November is Prematurity Awareness Month. November 17 (today) is the day that the entire world recognizes the fourth annual World Prematurity Day.  15 million babies are born prematurely, (before 37 weeks) worldwide (World Health Organization, 2017).  Prematurity is the leading cause of death of children under the age of five (Liu, 2016).  It is estimated that 1 million babies die due to being born prematurely.  Many millions of others are at increased risk of morbidities such as vision problems, developmental delays, and learning challenges.

There is a new Cochrane Review that was published earlier this week "Omega-3 fatty acid addition during pregnancy" that determined that increasing the intake of omega-3 long-chain polyunsaturated fatty acids (LCPUFA) during pregnancy reduces the risk of premature births.  Previously, the last review had been done in 2006. The review also examined the impact of increased Omega-3 fatty acids on maternal outcomes for mood disorders post birth amongst other things.

The study authors examined 70 randomized controlled trials that involved a total of 19,927 people. Almost all of the studies compared pregnant people who received omega‐3 LCPUFA (as a supplement or in foods) with people who received a placebo or nothing. The studies were primarily in upper-middle or high-income countries. There were some studies that included people who were at risk for preterm birth but most of the studies did not.

The researchers found that taking the Omega-3 LCPUFA:

• lowered the risk of having a premature baby (less than 37 weeks) by 11% (from 134 per 1000 to 119 per 1000 births)
• lowered the risk of having an early premature baby (less than 34 weeks) by 42% (from 46 per 1000 to 27 per 1000 births)
• reduced the risk of having a small baby (less than 2500g) by 10%

The researchers found that preterm birth (< 37 weeks) and early preterm birth (< 34 weeks) were both lower in people who received omega‐3 LCPUFA compared with no omega‐3.  Additionally, prolonged gestation > 42 weeks was probably increased from in people who received omega‐3 LCPUFA compared with no omega‐3 but there was no difference in induction of labor for post-term pregnancies.  For infants, there was a possibly reduced risk of perinatal death and possibly fewer neonatal care admissions. There was a reduced risk of low birthweight (LBW) babies but a possible small increase in large-for-gestational-age (LGA) babies for omega‐3 LCPUFA compared with no omega‐3. Little or no difference in small-for-gestational-age or intrauterine growth restriction was seen.

There were no discernable differences in postpartum depression rates in the parent or in long-term child development and growth in one group over the other.

The quality of evidence was high in determining the effect of omega-3 long-chain polyunsaturated fatty acids on premature birth rates.

Many pregnant people are reluctant to consume increased quantities of fish during pregnancy out of concern for mercury levels.  It appears from the research review that it is appropriate to increase the Omega-3 as a supplement if safe species of fish are unavailable for a pregnant person to eat.

Researchers state that:

"Omega‐3 long‐chain polyunsaturated fatty acids (LCPUFA) supplementation during pregnancy is a simple and effective way to reduce preterm, early preterm birth and low birthweight, with low cost and little indication of harm."

According to researcher Middleton: 

"There are not many options for preventing premature birth, so these new findings are very important for pregnant women babies and the health care professionals who care for them.  We don't yet fully understand the causes of premature labor, so predicting and preventing early birth has always been a challenge.  This is one of the reasons omega-3 supplementation in pregnancy is of such great interest to researchers around the world."

For more information on omega-3 fatty acids for pregnant people and providers, some of the authors of this research review along with other scientists have created further resources that will be useful, including information on dosing and the types of omega-3 supplementation that appear to be most helpful. Taking Omega-3 to Give Your Baby a Great Start in Life includes pdfs for consumers and another set for professionals along with a helpful FAQ section.

Prematurity is a significant problem in under-resourced countries as well as more economically stable locations.  Many babies are at risk of death if they are born prematurely and those that survive may face ongoing health challenges.  Caring for premature babies is expensive and stressful.  During November, when we recognize Prematurity Awareness and World Prematurity Day, it is encouraging to know that there may be a low cost, easily accessible supplement that people can use that can help reduce the rate of babies being born prematurely.

What do you tell the families in your classes about omega-3 fatty acid supplementation?

References

Liu L, Oza S, Hogan D, Chu Y, Perin J, Zhu J, et al. Global, regional, and national causes of under‐5 mortality in 2000‐15: an updated systematic analysis with implications for the Sustainable Development Goals. Lancet 2016;388(10063):3027‐35. [DOI: 10.1016/S0140‐6736(16)31593‐8]

Middleton  P, Gomersall  JC, Gould  JF, Shepherd  E, Olsen  SF, Makrides  M. Omega‐3 fatty acid addition during pregnancy. Cochrane Database of Systematic Reviews 2018, Issue 11. Art. No.: CD003402. DOI: 10.1002/14651858.CD003402.pub3.

World Health Organization. WHO fact sheet: Preterm birth. www.who.int/mediacentre/factsheets/fs363/en/ (accessed 15 April 2018).

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