Danger of spontaneous pre-term births can be reduced by implementing omega-3 supplementation early on in pregnancy - summary of presentation given at the 2019 NutraIngredients Omega-3 Summit
Dr Femke Hannes, DSM Nutritional Products APAC's regional lead for Nutrition, Science and Advocacy, was addressing the topic at the recent NutraIngredients Omega-3 Summit, held in Singapore.
She said: "If a baby is born too early, its chances of success are already lower. Statistics tell us there are a huge number of pre-term births around the world, and there is no preventive strategy in place to help lower these numbers.
"The numbers are staggering: 15 million babies are born prematurely every year, and over one million children die each year due to complications of premature birth.
"However, I'm confident we can prevent spontaneous pre-term births just by implementing omega-3 supplementation early on in pregnancy."
She went on to explain the importance of adequate nutrition in the first thousand days of life, characterised as the period starting from conception until the second year after birth.
Hannes said: "That particular window of time is very important — nutrition during that period is known to play a key role in not just short-term but also long-term health outcomes. Proper nutrition is key during this window, as it is associated with as much as a 10% higher IQ."
She added that within these 1,000 days, there was a high metabolic demand in both mother and child for omega-3 fatty acids, which would 'safeguard' proper growth and development, especially of the baby's brain.
DHA (docosahexaenoic acid) in particular is considered the key omega-3 component needed to support such development, and is transferred to the foetus through the placenta.
The foetus receives DHA from maternal circulation, which comes directly from maternal DHA intake and stores — the adipose or fat tissues — as well as endogenous conversion from ALA (alpha linoleic acid, which is only available through dietary intake) to DHA.
"Our bodies are able to synthesise DHA and EPA (eicosapentaenoic acid) themselves: starting from a precursor called ALA and going through a series of enzymatic steps whereby the elongation and desaturation of molecules occur, the body ends up with components like EPA and DHA, the functional nutrients for brain development and growth during pregnancy," said Hannes.
"However, we know this conversion is very inefficient and low, especially in adults. That's why there is a need for adequate preformed DHA intake. What our bodies can make is not enough, and we need DHA in our dietary intake, through food and supplements."
During pregnancy, a combination of dietary intake (two weekly portions of fatty fish, such as salmon, tuna, mackerel and shellfish, as well as DHA-enriched eggs) and supplementation (fish oils, algal oil and krill oil) is recommended.
Hannes said high DHA intake had benefits for both mothers and infants, with the most frequently reported one being high maternal blood and breastmilk DHA levels.
Other benefits include better immune responses to allergic inflammation, as well as anti-infectious protection and lowered infectious disease risk in offspring.
"This is very important for the cognitive and visual outcomes of infants, and these benefits have been shown to last until 11 years of age."
Hannes further said: "High maternal DHA intake also helps to reduce the risk of early preterm births. The length of most pregnancies is between 38 and 42 weeks, and premature birth is defined by the WHO as any birth before 37 completed weeks of gestation, and early preterm birth as any birth before 34 completed weeks of gestation.
"The goal is to bring babies to full-term as this is the optimal window for the best possible health outcomes, since decreasing gestational age is associated with increasing mortality, disability, and a greater requirement for intensive neonatal care if survival is to be assured, which means higher associated costs."
In terms of the number of preterm births, Asia outnumbers all other continents, with 52.9% of the world’s preterm births occurring in the region, thanks to especially high numbers in India and China.
Hannes presented the results of several studies, including the DOMInO trial by the South Australian Health and Medical Research Institute (SAHMRI), which involved 2,399 healthy pregnant women between 26 and 36 years of age.
Between 18 and 21 weeks gestation until birth, the women were each given a daily dose of either 800mg of DHA and 100mg of EPA, or a placebo consisting of rape seed, sunflower and palm oil (designed to match the polyunsaturated, monounsaturated and saturated fatty acid profile of the average Australian diet).
The researchers subsequently reported a 50% reduction in the incidence of early preterm births in the intervention group compared to the placebo group.
Hannes also mentioned a recent Cochrane review of 70 RCTs involving 19,927 women that examined the effect of nutritional interventions with long-chain omega-3 fatty acids during pregnancy on maternal and infant health outcomes.
The review found that such supplementation lowered preterm birth risk by 11% and early preterm birth risk by 42%.
Calling Cochrane reviews the "internationally recognised gold standard" for the analysis of scientific evidence, she said, "The latest Cochrane review looked at 70 RCTs, involving 19,927 women in high-income countries such as the US, UK, Netherlands, Australia and Denmark, and highlights the positive effects of nutrition on prematurity risk."
Hanned also referred to a newly launched prenatal DHA test kit developed by DSM's industry partner, OmegaQuant. The kit consists of an alcohol wipe, lancet, gauze pad, bandage, blood collection card and return envelope. After registering online at OmegaQuant's website, a finger-prick blood spot is to be collected and sent to the company for testing; the results are then sent back to the customer.
The test kit provides a level of personalisation that allows pregnant women to be aware of exactly what their DHA levels are and how much they need to ensure healthy foetal development.
Hannes said: "200mg to 300mg of DHA from diet and supplements daily is currently recommended for all pregnant women, but only up to 9% report taking DHA supplements, and the average DHA intake from food is up to 60mg a day.
"Beginning a daily dietary supplement with a combination of DHA and EPA in the second trimester of pregnancy could reduce nearly half of early preterm births and significantly reduce preterm births."
She also referenced the Cochrane review once more, saying, "As a result of these findings, the authors recommend the use of a supplement with long-chain omega-3 fatty acids that contain at least 500mg of DHA, with supplementation beginning from 12 weeks of pregnancy."