Supplementation of n-3 fatty acids during pregnancy and lactation reduces maternal plasma lipid levels and provides DHA to the infants

Objective.?Docosahexaenoic acid (DHA, 22:6 n-3) is considered an essential fatty acid for the fetus and newborn infant, but the optimal level of supply is not known. We studied the effect of supplementing pregnant and lactating women with marine n-3 polyunsaturated fatty acids (PUFAs) as compared to n-6 PUFAs related to maternal and infant lipid levels.

Study design.?Five hundred and ninety pregnant women in weeks 17–19 of pregnancy were recruited. They were given either 10 mL cod liver oil (n-3 PUFAs) or corn oil (n-6 PUFAs) daily until three months after delivery, and 341 women took part in the study until giving birth.

Results.?Maternal supplementation with cod liver oil increased the concentration of DHA in maternal as well as infant plasma and umbilical tissue phospholipids, as compared to corn oil. The maternal plasma triacylglycerol increase during pregnancy was less pronounced in women supplemented with cod liver oil as compared to corn oil. The concentration of high-density lipoprotein (HDL)-cholesterol was unchanged during pregnancy in the cod liver oil group, whereas it decreased in the corn oil group, promoting a greater increase in the ratio of total cholesterol/HDL-cholesterol in the corn oil group.

Conclusion.?Maternal supplementation with n-3 fatty acids during pregnancy and lactation provides more DHA to the infant and reduces maternal plasma lipid levels compared to supplementation with n-6 fatty acids.     

Placental tissue levels of nonesterified polyunsaturated fatty acids in normal and preeclamptic pregnancies.

OBJECTIVE: We previously reported that maternal plasma levels of nonesterified polyunsaturated fatty acids were decreased in women with preeclampsia as compared to women with normal pregnancies. Polyunsaturated fatty acids of the n-6 and n-3 families are essential dietary fatty acids. The n-6 polyunsaturated fatty acids are involved in inflammatory reactions, whereas n-3 polyunsaturated fatty acids protect against inflammation. METHODS: In this study, we investigated the composition of nonesterified polyunsaturated fatty acids in placental tissue of normal and preeclamptic pregnancies. Linoleic (18:2) and arachidonic (20:4, AA) acids of the n-6 family and linolenic (18:3), eicosapentaenoic (20:5, EPA) and docosahexaenoic (22:6, DHA) acids of the n-3 family were analyzed. CONCLUSIONS:We found that total concentrations of nonesterified polyunsaturated fatty acids were lower in placental tissues from preeclamptic pregnancies than from normal pregnancies. Both n-6 and n-3 polyunsaturated fatty acids were decreased. The decrease in n-6 polyunsaturated fatty acids was due to a decrease in AA. The concentration of linoleic acid was not altered. For n-3 polyunsaturated fatty acids, DHA was decreased, with no change in linolenic acid. The percentage decrease in EPA and DHA was greater than for AA, so the ratio of n-6 to n-3 polyunsaturated fatty acids was two-fold higher in preeclampsia than normal pregnancy. Because the levels of essential fatty acids, linoleic (18:2) and linolenic (18:3), are preserved but levels of metabolites (AA and DHA) are reduced, we speculate that placental oxidative stress and increased conversion of AA to thromboxane are responsible for the decreased concentrations of polyunsaturated fatty acids in preeclampsia.     

Placental Tissue Levels of Nonesterified Polyunsaturated Fatty Acids in Normal and Preeclamptic Pregnancies

Objective. We previously reported that maternal plasma levels of nonesterified polyunsaturated fatty acids were decreased in women with preeclampsia as compared to women with normal pregnancies. Polyunsaturated fatty acids of the n-6 and n-3 families are essential dietary fatty acids. The n-6 polyunsaturated fatty acids are involved in inflammatory reactions, whereas n-3 polyunsaturated fatty acids protect against inflammation. Methods. In this study, we investigated the composition of nonesterified polyunsaturated fatty acids in placental tissue of normal and preeclamptic pregnancies. Linoleic (18:2) and arachidonic (20:4, AA) acids of the n-6 family and linolenic (18:3), eicosapentaenoic (20:5, EPA) and docosahexaenoic (22:6, DHA) acids of the n-3 family were analyzed. Conclusions. We found that total concentrations of nonesterified polyunsaturated fatty acids were lower in placental tissues from preeclamptic pregnancies than from normal pregnancies. Both n-6 and n-3 polyunsaturated fatty acids were decreased. The decrease in n-6 polyunsaturated fatty acids was due to a decrease in AA. The concentration of linoleic acid was not altered. For n-3 polyunsaturated fatty acids, DHA was decreased, with no change in linolenic acid. The percentage decrease in EPA and DHA was greater than for AA, so the ratio of n-6 to n-3 polyunsaturated fatty acids was two-fold higher in preeclampsia than normal pregnancy. Because the levels of essential fatty acids, linoleic (18:2) and linolenic (18:3), are preserved but levels of metabolites (AA and DHA) are reduced, we speculate that placental oxidative stress and increased conversion of AA to thromboxane are responsible for the decreased concentrations of polyunsaturated fatty acids in preeclampsia.     

Relationship between dietary intake of cod liver oil in early pregnancy and birthweight

OBJECTIVE: To investigate the possible association between birth outcome and marine food and cod liver oil intake of healthy women in early (prior to 15 weeks of gestation) pregnancy. DESIGN: An observational study. SETTING: Free-living conditions in a community with traditional fish and cod liver oil consumption. POPULATION: Four hundred and thirty-five healthy pregnant Icelandic women without antenatal and intrapartum complications. METHODS: Dietary intake of the women was estimated with a semi-quantitative food frequency questionnaire (FFQ) covering food intake together with lifestyle factors for the previous three months. Questionnaires were filled out at between 11 and 15 weeks and between 34 and 37 weeks of gestation. The estimated intake of marine food and cod liver oil was compared with birthweight by linear and logistic regression controlling for potential confounding. MAIN OUTCOME MEASURES: Birthweight, cod liver oil intake, lifestyle factors (alcohol, smoking). RESULTS: Fourteen percent of the study population used liquid cod liver oil in early pregnancy. Regression analysis shows that these women gave birth to heavier babies (P < 0.001), even after adjusting for the length of gestation and other confounding. CONCLUSIONS: Maternal intake of liquid cod liver oil early in pregnancy was associated with a higher birthweight. Higher birthweight has been associated with a lower risk of diseases later in life and maternal cod liver oil intake might be one of the means for achieving higher birthweight.     

Efficacy of n-3 fatty acids supplementation on the prevention of pregnancy induced-hypertension or preeclampsia: A systematic review and meta-analysis

The efficacy of n-3 fatty acids supplementation on the prevention of pregnancy-induced hypertension or preeclampsia remains unclear. The aim of study was to examine the effect of supplementation with EPA, and/or DHA, and/or ALA during pregnancy on the pregnancy-induced hypertension or preeclampsia. A systematic search was performed on Scopus, PubMed, Web of Science (WoS), Cochrane Library, and Google scholar, which covered the period between 1991 and 2018. The clinical trials with any control groups (i.e. placebo or other supplementation) were selected. The whole process of meta-analysis and data analysis was done using Comprehensive Meta-Analysis (Version 2.0, Biostat). The searched keywords were: “Fatty Acids, Omega-3”, “n-3 Polyunsaturated Fatty Acid” “Eicosapentaenoic Acid”, “Docosahexaenoic Acids”, “n-3 Polyunsaturated Fatty Acid”, “n-3 PUFAs”, “alpha-Linolenic Acid”, “fish oil”, “Nuts”, “nutrient”, or their synonyms “pregnancy induced hypertension” and preeclampsia. In addition, some key journals, according to Scopus report and the references of the original and review articles, were manually searched for possible related studies. The meta-analysis of the 14 comparisons demonstrated that n-3 fatty acids supplementation played a protective role against the risk of preeclampsia (RR, 0.82; 95% CI, 0.70–0.97; p = 0.024; I2 = 19.0%). The analysis of the 10 comparisons revealed that n-3 fatty acid supplements for pregnant women did not mitigate the risk of pregnancy-induced hypertension (RR, 0.98; 95% CI, 0.90–1.07; p = 0.652; I2 = 0%). The n-3 fatty acid supplements are an effective strategy to prevent the incidence of preeclampsia in women with low-risk pregnancies.     

Erythrocyte omega-3 and omega-6 polyunsaturated fatty acids and preeclampsia risk in Peruvian women

Objective: This case–control study was conducted in Lima, Peru, from June 1997 through January 1998 to assess whether alteration in maternal erythrocyte omega-3 (n-3) and omega-6 (n-6) fatty acids was associated with increased risk of preeclampsia. Methods: A total of 99 preeclampsia and 100 normotensive pregnant women were included. Maternal erythrocyte n-3 and n-6 fatty acids were determined using capillary gas chromatography/mass spectrometry and expressed as micromolar (mM) concentrations. We employed logistic regression procedures to estimate odds ratios (ORs) and 95% confidence intervals (CIs). Result: n-3 fatty acids were consistently lower in preeclampsia cases than controls. After adjusting for confounders, the corresponding ORs for preeclampsia across decreasing quartiles of sum of long-chain n-3 fatty acids were 1.0, 3.3, 2.4, and 3.3, respectively (P=0.07 for trend). A similar pattern was observed for eicosapentenoic acid (20:5n-3, EPA) and docosahexenoic acid (22:6n-3, DHA). There was no clear evidence of an association between arachidonic acid (20:4n-6, AA) and preeclampsia risk, the ORs in successively lower quartiles were 1.0, 1.1, 1.0, and 1.5 (P=0.48 for trend). A similar pattern was seen for the sum of long-chain n-6 fatty acids. Conclusion: In Peruvian women, low erythrocyte n-3 fatty acids appeared to be associated with an increased risk of preeclampsia.     

The roles of long-chain polyunsaturated fatty acids in pregnancy, lactation and infancy: review of current knowledge and consensus recommendations

This paper reviews current knowledge on the role of the long-chain polyunsaturated fatty acids (LC-PUFA), docosahexaenoic acid (DHA, C22:6n-3) and arachidonic acid (AA, 20:4n-6), in maternal and term infant nutrition as well as infant development. Consensus recommendations and practice guidelines for health-care providers supported by the World Association of Perinatal Medicine, the Early Nutrition Academy, and the Child Health Foundation are provided. The fetus and neonate should receive LC-PUFA in amounts sufficient to support optimal visual and cognitive development. Moreover, the consumption of oils rich in n-3 LC-PUFA during pregnancy reduces the risk for early premature birth. Pregnant and lactating women should aim to achieve an average daily intake of at least 200 mg DHA. For healthy term infants, we recommend and fully endorse breastfeeding, which supplies preformed LC-PUFA, as the preferred method of feeding. When breastfeeding is not possible, we recommend use of an infant formula providing DHA at levels between 0.2 and 0.5 weight percent of total fat, and with the minimum amount of AA equivalent to the contents of DHA. Dietary LC-PUFA supply should continue after the first six months of life, but currently there is not sufficient information for quantitative recommendations.     

Relationship between high consumption of marine fatty acids in early pregnancy and hypertensive disorders in pregnancy

OBJECTIVE: To investigate whether there is a relationship between maternal intake of cod-liver oil in early and late pregnancy and hypertensive disorders in pregnancy. DESIGN: An observational prospective study. SETTING: Free-living conditions in a community with traditional fish and cod-liver oil consumption. POPULATION: Four hundred and eighty-eight low-risk pregnant Icelandic women. METHODS: Maternal use of cod-liver oil, foods and other supplements was estimated with a semiquantitative food frequency questionnaire covering food intake together with lifestyle factors for the previous 3 months. Questionnaires were filled out twice, between 11 and 15 weeks of gestation and between 34 and 37 weeks of gestation. Supplements related to hypertensive disorders in pregnancy, i.e. gestational hypertension and pre-eclampsia, were presented, with logistic regression controlling for potential confounding. MAIN OUTCOME MEASURES: Gestational hypertension, pre-eclampsia, cod-liver oil and multivitamins. RESULTS: The odds ratio for developing hypertensive disorders in pregnancy for women consuming liquid cod-liver oil was 4.7 (95% CI 1.8-12.6, P= 0.002), after adjusting for confounding factors. By dividing the amount of n-3 long-chain polyunsaturated fatty acids (n-3 LCPUFA) into centiles, the odds ratio for hypertensive disorders across groups for n-3 LCPUFA suggested a u-shaped curve (P = 0.008). Similar results were found for gestational hypertension alone. Further, the use of multivitamin supplements without vitamins A and D in late pregnancy doubled the odds of hypertensive disorders (OR 2.4, 95% CI 1.0-5.4, P= 0.044). CONCLUSIONS: Consumption of high doses of n-3 LCPUFA in early pregnancy, or other nutrients found in liquid cod-liver oil, may increase the risk of developing hypertensive disorders in pregnancy.     

Supplementation with docosahexaenoic acid in the last trimester of pregnancy: maternal-fetal biochemical findings

The nutritional significance of long-chain polyunsaturated fatty acids (LCPS) during the perinatal period is becoming increasingly important. There are currently very few studies on dietary intervention during gestation. The aim of the study was to analyze the effect of docosahexaenoic acid (DHA) supplementation during pregnancy on levels in both the newborn and the mother. A randomized placebo controlled study was carried out on 20 pregnant women in study group receiving 200 mg/day of docosahexaenoic acid-(DHA) during the last trimester of pregnancy. Results in both groups (A supplemented, B non-supplemented) highlighted a decrease in plasma arachidonic acid (5.99 +/- 0.91 vs. 4.51 +/- 0.71 p<0.001 for group A and 5.84 +/- 0.71 vs. 4.80 +/- 0.51 p<0.01 for group B) in the baseline-final intra-group comparison. The intergroup comparison revealed a significant difference in plasma DHA at delivery: it was found to be higher in the population of supplemented pregnant women (3.17 +/- 0.26 vs. 2.77 +/- 0.31). The neonate population displayed no significant differences between the two groups. The results show that LCPS are consumed during the final stages of pregnancy and that oral supplementation with 200 mg/day of DHA is reflected in an increase in the plasma level of this fatty acid in the mother. One could speculate that there would be a corresponding increase in DHA bioavailability for the fetus.     

Prenatal omega-3 fatty acids: review and recommendations

The influence of dietary omega-3 fatty acids on health outcomes is widely recognized. The adequate intake of omega-3 fatty acids docasahexaenoic acid (DHA) and eicosapentaenoic acid (EPA) in particular can increase gestation length and improve infant cognitive and visual performance. Adequate levels of omega-3 fatty acids have also been shown to reduce the incidence of preterm birth in some populations. Research on prenatal omega-3 intake and other outcomes, such as preeclampsia and fetal growth restriction, is inconclusive. Women in the United States consume low levels of omega-3 fatty acids compared to omega-6 fatty acids; this dietary pattern is associated with poor health outcomes. Omega-3 fatty acids are found primarily in fish, yet many pregnant women avoid fish because of concerns about potential mercury and polychlorinated biphenyl contamination. It is important for prenatal care providers to assess women's diets for omega-3 fatty acid intake and ensure that pregnant women are consuming between 200 and 300 mg daily from safe food sources. Purified fish, algal oil supplements, and DHA-enriched eggs are alternative sources for pregnant women who do not eat fish.     

Arachidonic and docosahexaenoic acid in the blood of a mother and umbilical vein in diabetic pregnant women

Abstract

Objective: The aim of the study was to determine the total concentration of fatty acids (FAs) in the maternal vein serum and in the umbilical vein serum in pregnant women suffering from Type 1 diabetes compared to healthy women. Additional goal was to determine the percentages of arachidonic (AA) and docosahexaenoic acid (DHA) in comparison to the total concentration of FAs.

Methods: The study included 63 pregnant women, 32 suffering from Type 1 diabetes and 31 healthy pregnant women. Extraction of total lipids was performed using gas chromatography.

Results: There was statistically significant difference in the total FAs concentration in the maternal vein serum and the umbilical vein serum between the two groups. There was a statistically significant higher concentration of total FAs in the maternal and umbilical vein serum of the diabetic group. Higher AA and DHA concentrations were found in the maternal vein serum compared to an umbilical vein serum of the diabetic group.

Conclusion: No difference was found in AA and DHA percentages in the maternal or in the umbilical vein serum of diabetic pregnant women. Despite of T1DM, a good metabolic control leads to insignificant changes in the AA and DHA levels in diabetic pregnancy.     

Maternal omega-3 fatty acid supplementation and risk for perinatal maternal depression

Objective.?A systematic review was conducted to assess the possible association between omega-3 polyunsaturated fatty acid (PUFA) supplementation and intake in the perinatal period and the risk of maternal perinatal depression.

Methods.?Two PubMed searches and a BIOSIS Preview, a Web of Science and a PsychInfo search were conducted with the search terms ‘DHA, pregnancy and depression’ and ‘omega-3 fatty acids, pregnancy and depression’.

Results.?Ten articles – three longitudinal cohort studies, five randomized controlled trials and two pilot trials– that met selection criteria were reviewed. Six found no association, two found mixed results, and two found a positive association between omega-3 PUFAs and reduced incidence of maternal perinatal depression. The heterogeneity of results can be explained by dissimilar study designs, including differences in study duration, time period of measurement and number of participants, and in varied dosages and types of supplemental PUFAs. Some of the larger studies and those that found a positive effect were more likely to be using higher doses, close to 2?g of docosahexaeonic acid (DHA)+?eicosapentaenoic acid (EPA), and began the supplementation earlier in pregnancy.

Conclusions.?Future RCTs to investigate the role of PUFA supplementation and risk for maternal perinatal depression should begin supplementation early in pregnancy and use a dosage closer to 2?g of DHA?+?EPA. Depression should also be measured using a diagnostic interview schedule in addition to a screener.     

Effects of fish oil supplementation in late pregnancy on blood pressure: a randomised controlled trial

Objective To study the effect of fish oil supplementation on blood pressure during the third trimester of pregnancy.
Design In the 30th week of pregnancy 533 healthy women were randomly assigned in a ratio 2:1:1 to receive fish oil (2–7 g/day n-3 fatty acids (Pikasol)), or a control regimen of either olive oil or no oil supplementation.
Main Outcome measures Blood pressure measured with an automatic device (Dinamap 1846 SX, Criticon) at baseline and in weeks 33, 37, 39 and subsequently weekly until delivery.
Results Mean blood pressure increased during the third trimester, and this was not influenced by group assignment. No significant effects on either systolic or diastolic blood pressure were seen in the fish oil group compared to the control groups. The proportions of women with a systolic blood pressure above 140 mmHg or a diastolic blood pressure above 90 mmHg were not significantly different in the fish oil group compared with the control groups, although the proportion of women with diastolic above 90 mmHg tended to be lower in the fish oil group compared with the olive oil group. The corresponding relative risk was RR = 048 (95 % CI 0.22–1.06;   P = 007  ).
Conclusion 2.7 g/day of marine n-3 fatty acids provided in the third trimester of normal pregnancy showed no effect on blood pressure.     

Implications of Dietary Fatty Acids During Pregnancy on Placental,Fetal and Postnatal Development—A Review

During pregnancy, the mother adapts her metabolism to support the continuous draining of substrates by the fetus. Her increase in net body weight (free of the conceptus) corresponds to the accumulation of fat depots during the first two-thirds of gestation, switching to an accelerated breakdown of these during the last trimester. Under fasting conditions, adipose tissue lipolytic activity is highly enhanced, and its products, free fatty acids (FFA) and glycerol, are mainly driven to maternal liver, where FFA are converted to ketone bodies and glycerol to glucose, which easily cross the placenta and sustain fetal metabolism. Lipolytic products reaching maternal liver are also used for triglyceride synthesis that are released in turn to the circulation, where together with an enhanced transfer of triglycerides among the different lipoprotein fractions, and a decrease in extrahepatic lipoprotein lipase activity, increase the content of triglycerides in all the lipoprotein fractions. Long chain polyunsaturated fatty acids (LCPUFA) circulate in maternal plasma associated to lipoprotein triglycerides, and in a minor proportion in the form of FFA. Despite the lack of a direct placental transfer of triglycerides, diffusion of their fatty acids to the fetus is ensured by means of lipoprotein receptors, lipoprotein lipase activity and intracellular lipase activities in the placenta. Maternal plasma FFA are also an important source of LCPUFA to the fetus, and their placental uptake occurs via a selective process of facilitated membrane translocation involving a plasma membrane fatty acid-binding protein. This mechanism together with a selective cellular metabolism determine the actual rate of placental transfer and its selectivity, resulting even in an enrichment of certain LCPUFA in fetal circulation as compared to maternal. The degree to which the fetus is capable of fatty acid desaturation and elongation is not clear, although both term and preterm infants can synthesize LCPUFA from parental essential fatty acids. Nutritional status of the mother during gestation is related to fetal growth, and excessive dietary intake of certain LCPUFA has inhibitory effects on Δ-5- and Δ-6-desaturases. This inhibition causes major declines in arachidonic acid levels, as directly found in pregnant and lactating rats fed a fish oil-rich diet as compared to olive oil. An excess in dietary PUFA may also enhance peroxidation and reduce antioxidant capacity. Thus, since benefit to risks of modifying maternal fat intake in pregnancy and lactation are not yet completely established, additional studies are needed before recommendations to increase LCPUFA intake in pregnancy are made.     

Maternal plasma and amniotic fluid interleukin-6 and tumor necrosis factor-alpha levels in imminent preterm labor

DESIGN: Our purpose was to investigate the maternal plasma and amniotic fluid interleukin-6 and tumor necrosis factor-alpha levels in women with imminent preterm labour. MATERIAL AND METHODS: The present study was designed to evaluate IL-6 and TNF-alpha levels in 93 pregnant women with threatened preterm labour and 40 women with normal pregnancy. Maternal blood samples were collected by routine forearm venipuncture at admission during routine laboratory tests. Amniotic fluid was collected through hysterectomy during caesarean delivery from women at term but not in labour and by amniotomy or hysterectomy from women with preterm labour. RESULTS: Maternal plasma and amniotic fluid IL-6 and TNF-alpha concentrations were significantly elevated in women with preterm labour (premature rupture of membranes and uterine contractions) compared to gestationally matched, non-labouring controls.     

Placental transfer of long-chain polyunsaturated fatty acids (LC-PUFA)

Considerable evidence exists for marked beneficial effects of omega-3 long-chain polyunsaturated fatty acids (LC-PUFA) during pregnancy. The omega-3 LC-PUFA docosahexaenoic acid (DHA) is incorporated in large amounts in fetal brain and other tissues during the second half of pregnancy, and several studies have provided evidence for a link between early DHA status of the mother and visual and cognitive development of her child after birth. Moreover, the supplementation of omega-3 LC-PUFA during pregnancy increases slightly infant size at birth, and significantly reduces early preterm birth before 34 weeks of gestation by 31%. In our studies using stable isotope methodology in vivo, we demonstrated active and preferential materno-fetal transfer of DHA across the human placenta and found the expression of human placental fatty acid binding and transport proteins. From the correlation of DHA values with placental fatty acid transport protein 4 (FATP 4), we conclude that this protein is of key importance in mediating DHA transport across the human placenta. Given the great importance of placental DHA transport for infant outcome, further studies are needed to fully appreciate the effects and optimal strategies of omega-3 fatty acid interventions in pregnancy, dose response relationships, and the potential differences between subgroups of subjects such as women with gestational diabetes or other gestational pathology. Such studies should contribute to optimize substrate intake during pregnancy and lactation that may improve pregnancy outcome as well as fetal growth and development.     

Fetal fatty acid oxidation defects and maternal liver disease in pregnancy

OBJECTIVE: The objective was to evaluate the relationships between all types of fetal fatty acid oxidation defects and maternal liver disease, including acute fatty liver of pregnancy and hemolysis, elevated liver enzymes, and low platelets (HELLP) syndrome. METHODS: This was a case-control study comparing fetal fatty acid oxidation defects to the outcome of maternal liver disease. Fifty case infants with fatty acid oxidation defects were identified, with 25 matched controls collected per case. This generated a total of 50 case infants and 1,250 control infants. Pregnancies were evaluated for the presence of maternal liver disease (comprised of acute fatty liver of pregnancy, HELLP syndrome, and preeclampsia evolving into HELLP syndrome) using a conditional logistic regression model. Subgroup analysis compared long chain to short and medium chain fatty acid defects. RESULTS: Maternal liver disease was noted in 16.00% of all fatty acid oxidation defect pregnancies compared with 0.88% in the general population (odds ratio 20.4, 95% confidence interval 7.82-53.2). These pregnancies demonstrated an 18.1-fold increase in maternal liver disease when compared with our matched population controls with unaffected fetuses. All classifications of fatty acid oxidation defects were at high risk of developing maternal liver disease. Long chain defects were 50 times more likely than controls to develop maternal liver disease and short and medium chain defects were 12 times more likely to develop maternal liver disease. CONCLUSION: Maternal liver disease is significantly higher across the entire spectrum of fatty acid oxidation defects pregnancies compared with the matched control population. Notably, there is significant risk to the pregnancies with fetuses affected with short and medium chain defects, not just those with fetal long chain fatty acid oxidation defects as previously reported. Future studies should examine the pathophysiology of all infant fatty acid oxidation defects and its implications for maternal liver disease for improved future health outcomes. LEVEL OF EVIDENCE: II-2.     

Status of cis and trans Fatty Acids in Brazilian Adolescent Mothers and Their Newborns

Study ObjectiveThe objective was to quantify cis and trans fatty acids in maternal plasma and infant cord plasma from adolescent mothers.DesignFrom 80 adolescent healthy mothers, we sampled postpartum maternal blood and umbilical cord blood at birth. Trans fatty acids (tFAs), linoleic (18:2), and arachidonic (AA, 20:4) acids of the n-6 family, and α-linolenic (18:3), eicosapentaenoic (20:5) and docosahexaenoic (22:6) acids of the n-3 family were analyzed by gas-liquid chromatography. Results were expressed as a percentage of total fatty acids.ResultsLinoleic fatty acid was present in greater proportions in the maternal plasma than in that of the umbilical cord, whereas AA was present in greater proportions in the total lipids of umbilical cord blood. Docosahexaenoic acid was the long-chain polyunsaturated fatty acid of the n-3 family that was predominant in both maternal and umbilical cord plasma. The tFAs in the maternal plasma had a negative correlation with oleic acid and linoleic acid. Linolenic acid had a positive correlation with cephalic perimeter upon birth. A tendency for a negative correlation between trans isomers and gestational age at birth (P = .05) was observed.ConclusionsLong-chain polyunsaturated fatty acids, which are important to fetal growth and development, were found in greater quantities in the cord blood of newborns of adolescents than in the maternal blood, indicating a priority of transfer of AA and docosahexaenoic fatty acids to the fetus. Despite the lower levels of tFAs found in maternal blood, we verified potential risk for premature birth.     

Maternal high fat diet deficient in vitamin B12 influences long chain polyunsaturated fatty acid composition in rats

Objective: In India, there is a rise in non-communicable diseases due to diets deficient in vitamin B₁₂, low in docosahexaenoic acid (DHA) and increased consumption of westernized diet. The present study aims to examine the effect of maternal high fat diet (HFD) in absence of vitamin B₁₂ on pregnancy outcome and tissue fatty acid composition in dams.

Methods: Pregnant Wistar rats were assigned to following diets: Control (C), HFD, High fat diet supplemented with omega-3 fatty acids (HFDO), 4) High fat diet deficient in vitamin B₁₂ (HFBD), High fat deficient in vitamin B₁₂ supplemented with omega-3 fatty acids (HFBDO).

Results: There was no effect on pregnancy outcome as a consequence of different dietary treatments. The levels of DHA in HFBD group were lower (p?Conclusion: This data suggests that maternal HFD (using dairy fat) did not adversely affect pregnancy outcome. However, maternal HFBD reduced levels of placental DHA. This may have implications for reduced fetal brain growth and development.     

Community attitudes to pregnancy, anaemia, iron and folate supplementation in urban and rural Lagos, south-western Nigeria

OBJECTIVE: To identify community perspectives and attitudes to pregnancy, anaemia, iron and folate supplements during pregnancy in Lagos, south-western Nigeria. DESIGN: Qualitative using focus group discussions, observational data and in-depth interviews. SETTING: Amukoko, a peri-urban slum area and Ibese a rural coastal area in Lagos, south-western Nigeria. PARTICIPANTS: 23 pregnant women and two health-care providers. FINDINGS: Maternal anaemia is not perceived as a priority health problem by pregnant women. Knowledge of the signs and symptoms of anaemia is limited among rural pregnant women. The recognition of maternal complications associated with anaemia is low among pregnant women and some health-care providers. Severe blood loss at or after delivery is sometimes attributed to the excessive use of iron and folate supplements. Sustaining the motivation to continue taking iron tablets and communicating the benefits of iron supplementation which could encourage compliance was also lacking. IMPLICATIONS FOR PRACTICE: An understanding of the local beliefs, attitudes and practices regarding pregnancy is needed to design more effective methods of health education for pregnant women and to provide maternal services which are 'culturally acceptable'.