. Prenatal vitamins contain many of the same nutrients as adult multivitamins, with a few ingredients in larger amounts. This is true of iron to prevent anemia during pregnancy, as well as iodine. Another crucial, and often overlooked, nutrient is folic acid. Also called vitamin B-9 or folate, folic acid protects both brain and spinal cord development – especially during early pregnancy. Kids Health recommends 400 micrograms a day before conception and throughout pregnancy. Folic acid is naturally present in orange juice and enriched grains, but even a balanced diet may not offer enough. Making sure your prenatal vitamin features DHA, folic acid and other vital nutrients can help ensure a healthy baby.
DHA in Pregnancy: Should You Supplement?
Fish oil and walnuts provide an essential fatty acid that can help boost your baby’s brain and visual development.
There’s nothing fishy about it: DHA (or docosahexaenoic acid), an omega-3 fatty acid found in fish oil, is an essential nutrient for women — especially during pregnancy. DHA helps build your baby’s brain, nervous system, and eyes. “Omega-3s are a specific type of fat that our body needs but cannot make,” says Melinda Johnson, RD, a spokesperson for the American Dietetic Association.
Adults need to get DHA from food, and a baby in utero needs to get these fats from its mother. Newborns get DHA from breast milk or from baby formula supplemented with DHA. It’s so important that even if a mother doesn’t consume much DHA, her body will use its own reservoir of DHA to provide it to her growing baby during gestation and then through breast milk after birth.
Benefits of DHA for growing babies include:
- Brain development. In a study of 98 pregnant women, researchers at the School of Pediatrics and Child Health at the University of Western Australia found that two years after birth, the children whose mothers had received a high dose of fish oil (including 2.2 g of DHA) in the second half of their pregnancy had higher scores in tests of their eye-hand coordination. Another study, from the University of Oslo in Norway, found that four-year-olds scored better on IQ tests if their mothers took DHA supplements during pregnancy and breastfeeding. The results of other studies also suggest positive effects of maternal DHA supplementation on cognitive outcomes, such as motor development at 30 months of age and attention span at 5 years of age.
- Visual development. A study of 167 pregnant women conducted at the University of British Columbia’s Department of Pediatrics suggested a correlation between visual acuity in two-month-old babies and their mother’s DHA intake during their second trimester and third trimester of pregnancy. Reviews of other studies have found mixed results, possibly due to differences in how DHA was provided to the pregnant women and how visual acuity was measured.
- Higher birth weight. Researchers at Maastricht University in the Netherlands studied 782 mother-baby pairs and found “significant positive associations” between the mother’s DHA levels (especially early in pregnancy) and the baby’s weight and head circumference at birth. Other studies suggested that DHA consumption during pregnancy may have a small benefit in reducing the likelihood of repeat preterm birth among women who previously had preterm birth.
How much DHA do you need?
While there are not yet official recommendations on the amount of DHA pregnant women need, a recent review of research published by the Journal of Perinatal Medicine concluded that pregnant and lactating women need 200 mg of DHA a day; Johnson suggests the same amount.
Sources of DHA
So where can pregnant women get that daily dose of DHA? “Food is best,” says Johnson, “so if a woman can, she should start there. Salmon, canned light tuna, and products with added DHA such as eggs and milk are all good options, as are anchovies, herring, sardines, walnuts, and walnut oil. If you’d rather take a DHA supplement, go for one derived from algae rather than fish oil — it’ll be gentler on your stomach. (Then you’ll be getting your DHA just as the fish do; their source is marine algae.)
Eating Fish Safely
Fish is a fantastic source of DHA, but pregnant and breastfeeding women need to exercise caution. You want to eat enough oily, fatty fish to reap the DHA benefits but not enough to add too much dangerous mercury to your diet (and your baby’s). The Institute of Medicine and the Food and Drug Administration make the following recommendations.:
Avoid Shark, swordfish, king mackerel, tilefish
Eat sparingly (6 oz. or less per week) Canned (or packaged) albacore tuna and freshwater fish caught by family and friends
Eat carefully (up to 12 oz. per week) Other seafood, such as shellfish, canned (or packaged) light tuna, salmon, pollock, and catfish
However, these recommended limitations on seafood consumption during pregnancy have been challenged by a study of over 8,000 pregnant women and their children in the UK. The study found that children of women who ate more than the recommended amount of seafood during pregnancy had higher scores for verbal intelligence, fine motor skills, communication, and social development. This led the investigators to conclude that in terms of early childhood development, the benefits of seafood consumption during pregnancy may outweigh the risks related to mercury. It has yet to be seen whether official recommendations about fish consumption during pregnancy will be modified.
5 Ways Pregnant Women Can Get More DHA in Their Diets
In order to give baby the best start, expectant mothers must ensure they are getting enough DHA (short for “docosahexaenoic acid”) in their diets. During pregnancy, women need at least 200 milligrams daily of this powerful omega-3 fatty acid to support the development of baby’s brain, eyes and nervous system. Plus, getting that daily dose of DHA has been shown to prevent pre-term labor, increase birth weight, and support postpartum mood in new mothers.
However, the majority of moms-to-be are severely deficient in this essential nutrient. Research indicates that most women are only getting around 60 mg/day and that just 1 in 14 actually take a DHA supplement.
It’s estimated that about 80% of women of childbearing age in the US have DHA blood level less than 5%, a suggested blood DHA target for pregnancy. Unpublished data from OmegaQuant found that in a study of 26 pregnant women in their third trimester (when the baby needs most of this nutrient) close to 50% had prenatal DHA blood levels less than 5%. In this particular population, taking 200 mg of DHA per day for 10 weeks within a highly controlled diet was enough to increase DHA levels in all of the women to at least 5%.
Since the human body is unable to make DHA efficiently from other omega-3 fatty acids, dietary intake is very important. Follow these guidelines to be sure you’re getting enough DHA to support a healthy pregnancy:
#1 – Fish First
Low in calories and saturated fat, and high in protein, vitamin D and omega-3s, fish can be an excellent source of nutrition for a developing baby and highly beneficial to expectant mothers. The U.S. Food and Drug Administration (FDA) recommends eating 8 to 12 ounces a week of a variety of seafood that’s low in methylmercury while you’re pregnant or nursing a baby.
Consistently safe options like salmon, trout and herring can be eaten 2-3 times per week and are not only low in mercury but also high in omega-3s, which are shown to be especially important for baby’s cognitive development. White or albacore canned tuna is also a good source of DHA, but should only be eaten once per week due to a slightly higher mercury content.
One large Danish study, for example, showed children whose mothers ate the most fish during pregnancy had better motor and cognitive skills at 6 months and at 18 months than those whose mothers ate little fish. And those whose mothers ate the least fish had the lowest developmental scores.
While many fish prove to be an excellent source of DHA, the FDA advises women of childbearing age to steer clear of high-mercury species like swordfish, shark, king mackerel, and tilefish, which, according to the Environmental Protection Agency (EPA) can be detrimental to a baby’s brain development, vision, cognition and motor skills.
The FDA has released a helpful guide to choosing low-mercury fish, but be aware that not all the fish are rich in DHA. A list of fish that is both high in DHA and low in mercury is included in the Prenatal DHA Test report.
BLOG: You’re Pregnant! Now What?
#2 – Algal DHA Supplements
Vegan, vegetarian, or just don’t love the taste of fish? Algae is a great plant-based solution to getting your omega-3s. While consuming oily fish was once thought to be the only way to get adequate amounts of DHA and EPA, an omega-3 similar to DHA. It’s now known that fish don’t naturally produce these omega-3s and only have high levels of them because of their algae-rich diet.
In recent years, DHA has been successfully obtained from algae, which has opened up new opportunities for Vegan and Vegetarian Omega-3 supplements like Nordic Naturals Algae Omega and Vegetology Opti3 Omega-3 EPA & DHA. And research shows, such options can be extremely effective in meeting one’s DHA requirements.
One recent study had 32 healthy adults consume either algal oil capsules or cooked salmon with an equivalent amount of DHA each day for two weeks. By the end of the trial both group showed comparable increases in their blood levels of DHA, leading researchers to conclude that “algal-oil DHA capsules and cooked salmon appear to be bioequivalent in providing DHA to plasma and red blood cells.” Another 2014 scientific review similarly found that algal oil serves as an effective alternative source of DHA.
Algal oil is also a safe option when it comes to protecting the environment. Overfishing occurs when fish are caught at higher rates than they can reproduce, which negatively affects ocean food chains, increases global food insecurity, and destroys coral reefs. Algae-based DHA supplements, often harvested from ponds, represents a much more sustainable choice. Plus, algae don’t contain any heavy metals or toxins so there’s no risk of ocean-borne contaminants.
#3 – Fish Oil Supplements
When it comes to how to pick your fish oil supplement, the key is to choose one that provides at least 200 mg of DHA per serving, to be sure that both mom and baby are properly supported. Taking up to 1000 mg DHA per day has been shown to be safe.
One fish oil supplement to consider is this prenatal offering from Wiley’s Finest. It contains well over the recommended amount of 200 mg DHA, as well as EPA.
In terms of fish oil supplement studies, one showed that these types of supplements could provide neurodevelopment benefits in children, when pregnant or nursing women take them before and during pregnancy.
BLOG: Make Sure You Are Getting Enough of These Nutrients During Pregnancy
#4 – Eggs*
Packed with protein, vitamins and minerals essential to a healthy pregnancy, the incredible edible egg can also be fortified with two different omega-3 fatty acids: DHA and ALA (an omega-3 found in plant sources like flax).
Hens fed a diet containing flaxseed, which is known to contain large amounts of ALA, produce omega-3 eggs. When the hens digest the flax, some of the ALA gets broken down into DHA and both fatty acids transfer to the yolk.
The Flax Council of Canada states that chickens fed ALA (as flaxseed) have eggs with an “average of 340 mg ALA and 130 mg EPA+DHA.” However, a commercially available omega-3 egg, GoldEgg Omega Choice, provides only 75 mg of DHA per egg, so it’s important to look at the label when you purchase it.
Some companies add fish oil to the chicken’s feed to further increase the DHA content of egg, like Phil’s Cage Free brand, which offers 150 mg of DHA per serving and 350 mg of omega-3 per egg. (By comparison, the USDA Nutrient Database lists a standard large egg as containing 18 mg ALA and 29 mg DHA).
Also, be sure to eat the whole egg when you buy omega-3 eggs — all the omega-3s are in the yolk!
#5 – Fortified Milk*
According to the United States Department of Agriculture, pregnant women should consume three cups of milk each day for calcium, protein, and vitamin D to ensure a safe and healthy pregnancy.
And since DHA is to brains what calcium is to bones, moms-to-be can get the best of both worlds by drinking a fortified milk like Horizon Organic or Fairlife. DHA, calcium and vitamin D stores in baby are based entirely on what they get while in the womb. So, it’s essential to a newborn’s health that the mother gets enough of these nutrients while pregnant.
*The amount of DHA in fortified milks and eggs is relatively low per serving, so they should always be consumed in addition to whatever diet or supplementation strategy an expectant mother is already following.
Pregnancy Meal Plan Recommendations
Check out the following nutritional strategies from Kristina Harris Jackson, PhD, RD, a Research Associate at OmegaQuant Analytics, and inventor of the Prenatal DHA Test to be sure you’re getting enough DHA from your diet:
Ex: 1 fish meal per week + 2 egg meals + a glass of DHA milk per day….
- Horizons DHA Whole Milk = 32 mg per 1 cup
- Omega-3 Eggs (Phil’s DHA Eggs) = 150 mg per egg
- Farmed Atlantic Salmon = 1825 mg per 3 oz serving
- Rainbow Trout = 744 mg per 3 oz serving
- Albacore/white canned tuna = 733 per 3 oz serving
- Sockeye salmon (wild) = 501 mg per 3 oz serving
- Light chunk tuna (canned) = 230 mg per 3 oz serving
- Tilapia = 115 mg per 3 oz serving
- Shrimp = 26 mg per 3 oz serving
“The 200 mg/d can also be spread out throughout the week,” says Jackson. She shares the following samples as recommendations:
- 1 serving Atlantic salmon in a week (1825 mg / 7 days) = 250 mg/d
- 2 DHA-enriched eggs per day = 300 mg/d
Total = 216 mg DHA per day
- Example 2:
- 2 servings of Sockeye salmon in a week (501 x 2 = 1002/7) = 143 mg/d
- 2 cups of DHA milk per day (32 x 2) = 64 mg/d
Total = 207 mg DHA per day
VIDEO: How Much DHA Needed During Pregnancy is Unique to Each Person
ORIGINAL | ORIGINAL
Supplementation with the omega-3 docosahexaenoic acid: influence on the lipid composition and fatty acid profile of human milk
Suplementação com ácido graxo ômega-3 docosahexaenoico: influência sobre a composição lipídica e perfil de ácidos graxos no leite humano
Eliana Aparecida Fagundes Queiroz BortolozoI; Elenise SauerI; Marli da Silva SantosI; Sueli Regina BaggioII; Guataçara dos Santos JuniorI; Paulo Vitor FaragoIII; Lys Mary Bileski CândidoIV; Luiz Alberto PilattiI
IUniversidade Tecnológica Federal do Paraná. Av. Monteiro Lobato, km 4, Campus Ponta Grossa, 84016-210, Ponta Grossa, PR, Brasil. Correspondence to/Correspondência para: EAFQ BORTOLOZO. E-mail: <[email protected]>
IIInstituto de Tecnologia de Alimentos, Centro de Química de Alimentos e Nutrição Aplicada. Campinas, SP, Brasil
IIIUniversidade Estadual de Ponta Grossa, Centro de Ciências Biológicas e da Saúde, Departamento de Ciências Farmacêuticas. Ponta Grossa, PR, Brasil
IVUniversidade Tecnológica Federal do Paraná, Setor de Ciências da Saúde, Departamento de Nutrição. Curitiba, PR, Brasil
OBJECTIVE: This study assessed the impact of supplementing the diet of women during pregnancy and lactation with fish oil containing the omega-3 fatty acid docosahexaenoic acid, and its influence on the composition of human milk.
METHODS: The sample comprised 60 women aged 18 to 38 years with appropriate dietary pattern, all of them healthy and nonsmokers. The intervention consisted of a daily supplementation with fish oil capsules that corresponded to a daily intake of 315mg of docosahexaenoic acid and 80mg of eicosapentaenoic acid during the third trimester of pregnancy and the first three months postpartum. The total fat content and fatty acid profile of their milk were determined by creamatocrit and gas chromatography. Descriptive statistics were used for data analysis and the significance level was set at p<0.05.
RESULTS: There was no statistical difference between the fat contents of the study (fish oil capsules) and control (capsules containing corn starch as filler) groups. However, the milk of women taking fish oil contained higher docosahexaenoic and eicosapentaenoic acid levels 30 and 60 days after delivery. These results demonstrate that high omega-3 intake can influence its concentration in human milk.
CONCLUSIONS: Given the importance of docosahexaenoic acid in the neonatal period, it is appropriate for pregnant and breastfeeding women to supplement on long-chain polyunsaturated fatty acids, which may be done by adding fish oil to the regular diet.
Indexing terms: Docosahexaenoic acids. Pregnant women. Lactation. Milk, human. Supplementation feeding.
OBJETIVO: Este estudo teve como objetivo avaliar o impacto da suplementação na dieta de gestantes e de lactantes com ácidos graxos ômega-3 docosahexaenoico, sob a forma de óleo de peixe, e sua influência na composição do leite humano.
MÉTODOS: A amostra foi constituída de 60 gestantes, com idade entre 18 e 38 anos, saudáveis, com padrão alimentar adequado e não fumantes. A intervenção consistiu na suplementação da dieta com cápsulas de óleo de peixe, totalizando um consumo diário de 315mg de ácido docosahexaenoico e 80mg de ácido eicosapentaenoico, no período entre o terceiro trimestre de gravidez e o terceiro mês após o parto. O teor de lipídeos totais e do perfil de ácidos graxos foi determinado pelos métodos de crematócrito e de cromatografia gasosa. Para a análise dos dados foi utilizada estatística descritiva e nível de significância de p<0,05.
RESULTADOS: Entre o grupo sujeito à dieta suplementada (cápsulas de óleo de peixe) e o grupo controle (cápsulas contendo amido de milho como excipiente), não se constatou diferença estatística quanto aos valores totais de lipídeos. Entretanto, no leite das mães do primeiro grupo, a suplementação com óleo de peixe mostrou teores mais elevados na concentração dos ácidos docosahexaenoico e eicosapentaenoico, nos tempos 30 e 60 dias, demonstrando que um maior consumo de ômega-3 pode influenciar na sua concentração no leite humano.
CONCLUSÃO: Considerando a importância do ácido docosahexaenoico no período neonatal, é adequado incrementar com ácidos graxos poliinsaturados de cadeia longa a alimentação de gestantes e de lactantes, o que pode ocorrer pela suplementação da dieta com óleo de peixe.
Termos de indexação: Ácido docosahexaenóicos. Gestantes. Lactação. Leite humano. Suplementação alimentar.
The Long-Chain Polyunsaturated Fatty Acids (LC-PUFA) of the omega-3 series, such as Docosahexaenoic Acid (DHA), Eicosapentaenoic Acid (EPA) and Arachidonic Acid (AA), are important components of cell membranes and central nervous system cells, and are essential for fetal development and development during the first months of life1-3.
The brain develops during the third trimester of pregnancy, when the active formation of neurons begins, and this increases DHA requirement considerably4. The amount of DHA that the fetus is capable of synthesizing from its precursors is limited, so it is supplied by the placenta,which takes it from the maternal plasma at a rate of 60-70mg/day and transfers it to the fetal plasma5-7.
After birth, polyunsaturated fatty acids are transferred from mother to infant through milk since the infant’s liver is immature and still incapable of synthesizing long-chain polyunsaturated fatty acids, which are important for the development of the nervous system6,8. Adequate DHA intake has been associated with better cognitive development, growth and visual acuity8-10.
During pregnancy, some situations are capable of changing the availability of LC-PUFA, such as inappropriate nutrition, intake of fats and oils having a high omega-6 to omega-3 ratio, and multiple and frequent pregnancies, factors that can significantly decrease the body reserves of these acids. The significant demand and accumulation of DHA by the fetus may cause an important reduction in the mother’s body reserve of this acid, justifying its supplementation, especially when pregnancies are frequent or multiple11,12.
After birth, DHA required by the newborn is ensured by the mother’s milk which contains a small but significant amount of DHA (0.2-0.6% of the milk fat) but the amount varies according to the dietary habits of the mother13. Maternal DHA intake has a significant impact on its concentration in her plasma and milk6,8-10,14. Supplementation with LC-PUFA, especially omega-3, during pregnancy and lactation favors the mental development of the child10,15.
Pregnant and lactating women should take 300mg/day of DHA16. According to Kolelzko et al.17, the diet of lactating and pregnant women should provide a minimum of 200mg/day of DHA. However, it is difficult to establish a precise amount since the mother’s ability to store this acid and synthesize it from its precursor may vary15,18.
Supplementation of the diet of pregnant women with fish oil (DHA>200mg/day) from the thirtieth week of gestation to delivery increased the amount of omega-3 fatty acids in their milk significantly5 Filder et al.19 also found a significant increase of DHA in the milk of lactating women whose diets were supplemented with 200mg/day of DHA. In a study including 98 pregnant women during the last trimester of pregnancy, Dunstan et al.20 found that supplementation with fish oil is an effective way of improving the omega-3 fatty acid status of newborns. This inference shows the direct correlation between the mother’s diet and LC-PUFA concentration in human milk, proving that frequent intake of fish during lactation helps to increase omega-3 fatty acid status21-23. However, there is controversy regarding the impact of the mother’s diet on lipid profile since individual factors, such as adiposity and nutritional status, may also impact it24. In Brazil, there are no longitudinal studies about the theme with the same duration as the present study. In the only existing study, Patin et al.21 assessed 31 lactating women who consumed sardines weekly over a period of 30 days.
The objective of the present study was to assess the impact of supplementing the diet of Brazilian pregnant and lactating women living in the state of Paraná with the omega-3 fatty acid DHA in the form of fish oil by verifying its influence on the lipid profile of their milk, especially on DHA content.
The study consisted of a randomized, placebo-controlled trial involving pregnant women who received prenatal care in an obstetric healthcare facility at the municipality of Ponta Grossa, Paraná. The inclusion criteria were: non-smoker, healthy pregnant women aged 18 to 38 years in the last trimester of pregnancy, no high-risk pregnancy and appropriate dietary patterns. Clinical data were obtained from their medical records. Twenty-four-hour recalls were used for assessing their dietary patterns. They were administered on alternating days during the same week, including a weekend day25,26. Food intake was reported in preestablished cooking units by the pregnant women during the prenatal visits and by lactating women during home visits. A qualitative analysis was done based on the Food Pyramid Guide. This guide recommends number of portions according to food groups, which are grains (breads, cereals, roots, tubers); vegetables; fruits; meats and milk27. During the study period, the recruited women received dietary advice from a dietician once a month.
The intervention period consisted of the last trimester of pregnancy and first three months of lactation, since DHA is an important component of the nervous system and retinal membranes of the fetus, and accumulates mainly during the last months of intrauterine life and first months of life28.
The study was done from 2007 to 2008. Its experimental design was approved by the Ethics Committee of the Health Sciences Sector of the Federal University of Paraná, under protocol number 095.SM058/04-07. All participants signed a free and informed consent form before they joined the study.
The casuistic consisted of 80 pregnant women divided into two groups of 40. The minimum sample size was determined according to Triola29. The greatest difficulty regarded estimating the variation (standard deviation) of the data. In order to minimize errors in the mean estimates, the standard deviation was calculated from the results obtained by Patin et al.21 and Jensen et al.30. The mean standard deviation was considered to be 0.35 and the maximum error margin 0.11. Considering a significance level of 5%, the study would need a sample size of at least 40 pregnant women.
The 80 participants were randomly divided into two groups of 40 women: the study group who received Omega-3 Supplementation (OG) and the Control Group (CG). The intervention consisted of daily supplementation with five gel capsules of fish oilrich in DHA (Anew Co), totaling 1,150mg of fish oil, 315mg of DHA and 80mg of EPA, according to the recommendation for pregnant and lactating women, which is 300mg/day of DHA16. The composition of the capsules was confirmed by chromatographic analysis31,32. The CG received gel capsules containing cornstarch as filler.
Each milk sample was qualitatively and quantitatively analyzed three times for determining their total fat content and fatty acid profile.The samples were collected as recommended by the Brazilian Pediatric Society (Sociedade Brasileira de Pediatria)33 30 (time 30), 60 (time 60) and 90 (time 90) days after delivery. Collection was done at the participants’ homes by hand expression. The samples were stored in a sterile recipient, transported in a cooler, frozen and thawed in a water bath at 38ºC when ready for analysis.
Total fat content was determined by the creamatocrit method adapted for human milk34. The omega-3 fatty acids were assessed by gas chromatography32 using the gas chromatographer Varian, model 3900. The chromatographic conditions were: programmed column temperature; initial temperature of 120°C/5min, heating from 120ºC to 220ºC (3ºC/min) and from 220ºC to 235ºC (1ºC/min), staying at 235ºC for 12 minutes; the carrier gas was hydrogen at a flow rate of 1mL/min; the make-up gas was nitrogen at a flow rate of 30mL/min; injector temperature: 270°C; detector temperature: 300°C; injection volume: 1µL.
For the chromatographic analysis, the samples were prepared by making small changes to the method proposed by Bligh & Dyer31. In the extraction phase, the samples were thawed to about 4ºC and homogenized. Each 1mL aliquot of milk received 10mL of methanol, 10mL of chloroform and 1.3mL of water. The mixture was stirred for 20 minutes followed by extraction, whose filtrate in a vacuum Buchner funnel was transferred to a decanting funnel. The filtrate received 10mL of chloroform and 5mL of anhydrous sodium sulfate (2%). After stirring and decantation, the bottom phase was filtered using filter paper with anhydrous sulfate. The sample was dried under nitrogen. For sterification32, 5mL of potassium hydroxide in methanol were added to the aliquot, keeping it in a water bath at 70ºC for 15 minutes. Once cooled, 15mL of the esterification reagent were added, and the solution submitted to another water bath at 70ºC for 10 minutes. After esterification, 10mL of hexane and 15mL of distilled water were added and stirred. After decantation, a Pasteur pipette was used for collecting the solvent fraction and transferring it to test tubes followed by filtration with anhydrous sulfate. Lastly, 15mL of water was added, followed by decantation and collection with a Pasteur pipette. The fatty acids were identified by comparing the retention time of the fatty acids of the samples and standards. A total of 37 saturated, monounsaturated and polyunsaturated fatty acid standards were used (Supelco 37 Component FAME Mix – 47885-U). Fatty acid quantification was done by normalization of the area and the results were expressed in grams per 100g of sample.
All data were expressed by descriptive statistics (mean and standard deviation). Next, boxplot diagrams were used for finding possible outliers,which were excluded. Hypothesis testing using analysis of variance was used for verifying the possibility of differences between the means and later, the Tukey test was used for identifying possible significant differences between the means. The significance level for all calculations was set at 5% (p<0.05). The software Minitab version 15 was used for all the statistical tests.
A group of 60 women completed the study, 25 from the OG and 25 from the CG. These women had a mean age of 25 years and their education level varied from elementary school (34%; n=20) to high school (37%, n=22). Most had a mean family in come of two to four minimum wages (57%; n=34). All of them had appropriate dietary patterns for pregnant and lactating women during the entire intervention period (Table 1).
Table 2 shows the lipid profiles of the milk of the two groups. The only significant difference found in DHA content occurred for the intervention group between times OGT30 and OGT90 (p=0.026). The DHA content of the milk of the control group did not vary during the entire study period (p=0.939). The total fat content of the two groups also did not differ significantly (p=0.390).
Table 3 shows the fatty acid profiles of the groups OG and CG (total percentage of fatty acids) 30, 60 and 90 days after delivery. The DHA and EPA contents (Table 4) of the milk of the mothers in the study group (OG) did not differ significantly during the study period (DHA, p=0.368; EPA, p=768). The DHA and EPA contents of the milk of the mothers in the control group (CG) also did not differ significantly during the study period(DHA, p=0.298; EPA, p=0.475).
Although the total fat content of the milk of the two groups (OG and CG) did not differ, the DHA and EPA contents of the milk of the two groups differed significantly (p<0.001). The pairs of means that differed statistically (p<0.05) were: DHAOG30 and DHACG30 (DHA content of the study and control groups 30 days after delivery) and DHAOG60 and DHACG60 (DHA content of the control and study groups 60 days after delivery).
The participants who remained in the study (n=60) had similar socioeconomic characteristics, and little variation in education level (elementary and high school) and family income (two to four minimum wages). They received nutritional follow-up during the study period and their mean food intake, determined by three dietary recalls,was within the recommendations27. Their food intake did not vary significantly throughout the study period.
The mean fat contents at OGT30 were close to those reported by Rona et al.35 and Aksit et al.36, who studied the fat composition of human milk by creamatocrit. Variation of the total fat content of the milk of the study group OG during the lactating period was similar to those found by other studies36,37, showing that fat content decreases over time, possibly because of a reduction in the maternal fat reserves24. However, the total fat contents were with in the ranges found in the literature for mature milk38.
The same variation was not found in the CG, who presented similar fat contents 30 and 90 days after delivery. Likewise, there was no variation between the two groups on the different occasions, showing that omega-3 supplementation in the proposed dosage did not influence the total fat content of the milk. This result was expected because the supplementation consisted of 1,150mg of fish oil, and the women had similar dietary patterns.
The fatty acid profile of the two groups presented some variations, but the differences were not uniform. The fat profile found for the CG were similar to those found by Silva et al.39, Cunha et al.40 and Patin et al.21, while studying the fat profile of the milk of Brazilian women, including EPA and DHA. Trans fatty acids were also found by Kolelzko et al.17 and by authors of other countries whose results were discussed by Costa & Sabarense24.
Omega-6 (C20:2) fatty acid content of the OG during the entire study period was similar to that found by Silva et al.39 and other studies done on human milk in other countries24, showing that supplementation with 300mg/day of omega-3 did not affect the concentration of omega-6, despite the fact that these fatty acids compete for the same metabolic pathways11,12,24. Short-chain fatty acids (C4:0) were found only in the milk of the control group CG. These fatty acids were not found in human milk by other studies21,39 possibly because a high-carbohydrate diet favors the endogenous synthesis of short- and medium-chain fatty acids, while a diet high in polyunsaturated fatty acids results in a higher concentration of the latter in the milk41.
Human milk is a natural source of Conjugated Linoleic Acid (CLA) but its concentration was higher 30 and 60 days after delivery in the milk of the study group (OG, 0.30% and 0.33% respectively) than in that of the control group. This difference is associated with variation in CLA intake, since humans do not synthesize this fatty acid42.
The docosahexaenoic acid and eicosapentaenoic acid contents of the milk of mothers who received supplementation OG were also different from those of the mothers who did not receive supplementation CG. The DHA and EPA contents of the study group OG were close to those found by Marangoni et al.43, who studied the composition of the milk of Italian women and by Jensen et al.30, who also provided fish oil supplementation to their study sample.
The milk of the group that received fish oil supplementation OG had a significantly higher DHA content 30 and 60 days after delivery than the other group CG. This suggests that higher DHA intake may influence its content in human milk, especially during the first weeks after delivery. This result is in agreement with those of other studies that demonstrated the positive influence of omega-3 supplementation on the milk of mothers taking such supplements1,17,21,28,30. Lauritzen et al.44 also observed an increase in the omega-3 content of human milk after fish oil supplementation.
The quality of the fat in the mother’s diet may not influence the total fat content of the milk, but influences the fatty acid profile of the milk. This has been observed by the present and other studies21,28. The highest DHA requirement occurs during the last trimester of pregnancy and first months of life. Therefore, a high intake of this nutrient by the mother increases its bioavailability to the fetus by placental transport and to the infant by milk2,17,28.
The significant impact of DHA intake on the composition of human milk reinforces the recommendation of frequent seafood intake, as recommended by Gaete & Atalah6, or fish oil supplementation (300mg/day of DHA). Jensen28 argues that 300mg/day of DHA may increase the amount of this fatty acid in human milk. It is noteworthy that Brazilian women do not have the habit of consuming fish twice a week, which would help them to meet their DHA requirement45.
The results of the present study showed that supplementation with fish oil providing 300mg/day of DHA in women with appropriate dietary patterns increased the amount of this fatty acid in their milk but did not change the total fat content of the milk. Ideally,pregnant and lactating women should keep their DHA status always high, supplementing if necessary.
We thank the company Anew Co. for donating the fish oil capsules. We thank the city hall of Ponta Grossa for authorizing the study in their healthcare facility. And most of all, we thank the mothers who voluntarily participated in the study.
EAFQ BORTOLOZO helped to develop the research project and participated in all stages of the study. E SAUER, MS SANTOS and S BAGGIO helped to perform the creamatocrit and chromatographic analyses. G SANTOS JUNIOR planned and performed the statistical analyses. PV FARAGO made the placebo capsules, analyzed the results and helped to write the article. LMB CÂNDIDO helped to plan the study, collect data from the literature, collect milk samples and write the article. LA PILATTI helped to plan the study, analyze the literature data and write the article.
5. Gaete MG, Atalah ES. Niveles de LC-PUFA n-3 en la leche materna después de incentivar el consumo de alimentos marinos. Rev Chil Pediatr. 2003; 74:158-65.
6. Gaete MG, Atalah ES. Efecto de la suplementación de la dieta de la madre durante la lactancia con ácidos grasos omega-3 en la composición de los lípidos de la leche. Rev Chil Pediatr. 2002; 73(3):239-47. doi: 10.4067/S0370-41062002002000300004.
7. Crawford MA. Placental delivery of arachidonic and docosahexaenoic acids: implications for the lipid nutrition of preterm infants. Am J Clin Nutr. 2000; 71(1 Suppl):275s-84s.
8. Araya AJ, Fernándes MP, Rojas GM. Acidos grasos essenciales em eritrocitos de sangre umbilical de recién nacidos prematuros y de término, pequeños o adecuados a la edad gestacional. Rev Chil Pediatr. 1998; 69(1):1-7.
10. Lauritzen L, Hopope C, Straarup EM, Michaelsen K. Maternal fish oil supplementation in lactation and growth during the first 2,5 years of life. Pediatr Res. 2005; 48:235-42.
17. Kolelzko B, Liene E, Agostini C, Campoy C, Celin I, Decsi T, et al. The roles of long-chain polyunsaturated fatty acids in pregnancy, lactation and infancy: review of current knowledge and consensus recommendations. J Perinat Med. 2008; 36(1):5-14.
19. Filder N, Sauerwald T, Pohl A, Demmelmair H, Koletzko B. Docosahexaenoic acid transfer into human milk after dietary supplementation: a randomized clinical trial. J Lipid Res. 2000; 41(9): 1376-83.
23. Scopesi F, Ciangherotti S, Lantieri PB, Risso D, Bertini I, Campone F, et al. Maternal dietary PUFAs intake and human milk content relationships during the first month of lactation. Clin Nutr. 2001; 20(5): 393-97.
25. Moreira EAM, Corso ACT, Correia EM, Dorichil SS. Comparação entre duas metodologias de avaliação de consumo alimentar: recordatório de 24h e questionário de frequência alimentar. Hig Aliment. 2003; 17(110):24-9.
28. Jensen CL. Effects of n-3 fatty acids during pregnancy and lactation. Am J Clin Nutr. 2006; 83(Suppl): 1452-7.
29. Triola MF. Introdução à estatística. 7ª ed. Rio de Janeiro: LTC; 1999.
30. Jensen CL, Maude M, Anderson RE, Heird WC. Effect of docosahexaenoic acid supplementation of lactating women on the fatty acid composition of breast milk and maternal and infant plasma phospholipids. Am J Clin Nutr. 2000; 71(Suppl): 292-9.
32. Association Of Official Analytical Chemists. Official methods of analysis. 17nd ed. Gaithersburg: AOCC; 2000.
33. Sociedade Brasileira de Pediatria. Recomendações úteis para a manutenção do aleitamento materno em mães que trabalham fora do lar ou estudam. Conduta do Profissional de Saúde. Rio de Janeiro: SBP; 2003 . Disponível em: <www.cbpediatria2006.sbp.com.br> .
35. Rona MS, Novak FR, Portilho M, Pelissari FM, Martins ABT, Matioli G. Efeito do tempo e da temperatura de estocagem nas determinações de acidez, cálcio, proteínas e lipídios de leite humano de doadoras de leite humano. Rev Bras Saúde Mater Infant. 2008; 8(3):257-63. doi: S1519-38292008000300004.
42. Rocquelin G, Tapsoba S, Dop MC, Mbemba F, Traissa CP, Martin-Prével Y. Lipid content and essential fatty acid (EFA) composition of mature Congolese breast milk are influenced by mothers’ nutritional status: impact on infants’ EFA supply. Eur J Clin Nutr. 1998; 52(3):162-71.
43. Marangoni F, Agostoni C, Lammardo AM, Giovannini M, Galli C, Riva E. Polyunsaturated fatty acid concentrations in human hindmilk are stable throughout 12-month lactation and provide a sustained intake to the infant during exclusive breastfeeding: an Italian study. Br J Nutr. 2000; 84(1):103-9.
45. Oliveira T, Marquitti FD, Carvalhaes MABL, Sartoreli DS. Desenvolvimento de um Questionário Quantitativo de Frequencia Alimentar (QQFA) para gestantes usuárias de unidades básicas de saúde de Ribeirão Preto, São Paulo, Brasil. Cad Saúde Pública. 2010; 26(11):2296-306.
Received on: 14/7/2011
Final version on: 19/9/2012
Approved on: 2/10/2012
Vitamins and other nutrients during pregnancy
What are prenatal vitamins?
Prenatal vitamins are multivitamins made just for pregnant women. Compared to a regular multivitamin, they have more of some nutrients that you need during pregnancy. Your health care provider may prescribe a prenatal vitamin for you at your first prenatal care checkup. Or you can buy them over the counter without a prescription. Take a prenatal vitamin every day during pregnancy. If you’re planning to get pregnant, you can start taking prenatal vitamins before you get pregnant.
Your body uses vitamins, minerals and other nutrients in food to help it stay strong and healthy. During pregnancy, your growing baby gets all the nutrients she needs from you. So you may need more during pregnancy than you did before. If you’re pregnant with multiples (twins, triplets or more), you may need more nutrients than if you’re pregnant with one baby. Your prenatal vitamin contains the right amount of nutrients you need during pregnancy.
If you’re a vegetarian, you have food allergies or you can’t eat certain foods, your provider may want you to take a supplement to help you get more of certain nutrients. A supplement is a product you take to make up for certain nutrients that you don’t get enough of in foods you eat. For example, your provider may recommend that you take a vitamin supplement to help you get more vitamin D, iron or calcium.
Which nutrients are most important during pregnancy?
All nutrients are important, but these six play a key role in your baby’s growth and development during pregnancy:
- Folic acid
- Vitamin D
What is folic acid?
Folic acid is a B vitamin that every cell in your body needs for healthy growth and development. Taking folic acid before and during early pregnancy can help prevent birth defects of the brain and spine called neural tube defects (also called NTDs). Some studies show that taking folic acid may help prevent heart defects and birth defects in your baby’s mouth called cleft lip and palate.
To help prevent NTDS, take a vitamin supplement with 400 mcg of folic acid in it every day at least 1 month before pregnancy through the first 12 weeks of pregnancy. Take a vitamin supplement with 400 mcg of folic acid each day, even if you’re not trying to get pregnant.
During pregnancy, take a prenatal vitamin each day that has 600 micrograms of folic acid in it. Folic acid only works to prevent NTDs before and during the first few weeks of pregnancy. Later in pregnancy, you need 600 mcg of folic acid each day to help your baby grow and develop.
If you’re at high risk for having a baby with an NTD, take 4,000 mcg of folic acid each day to help prevent an NTD. Start taking 4,000 mcg 3 months before you get pregnant through 12 weeks of pregnancy. Ask your provider how to safely get this much folic acid. It’s not safe to take several multivitamins or prenatal vitamins because you can get too much of other nutrients, which may be harmful to your health. Your provider can help you figure out the best and safest way for you to get the right amount of folic acid. You’re at high risk for NTDs if:
- You’ve had a pregnancy with an NTD in the past.
- You or your partner has an NTD.
- Your partner has a child with an NTD.
You also can get folic acid from food. Some foods have folic acid added to them. Look for “fortified” or “enriched” on the package and check the “supplement facts” label to see how much folic acid you get in each serving. Foods that are fortified with folic acid include:
- Breakfast cereal
- Products made from a kind of flour called corn masa, like tortillas, tortilla chips, taco shells, tamales and pupusas
- White rice
You also can get folic acid from some fruits and vegetables. When folic acid is naturally in a food, it’s called folate. Good sources of folate include:
- Leafy green vegetables, like spinach and broccoli
- Lentils and beans
- Orange juice
What is iron?
Iron is a mineral. Your body uses iron to make hemoglobin, a protein that helps carry oxygen from your lungs to the rest of your body. You need twice as much iron during pregnancy than you did before pregnancy. When you’re pregnant, your body needs this iron to make more blood so it can carry oxygen to your baby. Your baby needs iron to make his own blood.
During pregnancy you need 27 milligrams of iron each day. Most prenatal vitamins have this amount. You also can get iron from food. Good sources of iron include:
- Lean meat, poultry and seafood
- Cereal, bread and pasta that has iron added to it (check the package label)
- Leafy green vegetables
- Beans, nuts, raisins and dried fruit
There are two kinds of iron. You get heme iron from meat, poultry and fish. You get non-heme iron from plant-based foods, like beans, fruits, vegetables and nuts, or foods made from plants, like cereal. Your body absorbs more non-heme iron when you eat fruits and veggies together with meat, poultry and fish or with food that is high in vitamin C. Foods with a lot of vitamin C include grapefruit, mango, papaya, cantaloupe, tomatoes, cabbage, spinach and broccoli.
If you don’t get enough iron during pregnancy, you may be more likely to:
- Get infections
- Have anemia. This means you have too little iron in your blood.
- Be fatigued. This means you feel really tired or exhausted.
- Have a premature baby. This means your baby is born too soon, before 37 weeks of pregnancy.
- Have a low-birthweight baby. This means your baby is born weighing less than 5 pounds, 8 ounces.
What is calcium?
Calcium is a mineral that helps your baby’s bones, teeth, heart, muscles and nerves develop. During pregnancy, you need 1,000 milligrams of calcium each day. You can get this amount by taking your prenatal vitamin and eating food that has a lot of calcium in it. Good sources of calcium include:
- Milk, cheese and yogurt
- Broccoli and kale
- Orange juice that has calcium added to it (check the package label)
If you don’t get enough calcium during pregnancy, your body takes it from your bones and gives it to your baby. This can cause health conditions, like osteoporosis, later in life. In this condition, your bones become thin and break easily.
What is vitamin D?
Vitamin D helps your body absorb calcium. It also helps your body’s nerves, muscles and immune system work. Your immune system protects your body from infection. Your baby needs vitamin D to help his bones and teeth grow.
During pregnancy, you need 600 IU (international units) of vitamin D each day. You can get this amount from food or your prenatal vitamin. Good sources of vitamin D include:
- Fatty fish, like salmon
- Milk and cereal that has vitamin D added to it (check the package label)
Your body also makes vitamin D when your skin comes in contact with sunlight. But too much sun can lead to skin aging and cancer, so it’s a good idea to get your vitamin D from food or your prenatal vitamin.
DHA stands for docosahexaenoic acid. It’s a kind of fat (called omega-3 fatty acid) that helps with growth and development. During pregnancy, you need 200 milligrams of DHA each day to help your baby’s brain and eyes develop. Not all prenatal vitamins contain DHA, so ask your provider if you need to take a DHA supplement. You also can eat foods that have DHA in them. Good sources of DHA include:
- Fish that are low in mercury, like herring, salmon, trout, anchovies and halibut. During pregnancy, eat 8 to 12 ounces of these kinds of fish each week.
- Orange juice, milk and eggs that have DHA added to them (check the package label)
What is iodine?
Iodine is a mineral your body needs to make thyroid hormones. The thyroid is a gland in your neck that makes hormones that help your body use and store energy from food. You need iodine during pregnancy to help your baby’s brain and nervous system develop. The nervous system (brain, spinal cord and nerves) helps your baby move, think and feel.
During pregnancy, you need 220 micrograms of iodine every day. Not all prenatal vitamins contain iodine, so make sure you eat foods that have iodine in them. Ask your provider if you need to take an iodine supplement.
Good sources of iodine include:
- Milk, cheese and yogurt
- Enriched or fortified cereal and bread (check the package label)
- Iodized salt (salt with iodine added to it; check the package label)
Last reviewed: February, 2018
Pregnant Women Need DHA — But Diet Beats Supplements
It’s been known for a while that docosahexaenoic acid (DHA) plays a valuable role in children’s brain development and is therefore important for women to consume during pregnancy. That’s one reason the American College of Obstetricians and Gynecologists recommends including limited amounts of fish in pregnant women’s diets since fish are a major source of this DHA.
DHA is an omega-3 fatty acid that’s important for a developing fetus’s eyes, nervous system and overall cognitive development, but the body doesn’t naturally produce this fat. What’s been less clear from the evidence is whether taking supplements of DHA during pregnancy makes any difference in the children’s brain development. A new follow-up study suggests—as the two previous ones from these researchers did—that DHA supplements don’t do much at all.
Researchers led by Jacqueline Gould, Ph.D., of the South Australian Health and Medical Research Institute in Adelaide, Australia, had previously compared the children of 800 women who either received a DHA supplement or a placebo daily during the second half of their pregnancies. At 18 months old, the children did not show any differences in brain development, language or motor skills development. A secondary analysis of that data found slightly less cognitive delay among the children whose mothers received DHA supplements—but those same children had slightly lower language skills.
When the children were 4 years old, they underwent assessment again. And again, the researchers didn’t find any differences in the children’s overall intelligence, language skills or executive functioning. Executive functioning refers to the higher-level thinking that helps people go about their daily lives, such as self control, planning, focus, working memory, multitasking and prioritizing. The children whose mothers supplemented with DHA received slightly lower ratings from their parents on behavior and executive functioning, but no differences on the objective testing showed up.
This time, the researchers tested the children’s IQ at age 7, the earliest age at which a child’s IQ might potentially predict future intelligence as an adult. The psychologists who conducted the testing between June 2013 and September 2015 did not know which children had been exposed to DHA or the placebo. They were able to test 543 children from the original group.
In addition to IQ, the psychologists tested the children on language, academic abilities and the main aspects of executive functioning: memory, self control and mental flexibility (which allows moving from one task to another). The parents also answered questionnaires about their children’s behavior, thinking skills, any developmental diagnoses and intake of DHA.
Once again, the researchers found no major differences in IQ. The children exposed to DHA had an average IQ of 98.3, and the children of mothers who received a placebo had an average IQ of 97.3. An average IQ is considered 100, and the difference of one point between the groups was small enough that it was likely from chance. Neither of the groups had any more diagnoses of neurological or developmental conditions, either.
A variety of foods contain DHA omega-3 fatty acids, but supplements may not offer the same benefits… as getting the nutrient naturally through diet. ()
The children across both groups also had similar results from the assessment of their language, academic skills and executive functioning in all areas except higher perceptual reasoning, which was slightly higher among the children whose mothers took DHA in pregnancy. Perceptual reasoning is an important foundational skill in math because it involves recognizing, understanding and organizing non-verbal information and drawing conclusions based on reasoning.
Similar to the findings when the children were 4 years old, the parents of children exposed to DHA reported somewhat greater behavior problems, though the difference wasn’t much. The behavior difficulties score for children exposed to DHA was 9.7, compared to 8.6 for the children of mothers who took placebo (higher score indicates more problem behaviors). The parents of children exposed to DHA also reported more difficulties in the children’s executive functioning. Similarly, though, the difference was modest: 54.9 for the DHA group and 52.5 for the control group (higher score indicates more dysfunction).
However, all these secondary findings could simply result from “chance due to the high number of comparisons made,” the authors explain. The more things that researchers compare between two groups, the more likely it is that they will find results that seem to be statistically accurate but may actually still result from chance.
The bottom line? “This randomized clinical trial provides strong evidence for the lack of benefit of prenatal DHA supplementation on IQ at 7 years and cognition at 18 months and 4 years, despite higher numbers of preterm children in the control group,” the authors conclude. “Direct assessments consistently demonstrated no significant differences in language, academic abilities or executive functioning.”
So if DHA is supposedly so good for brain development, why wouldn’t mothers taking these supplements see a difference? There are a couple of possibilities. First, it’s possible that most of the women in both groups were getting enough DHA from their diet that additional supplements didn’t make a difference. The best known source of DHA is from fish, but it’s also present in walnuts and walnut oil as well as eggs and milk that have had DHA added.
When choosing fish, pregnant women generally want to balance the benefits of DHA with the risks of mercury. High levels of mercury can have a negative effect on babies’ brain development, and mercury levels increase as fish move up the food chain. Sharks, for example, have high levels of mercury whereas herring, sardines and anchovies have low amounts.
Salmon is a popular fish for both low mercury levels and high DHA levels. Some tuna, such as albacore “white” tuna, have higher levels of mercury, but canned light tuna has lower levels. The partly federally funded Sea Grant provides this handy chart of the fish highest in DHA as well as a fact sheet on mercury in fish, and in our book The Informed Parent, Emily Willingham and I provide more detailed information on balancing mercury content with benefits from fish during pregnancy.
Another possibility is that the body doesn’t absorb and use the DHA from supplements as well as it does from nutritional sources. The ability of the body to extract nutrients and then use them metabolically—called bioavailability—can vary when the nutrients come from a healthy and balanced diet versus popping supplements. In some cases, the body does better getting nutrients from supplements. Other times, natural sources are best.
Of course, this study is not the final word on DHA supplementation during pregnancy. Other studies have found modest benefits, though most of the groups tended to be smaller than those in this study. Even if there are benefits, researchers have not yet been able to nail down what the right amount of additional DHA is that women should consume.
Some of the studies have also been observational, which provide lower-quality evidence than randomized controlled studies like this one. In an observational study, researchers simply compare women who are already taking DHA or not, but other factors might influence the results. In a randomized controlled study, the researchers randomly divide women who have similar characteristics, which should reduce the likelihood that other factors affect the results.
As researchers conduct more studies on DHA consumption during pregnancy, both from diet and from supplements, they will be able to fill in more and more pieces of the puzzle in figuring out what works best for most women. After all, the process of sifting through sometimes contradictory studies over time is how science works.
5 Key Benefits of DHA During Pregnancy
The health benefits of omega-3 fatty acids are widely known. DHA (docosahexaenoic acid) is one type of omega-3 fatty acid that is especially important during pregnancy. During your last trimester, your baby’s brain takes up a large amount of this vital omega-3 fatty acid. In this article, we share the five key benefits of DHA during pregnancy. Then, we reveal how you can make sure you get enough of this critical prenatal nutrient.
Health Benefits For Baby
Supplementing your diet with DHA during pregnancy supports a healthy full-term pregnancy and promotes healthy brain and eye development in your baby.
1. DHA supports full-term pregnancy.
According to the Centers for Disease Control and Prevention, 12% of babies born in the U.S. are born 22 to 36 weeks early. Babies born early may require costly lifesaving treatment and prolonged hospitalizations. DHA intake during pregnancy can help to support a healthy full-term birth.
2. DHA is utilized rapidly by the baby’s brain and retina during pregnancy.
Omega-3 fatty acids, including EPA and DHA, are building blocks of the baby’s brain and retina. According to Elizabeth Ward, MS, RD, an expert on nutrition during pregnancy and the author of Expect the Best, your baby’s brain and eyes utilize DHA during the second trimester of pregnancy and continuing until age two.
Since accumulation of DHA continues until age two, DHA intake is essential during breastfeeding and formula feeding. Nearly every brand of baby formula contains DHA, although the levels vary.
3. Taking DHA during pregnancy may support a healthy body weight and improve attention span in children.
Childhood obesity is on the rise. Although many factors play a role, studies have shown that DHA intake during pregnancy may support a healthy body weight in offspring. Other studies have also found that DHA during pregnancy may support healthy attention spans in preschool children.
A small study of infants living in urban, low-income environments showed better one-minute Apgar scores, higher birth weight, and better infant response to prenatal stress when moms had adequate DHA.
Health Benefits For Mom
Interestingly, consuming DHA during pregnancy is not just beneficial for your baby. Take DHA during pregnancy may have some impact on maternal health, as well.
5. Seafood intake during pregnancy may promote mother’s overall well-being.
Eating seafood during pregnancy may have a benefit for mom’s mental well-being since observational data show a connection between low intake of DHA and EPA from seafood and a higher risk of sadness.
Try this tasty slow-cooker salmon recipe to help you fit DHA-rich salmon into your regular meal rotation.
How to Get Enough DHA During Pregnancy
Because DHA is so vital for the health of both mom and baby, it is critical that you consume enough DHA during pregnancy. You can either consume DHA through your diet or take high-quality prenatal vitamins with DHA.
Choose fatty fish or prenatal vitamins with DHA.
To get the DHA you need through your diet, be sure to eat 8-12 ounces of fatty fish each week. Good food sources of DHA include salmon, herring, sardines, tuna, trout, and mackerel.
If you are not eating 8-12 ounces of fatty fish each week, choose a prenatal supplement with DHA and take it during the second and third trimester of pregnancy.
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The Importance of DHA for Babies
Maybe you’ve heard about DHA for babies, maybe you haven’t. We’ll break down what you need to know about DHA benefits for babies, its importance during your baby’s first few years, and how they can get it.
What is DHA for Babies?
DHA, or docosahexaenoic acid, is an omega-3 fatty acid. It’s a building block for your baby’s brain and eyes. While many people take supplements, DHA occurs naturally in foods such as salmon, sardines, and eggs.
Why is DHA Important for Babies?
During the first two years of life, your baby’s brain develops faster than it ever will. In fact, the brain grows 175% in the first year. That’s why many experts believe it’s important for babies to receive DHA during this time of rapid brain development.
Babies get DHA in the womb. After birth, breastfed babies get DHA from their mother’s breast milk. Many scientists believe that DHA is most important during the last trimester of your pregnancy through your child’s second year. This is when their brain and eyes rapidly develop.
How to Include DHA in Your Baby’s Diet
According to experts, pregnant and nursing women should eat foods rich in DHA. These include salmon, mackerel, sardines, and tuna. If you’re not breastfeeding, an infant formula that has DHA is recommended. Experts recommend that DHA should account for 0.2% to 0.36% of total fatty acids in the formula. For example, Enfamil NeuroPro™ has 0.32% of total fatty acids as DHA, similar to the average amount found in world-wide mature breast milk.
Once an infant outgrows infant formula, DHA continues to be important during the first years of life. Toddlers only get about 25% of the expert-recommended amount of DHA*. Enfagrow PREMIUM™ Toddler Transitions® or Enfagrow PREMIUM™ Toddler Nutritional Drink can help fill the gap in your toddler’s daily diet.
For more information, read more on DHA benefits for your growing toddler and the common foods you’ll find it in.
*experts recommend 70–100 mg of DHA per day for toddlers
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Horizons Developmental Resource Center
3120 68th Street SE
Caledonia, MI 49316
This document was last updated on May 30, 2016
When my daughter turned one and started drinking cow’s milk, I started to see DHA all over the place. Especially at Whole Foods. Milk with DHA. Eggs with DHA. Food packets with DHA. This really started to get to me – I had no idea what DHA was, but the people designing these packages sure made it look important.
Spoiler: DHA is a fatty acid found in fatty fish and breast milk. Learning this was a good start, but added to my anxiety about this topic: most experts recommend kids eat fish 2-3 times per week! and caution that the typical Western Diet does not contain enough DHA. But, experts also recommend that kids avoid fish high in mercury, which is poisonous in large amounts. AND, even in fatty fish, DHA levels can vary dramatically depending on whether fish were wild-caught or farm-raised and the species of fish. On top of all this were warnings that insufficient DHA in kids has been linked to ADHD, problems with vision, depression, and developmental delays.
Ah! So DHA is a critical nutrient that can only be obtained from very select (and expensive mind you) sources, and the wrong sources might poison my kid, cooking fish 2-3 times per week is logistically challenging, and my kid might not like eating the food that is the best source of DHA? Enough to freak me out.
Getting enough DHA from naturally occurring sources is challenging, to say the least. Suddenly all these foods with supplemental DHA were looking like mighty attractive purchases – the logic being … well, my daughter likes to drink milk. In fact, she drinks it every day. My daughter needs DHA. I get her a regular source of DHA by buying this milk fortified with DHA! But then there’s the whole anti-supplement argument, which goes something like: human beings should get their nutrients from whole foods (not to be confused with Whole Foods), not supplements, which are ‘unnatural’.
So, this post comes from the research and thinking I did to answer the question: should I give (should you give) my daughter (your kid) milk, eggs, or other foods fortified with DHA?
Note: one of the first places I started was our pediatrician’s office. I asked two different folks there – a doctor and a nurse practitioner. The answers? The doctor said, “I wish I had a good answer for you on that one.” The nurse practitioner said, “Eh, probably won’t hurt.”
What is DHA?
Let’s start with a definition. DHA (its full name is Docosahexaenoic acid) is an omega-3 fatty acid. DHA is the main structural component for several very important body parts: the brain, retinas, testicles and skin and is important to the early development of the brain, eyes and nervous system. The body naturally produces some DHA (especially by converting other fatty acids such as ALA), but this process must be supplemented with DHA we get from our diet because the turnover of DHA in the body is fast.
Natural Sources of DHA
Naturally-occurring DHA in the diet comes from three sources:
- human breastmilk
- fish oil
- Animal products made from animals who ate grass, though in much lower, and inconsistent, amounts
DHA in breastmilk is great news for babies who are breastfed: they’ll get all the DHA they need this way. (Some sources suggest that moms who are pregnant and breastfeeding should take a DHA supplement in addition to a prenatal vitamin, and experts seem to agree formula-fed infants should receive a formula with supplemental DHA.) The second source means eating cold-water oceanic fish (salmon, tuna, sardines, mackerel, herring, and many others). Let’s ignore the third source for now as it is so inconsistent and has low levels of DHA.
Does breast milk have DHA?
Yes. Human breast milk does contain DHA and other fatty acids that may be synthesized into DHA by babies. According to some studies, the concentration of DHA in breast milk does appear to be correlated with a mother’s diet – mothers who eat more seafood may have higher DHA levels.
There are two ways to procure DHA for supplements (or for the fortification of foods).
- Extract oil from cold water fatty fish, which will contain DHA and EPA, another important fatty acid.
- Extract DHA from seaweed or algae, which creates a vegetarian form of DHA, but no EPA (another Omega 3 fatty acid.
There are several important concerns with supplemental sources of DHA.
- The purity of the source: if fish oil is extracted from a fish with high levels of mercury, the oil will also contain mercury.
- Many supplements have other things added to them, and supplement manufacturers are not held to the high standards that a drug company is, so quality can vary widely.
- Some experts do not recommend DHA supplements that also contain EPA for infants and small children as they may upset the DHA/EPA balance during a child’s early development.
Let’s dive deeper into these three concerns.
The purity of the source: if fish oil is extracted from a fish with high levels of mercury, the oil will also contain mercury. In addition, many supplements have other things added to them, and supplement manufacturers are not held to the high standards that a drug company is, so quality can vary widely.
Some experts do not recommend DHA supplements that also contain EPA for infants and small children as they may upset the DHA/EPA balance during a child’s early development. Keep reading for more on this balance, and potentially upsetting it through ‘unnatural’ means.
As discussed in our superfoods for kids post, nutrition is a complex subject, and the full role of dietary DHA from natural or supplemental sources is not yet understood. The American Academy of Pediatrics has yet to take an official stance on supplemental DHA. Sources widely accepted as credible (the American Academy of Pediatrics, World Health Organization, etc.) agree wholeheartedly on the importance of DHA from naturally occurring sources, and seem to agree evidence points in the right direction to support supplemental DHA procured through infant formula. On the topic of supplemental DHA past formula age, these sources are more cautious. The NIH rates supplemental DHA as “possibly effective for” improving asthma symptoms, attention, mental function and behavior in kids with ADHD
So, what to do?
After much research, agonizing, and discussion, here’s where I landed:
1) There simply isn’t enough research out there to draw a definitive conclusion. That said, based on all the research I read there are a couple of steps I’m taking:
2) I’m not going to overdo it. If I wanted to I could buy milk, eggs, yogurt, baby food packets and much more all with supplemental DHA. I’m sticking to just milk with supplemental DHA (we buy Horizon Organic), and not obsessing over every single carton containing DHA (Whole Foods carries milk with DHA, Trader Joes does not, we shop at both).
3) I’m sticking with vegetarian sources of supplemental DHA. The University of Maryland article was the most prescriptive source I found on vegetarian vs. fish oil supplements for infants and small kids and recommended vegetarian sources.
4) Given the fact that supplemental DHA is far from a perfect solution, the argument that DHA from whole food (cold-water fatty fish) sources is hard to get, inconvenient, expensive, etc. so I’ll just use supplemental sources for my daughter is holding much less weight with me and has led to some creative ways to get more DHA from whole food sources: cooking and freezing, finding organic baby food packets with salmon, serving cold smoked salmon that requires no cooking and can be refrigerated for at least a few days (I’m getting my DHA this way too). I’ll be doing a post on how to get more fish in your child’s life down the road.
Hopefully, this has been helpful! Please let me know – paulfathercraft.com, along with your thoughts and ideas. For more healthy eating for kids, check out our guide to superfoods for babies and kids.
Sources and Further Reading
The American Heart Association on Fish Recommendations and Precautions
National Academy of Sciences on DHA
The National Institutes of Health on DHA for pregnant or breastfeeding
The National Institutes of Health on Supplemental DHA
University of Maryland Medical Center on Supplemental DHA
The Health Benefits of DHA According to the NIH
Harvard Nutrition Professor Frank Sacks on Omega-3s in the Diet
Natural Sources of DHA According to World’s Healthiest Foods
If you’re pregnant, or trying to get pregnant, you may have heard of DHA. But what is DHA?
DHA is an acronym for the nutrient docosahexaenoic acid, an Omega-3 fatty acid. (No wonder they abbreviate it.) Today, with people often eating on the go, our diets are typically deficient in Omega-3. Supplementing then becomes important because our bodies can’t make Omega-3 on their own.
So, why is DHA important?
For starters, Omega-3 fatty acids are necessary for human health, but the body can’t make them, so you have to get them through food or supplementation. In general, DHA is found in high amounts in the tissues of the brain and eye. A large amount of DHA is accumulated during the last in utero trimester and first year of life. DHA helps support general health and wellbeing before and after pregnancy.*
How much DHA is enough?
Salmon, herring, and anchovies are sources of Omega-3 fatty acid, specifically DHA. Tuna is as well, but pregnant women are typically advised to limit or avoid eating tuna, along with certain other fish, because of high mercury levels.
The American Congress of Obstetricians and Gynecologists recommends that women should eat at least two servings of fish or shellfish containing Omega-3 fatty acids (about 8–12 ounces) per week and while pregnant or breastfeeding.
Fortunately, if fish dinners aren’t regularly on your menu, there are plenty of Omega-3 fatty acid supplements available. To help supplement your diet, one serving of First Response™ Reproductive Health Multivitamin Gummies and First Response PreNatal and PostNatal Multivitamin Gummies provides 50 mg of DHA in an easy to take gummy form.
Just make sure you check with your doctor before starting a supplement regimen. It also wouldn’t hurt to ask your doctor which types of fish are safer for you to eat during pregnancy.