3/27/2017 WHO|Marineoilsupplementationtoimprovepregnancyoutcomes

eLibraryofEvidenceforNutritionActions(eLENA)
Marineoilsupplementationtoimprove
pregnancyoutcomes
Biological,behaviouralandcontextualrationale
WHOtechnicalstaff
April2011

Omega3fattyacidsarelongchainpolyunsaturatedessentialfattyacids
thatarenecessaryforgoodhealthanddevelopment.Unlikeomega3
fattyacidsfromplantsourcessuchasflaxseedandcanolaoils,fishoils
andalgaederivedmarineoilscontainthelongerchaindocosahexaenoic
(DHA)andeicosapentaenoic(EPA)acids.Thesearecalledessential
fattyacidsbecausethebodycannotproducethemindependently,so
theymustbeconsumedinadequateamounts.

Theprenatalperiodisatimeofincreasedriskforomega3deficiencyas
maternaltissuestorestendtodecline(1)astheyareusedforthe
developingfetus(2,3).Marineoilsupplementsareoftenrecommended
topregnantwomentofulfiltheiromega3requirements.

Theuseofmarineoilsupplementsduringpregnancyhasbeenstudied
asapossiblestrategytopreventpretermbirth(orincreasegestational
age)andpreventeclampsia,aswellastoincreasebirthweightalong
withotherpotentialbenefitssuchasimprovingfetalbraindevelopment,
andreducingtheriskofcerebralpalsyandpostpartumdepression(47).
Thetheoriesbehindthestudiesonbirthoutcomeswereoriginally
developedbasedontheobservationsofhighbirthweightandlong
gestationincommunitieswithhighfishconsumption(810).

ThefattyacidsDHAandEPAthatarecontainedinmarineoilsarethe
precursorsofprostaglandins,whichhavebeenshowntoinfluencethe
constrictionofbloodvessels.Amongpregnantwomenandnonpregnant
adults,marineoilshavebeenpromotedasatreatmentforhypertension,
orhighbloodpressure(11).Thesesamecomponentsofmarineoilmay
alsodelaylabourandthuspotentiallyincreasethelengthofpregnancy
andincreasebirthweightbypreventingtheproductionofprostaglandins
thatencouragethecervixtoripen(12).

Studiesthathaveinvestigatedthesemechanismsandtheirpotential
healthbenefitsformothersandchildrenhave,however,been
inconsistentintheirresults(4,5,10,13,14).Themostencouraging
conclusionsfromarecentsystematicreviewsuggestthatalthough
thereisnotyetenoughevidencetosupporttheroutinesupplementation
withmarineoilduringpregnancytoreducetheriskofpreeclampsia,
pretermbirthorlowbirthweight,pregnantwomencouldbenefitfrom
marineoilsupplementationasameanstoincreasethelengthof
gestation(12).

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3/27/2017 WHO|Marineoilsupplementationtoimprovepregnancyoutcomes

Nutritionaladviceforpregnantwomenregardingmarineoilconsumption
maybecomplicatedwithwarningsthatsuggestlimitingoverallfish
consumption.Fishareanimportantsourceofomega3fattyacids,
howevermanytypesoffishmaybepotentiallycontaminatedwith
methylmercuryorpolychlorinatedbiphenyls(PCBs),whichcanbe
harmfultofetaldevelopment(15,16).Thesepotentiallyharmful
contaminantscanaccumulatemoreinfishmeatthaninfishoil.
However,theremaystillbesafetyconcernsifunrefinedfishoil
preparationsareconsumed,astheymaycontainpesticidesandPCB
residues(17).

DosagesofDHAandEPAfrommarineoilsalsovaryintermsofthe
amountrequiredtoachieveanypotentialbenefitforthemotherand
child.Dosagesinresearchtrialsrangefrom133milligramsto3grams
perday,withmostwomenreceivingadoseofapproximately2.7grams
ofbothEPAandDHAperday(12).Translatingthisamountintofood
sourceswouldrequireapregnantwomantoeat300gramsofcooked
salmon,whichwouldnotnecessarilycorrespondtopossiblefish
consumptionrestrictionsbecauseofcontaminantsforwomenduring
pregnancy.Fishoilsupplementsdonotappear,however,tocauseany
serioussideeffectssuchasbleedingcomplicationsordiscomfortthat
wouldinfluencecomplianceissuesotherthantheratherminorcomplaint
ofunpleasanttaste(12,18,19).

References
1.MakridesM,GibsonR.S.Longchainpolyunsaturatedfattyacid
requirementsduringpregnancyandlactation.AmericanJournalof
ClinicalNutrition.200071:307S311S.

2.AlM,vanHouwelingenAC,KesterAD,HasaartTH,deJongAE,
HornstraG.Maternalessentialfattyacidpatternsduringnormal
pregnancyandtheirrelationshiptotheneonatalessentialfattyacid
status.BritishJournalofNutrition.199574:5568.

3.OttoSJ,HouwelingenAC,AntalM,ManninenA,GodfreyK,Lpez
JaramilloP,HornstraG.Maternalandneonatalfattyacidstatusin
phospholipids:aninternationalcomparativestudy.EuropeanJournalof
ClinicalNutrition.199751:232242.

4.OlafsdottirAS,MagnusardottirAR,ThorgeirsdottirH,HaukssonA,
SkuladottirGV,SteingrimsdottirL.Relationshipbetweendietaryintake
ofcodliveroilinearlypregnancyandbirthweight.BritishJournalof
ObstetricsandGynaecology.2005112:424429.

5.RamakrishnanU,SteinAD,ParraCabreraS,WangM,ImhoffKunsch
B,JurezMrquezS,etal.Effectsofdocosahexaenoicacid
supplementationduringpregnancyongestationalageandsizeatbirth:
randomized,doubleblind,placebocontrolledtrialinMexico.Foodand
NutritionBulletin.201031:S108S116.

6.PetridouE,KoussouriM,ToupadakiN,YouroukosS,Papavassiliou
A,PantelakisS,etal.Dietduringpregnancyandtheriskofcerebral
palsy.BritishJournalofNutrition.199879:407412.

7.BorjaHartNL,MarinoJ.Roleofomega3fattyacidsforpreventionor
treatmentofperinataldepression.Pharmacotherapy.201030:210216.

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8.OlsenSF,JoensenHD.HighlivebornbirthweightsintheFaroes:a
comparisonbetweenbirthweightsintheFaroesandinDenmark.
JournalofEpidemiologyandCommunityHealth.198539:2732.

9.OlsenSF,HansenHS.Marinefat,birthweight,andgestationalage:a
casereport.AgentsActions.198722:373374.

10.OlsenSF,SrensenJD,SecherNJ,HedegaardM,HenriksenTB,
HansenHS,GrantA.Randomizedcontrolledtrialofeffectoffishoil
supplementationonpregnancyduration.TheLancet.1992339:1003
1007.

11.MorrisMC,SacksF,RosnerB.Doesfishoillowerbloodpressure?
Ametaanalysisofcontrolledtrials.Circulation.199388:523533.

12.MakridesM,DuleyL,OlsenSF.Marineoil,andotherprostaglandin
precursor,supplementationforpregnancyuncomplicatedbypre
eclampsiaorintrauterinegrowthrestriction.CochraneDatabaseof
SystematicReviews.2006Issue3,Art.No.:CD003402.

13.HarperM,ThomE,KlebanoffMA,ThorpJ,SorokinY.,Varner,
MW,etal.Omega3fattyacidsupplementationtopreventrecurrent
pretermbirth.ObstetricsandGynecology.2010115:234242.

14.WilliamsM,ZingheimRW,KingIB,ZebelmanAM.Omega3fatty
acidsinmaternalerythrocytesandriskofpreeclampsia.Epidemiology.
19956:232237.

15.Nutritioninpregnancy:ScientificAdvisoryCommitteeOpinionPaper
18.London,RoyalCollegeofObstetriciansandGynaecologists.2010.

16.BuckGM,TeeGP,FitzgeraldEF,VenaJE,WeinerJM,SwansonM,
MsallME.Maternalfishconsumptionandinfantbirthsizeandgestation:
NewYorkStateanglercohortstudy.EnvironmentalHealth.20032:7
16.

17.RawnDFK,BreakellK,VeriginV,NicolidakisH,SitD,FeeleyM.
PersistentorganicpollutantsinfishoilsupplementsontheCanadian
market:polychorinatedbiphenylsandorganochlorineinsecticides.
JournalofFoodScience.200874:T14T19.

18.MakridesM.IsthereadietaryrequirementforDHAinpregnancy?
Prostaglandins,LeukotrienesandEssentialFattyAcids.200981:171
174.

19.AkabasSR,DeckelbaumRJ.Summaryofaworkshoponn3fatty
acids:currentstatusofrecommendationsandfuturedirections.
AmericanJournalofClinicalNutrition.200683:1536S1538S.

Correspondingintervention
Longchainpolyunsaturated
fattyacidsupplementation
duringpregnancy

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