Omega-3 and omega-6 polyunsaturated fatty acids in neurodevelopment and prematurity: Correcting imbalances and closing the Preterm PUFA Gap

FAB RESEARCH COMMENT:

OMEGA 3 FROM FISH AND SEAFOOD REDUCE PRE-TERM BIRTH, AND ARE VITAL FOR HEALTHY BRAIN DEVELOPMENT AND FUNCTION

Once again, new research from world-leading scientists stresses the vital role of long-chain omega-3 and omega-6 fats in human brain development, and the public health implications are HUGE.

To reduce the current crises in Special Needs Education provision - and Mental Health more generally - policymakers just need to ACT ON THE SCIENTIFIC EVIDENCE, and

1)      Encourage women to eat MORE FISH AND SEAFOOD IN PREGANCY, and/or to supplement with omega-3 DHA (from at least week 20 – but ideally, before conception).

2)      Ensure that nutrition of ALL infants provides sufficient long-chain omega-3 AND omega-6 – including higher intakes for preterm infants, needed to compensate for their being born too soon.

FAB Expert Speakers Dr Simon Dyall and Professor Michael Crawford, and other pioneers in the field – including Professors Susan Carlson and Tom Brenna recap the highest-level evidence that shows:

• sufficient omega-3 DHA can HALVE the risk of early preterm birth, and
• the vital roles of long-chain omega-3 (and omega-6) PUFAs in gene expression and organ maturation, including the brain, eyes, lungs and immune system.

They also introduce and explain the concept of ‘THE PRE-TERM ‘PUFA GAP’

This is THE DIFFERENCE BETWEEN WHAT PRETERM INFANTS GET, AND WHAT THEY ACTUALLY NEED for optimal brain development in terms of essential omega-3 and omega-6 fats.

Needs for long chain omega-3 and omega-6 fats (DHA and ARA) are highest in the third trimester, the main period for brain growth. In utero, this is met by ‘placental biomagnification’ (the placenta effectively doubles maternal concentrations).

But for babies born too soon, intakes typically fall well below what they would have received in the womb – leading to a marked decline in DHA and ARA, and a corresponding rise in the short-chain omega-6 linoleic acid (LA). The authors aslo the “Preterm PUFA Gap.”

Increasing Omega-3 LC-PUFA Intake in pregnancy reduces preterm birth

EIGHT YEARS AGO, definitive evidence that supplementing long-chain omega-3 LC-PUFA during pregnancy significantly reduces preterm birth rates was provided a Cochrane systematic review involving 70 randomised controlled trials, and almost 20,000 women: 

• Middleton et al 2018 - Omega‐3 fatty acid addition during pregnancy

FOUR YEARS AGO, an independent expert consensus statement from ISSFAL (The International Society for the Study of Fatty Acids and Lipids) recommended omega-3 in pregnancy for the prevention of pre-term birth.

• Best K et al 2022 - ISSFAL Statement Number 7 – Omega-3 fatty acids during pregnancy to reduce preterm birth

By that time, additional dose-ranging clinical trials had shown that up to 1000mg/day of omega-3 DHA is needed for women with fish and seafood intake below current guidelines - and that 

• providing the appropriate dose of omega-3 from week 20 of pregnancy can HALVE rates of early pre-term birth - which is associated with the greatest risks for lifelong physical and mental disabilities.

TWO YEARS AGO, clinical practice guidelines for reducing risks of preterm and early preterm birth were published (by leading scientists in the field, with support from clinical and community health organisations), based on the strong evidence from clinical trials and a formal consensus process:

• Cetin et al 2024 - Clinical Guidelines Omega-3 fatty acid supply in pregnancy for risk reduction of preterm and early preterm birth

These make very clear, simple recommendations and guidelines for APPLYING THESE FINDINGS IN EVERYDAY CLINICAL PRACTICE.

Putting this first-class evidence into practice would also save money - even in the short-term

Studies in both Australia and the US have shown that omega-3 supplementation in pregnancy would lead to significant cost savings even in the very short-term (i.e. immediate hospital costs). See:

• Ahmed et al 2015 - Analysis of hospital cost outcome of DHA-rich fish-oil supplementation in pregnancy: Evidence from a randomized controlled trial.

• Shireman et al 2016 - Docosahexaenoic acid supplementation (DHA) and the return on investment for pregnancy outcomes

Preterm birth is common - affecting 1 in 10 pregnancies worldwide, 1 in 12  in the UK (where rates are rising). It is also the leading cause of death in children under 5, and a major cause of lifelong mental and physical disabilities.

As research and expert clinical guidelines explain, the highest level of scientific evidence shows that:

• Ensuring adequate omega-3 status in pregnancy significantly reduces the harms - and huge costs - associated with preterm birth

• Screening for suboptimal omega-3 status (via a brief checklist of dietary intake) can easily identify women in need of supplementation with omega-3 DHA - and the dosage required to reduce preterm birth risks 

All the information that governments, health policymakers and professionals should need to promote and support this safe, effective, cheap and simple intervention for all pregnant women, as part of standard prenatal care is now available.

To receive a FREE downloadable summary for professionals, policymakers and the general public - with links to the key research, and further information, please see:

• Omega-3 for Brain Health and Preterm Birth

And for more information on this subject:

• Omega-3 and Pregnancy - News

• Omega-3 and Pregnancy - Research

• Pregnancy and Nutrition - Research

• Pregnancy and Nutrition - News