Daniel J. Murphy, DC and Michael L. Underhill, DC
October 1, 2010
There is mounting evidence implicating omega-3 deficiency as a determinant of various maternal and pediatric afflictions. As a consequence, physicians should consider recommending a purified fish oil supplement during pregnancy and lactation.
It is well known that diets containing adequate levels of omega-3 fatty acids have significant health benefits. Improvement in cardiovascular health, vision, improved immune system function and brain function are only a few examples. As chiropractors, we often treat pregnant women, infants and young children in our daily practices. Although well published, there is oftentimes a lack of appreciation regarding the many benefits of supplementation with long-chain omega-3 (n-3) polyunsaturated fatty acids (PUFA’s) for this group of patients. This article will review a small portion of the current literature regarding this topic and touch on the following points.
According to a recent article by Genuis and Schwalfengerg1 in the Journal of Perinatology, there is mounting evidence implicating omega-3 deficiency as a determinant of various maternal and pediatric afflictions. As a consequence, physicians should consider recommending purified fish oil supplement during pregnancy and lactation.
Hibbeln2 reported in Journal of Affective Disorders that mothers can become depleted of critical nutrients during pregnancy, with adverse consequences for both mother and infant. Deficiencies of docosahexaenoic acid (DHA), eicosapentaenoic acid (EPA) and arachidonic acid (AA) are related to neuropsychiatric consequences such as post partum depression, loss of visual acuity for the infant as well as less than ideal neurological development of the fetus and infant. Hibbeln noted that the prevalence of postpartum depression varied nearly fifty-fold depending on the amount of DHA in the mother's blood stream. The higher the DHA, the less depression.
"Supplementation with omega-3 fatty acids from both marine and algal sources during pregnancy is not only safe but has several important benefits during pregnancy, including longer gestational times and greater birth weights." The researchers report that supplementation with 2.7 g/day of EPA plus DHA during the last trimester increased mean birth weight and gestation time up to an average of seven days among infants whose mothers had a poor baseline omega-3 status.
Hibbeln also reported that there was a decreased risk of preterm delivery, and no significant adverse side effects after supplementation with doses ranging from 2.7 g/day to 6.1 g/day of EPA plus DHA. "No adverse side effects, specifically no increased bleeding times or hemorrhage during parturition, were observed in a treatment study of 223 women with high-risk pregnancies including gestational diabetes and pre-eclampsia."
The current recommendation, according to Hibbeln, is that pregnant women should consume a minimum of 650 mg/day of EPA plus a minimum of 300 mg/day DHA.
Helland, Smith, et al.,3 in Pediatrics reports that there is a growth spurt in the human brain during the last trimester of pregnancy and the first postnatal months, with a large increase in the cerebral content of AA and DHA. The fetus and the newborn infant depend on maternal supply of DHA and AA. Docosahexaenoic acid and arachidonic acid are critical for development of the central nervous system. The ability for the fetus and the newborn to convert vegetarian plant sources of omega-3 fatty acids, also known as short-chain omega-3's, like flax seed oil (alpha-linolenic acid) to EPA and DHA is inadequate. It must be supplied by fish or marine algae sources.
Helland found that supplementation of the mother by very-long-chain n-3 PUFAs during pregnancy and lactation improves the intelligence of children at four years of age.
In the Oxford Durham Study4 researchers noted, Omega-3 fatty acids are essential for normal brain development and function and must be provided by the diet. However, their low levels in modern diets in developed countries are a known risk factor for physical disorders such as cardiovascular and inflammatory diseases.
"Converging evidence indicates that fatty acid deficiencies or imbalances may also contribute to a range of adult psychiatric and neurologic disorders and several common and overlapping childhood neurodevelopmental disorders, including attention-deficit/hyperactivity disorder (ADHD), dyslexia (specific reading difficulties), dyspraxia (developmental coordination disorder [DCD]), and autistic spectrum disorders."
The Oxford Durham Study was a randomized, double blind, placebo-controlled trial. This study involved children between five and twelve years of age, from mainstream schools, all of whom met Developmental Coordination Disorder criteria, but were otherwise normal and not receiving any other treatment for their specific learning difficulties. Active treatment was provided by a supplement containing 80 percent fish oil and 20 percent evening primrose oil. (Evening primrose oil contains the omega-6 gamma linoleic acid.) A daily dose of six capsules provided 558 mg of eicosapentaenoic acid omega-3, 174 mg of docosahexaenoic acid omega-3, 60 mg of gamma-linoleic acid omega-6 fatty acid, and 9.6 mg of vitamin E (natural form, alpha-tocopherol).
Before treatment, achievement scores for reading and spelling were one year below chronologic age. With active treatment with oils for three months, reading age increased by 9.5 months and 3.3 months for placebo, a highly significant difference." The increase in spelling age was 6.6 months for active treatment and 1.2 months for placebo, again, a highly significant difference. Between 3-6 months, the oil treatment group reading age improved by 13.5 months and their spelling age improved by 6.2 months. "In the follow-up phase, they continued to make improvements above what would be expected for chronologic age." Children in the placebo group fell even more behind with spelling during the 0 to 3 month phase. "No adverse events were reported, and the high compliance rate also suggests good acceptability of fatty acid supplements."
It was also reported in this study that the omega-3 fatty acid supplementation improved ADHD symptoms better than Ritalin.
Horrocks and Yeo5 published an article concerning the health benefits of DHA, in the journal Pharmacological Research. They discuss how docosahexaenoic acid is essential for the growth and functional development of the brain in infants. DHA is also required for maintenance of normal brain function in adults. The inclusion of plentiful DHA in the diet improves learning ability, whereas deficiencies of DHA are associated with deficits in learning.
The visual acuity of healthy, full-term, formula-fed infants is increased when their formula includes DHA. During the last fifty years, many infants have been fed formula diets lacking DHA and other omega-3 fatty acids. Note that infants do not appear to require EPA as part of their diet. DHA deficiencies are associated with fetal alcohol syndrome, attention deficit hyperactivity disorder, cystic fibrosis, phenylketonuria, unipolar depression, aggressive hostility, and adrenoleukodystrophy.
"Both neural integrity and function can be permanently disturbed by deficits of omega-6 and omega-3 essential fatty acids during fetal and neonatal development."
Breast-feeding provides both AA and DHA to infants. However, the levels of DHA in breast milk will vary greatly according to the mother's diet. For optimal levels, it is necessary to supplement the mother's diet with the preformed long-chain polyunsaturated fatty acids AA and DHA.
During fetal development, DHA is transported across the placenta into the fetal circulation. Although the fetal brain can produce a limited amount of DHA from the precursor ALA and produce some DHA in the liver, it is not enough for optimal brain development.
Premature and low birth weight infants are born with deficits of DHA. This contributes to the fragility of the periventricular vascular system and hemorrhage risk. The vascular network serving the developing brain cannot accommodate the brain neuronal growth. Therefore, supplementation of their formulas with the amounts of DHA and AA typically found in human milk is critical.
Preterm infants fed with breast milk had an IQ that was 8.3 points higher at the age of 7.5-8 years when compared to those fed with formula containing LA and ALA (no DHA). Preterm infants fed formula supplemented with DHA had a higher Mental Development Index score at twelve months than control infants fed formula without DHA.
Studies indicate that the mental development and visual acuity of infants are positively affected by breastfeeding and that breastfed infants have higher levels of DHA in their brain tissue and enhanced mental ability later in life when compared to those fed infant formula not containing DHA.
"Brain development in humans takes place primarily in the last trimester in utero and in the first twelve months of post-natal life and then at a slower pace up to 30 years of age."
There is growing evidence of anti-inflammatory omega-3 polyunsaturated fatty acids preventing allergic disease. In a study by Dunstan,6 et al., a group of researchers supplemented pregnant women from twenty weeks gestation until delivery with ether 3.7 g of omega-3 polyunsaturated fatty acids or a placebo. All neonatal cytokine responses to allergens tended to be lower in the fish oil group. Although this study was not designed to examine clinical effects, the authors noted that infants in the fish oil group were three times less likely to have a positive skin prick test to egg at one year of age. In addition, infants in the fish oil group also had significantly less severe atopic dermatitis disease by 91 percent.
Logan and Lesperance,7 in the journal Medical Hypothesis, reported physiological abnormalities in children with primary nocturnal enuresis (PNE). They found deficits within the central nervous system and noted that omega-3 fatty acids are known to influence these abnormalities. In addition, they state that omega-3 fatty acids are well documented to play a critical role in the normal development of the central nervous system. Omega-3 fatty acids may, therefore, have therapeutic value in treatment of PNE. They conclude, "Given the current excess of omega-6 rich oils in Western countries, all health professionals should at least ensure adequate intake of omega-3 fatty acids in children with PNE."
Omega-3 essential fatty acids are necessary at all stages of life and, since they cannot be synthesized by the body, must be ingested. Caution must be utilized in obtaining these PUFAs from eating fish due to the oftentimes high levels of contaminants, such as mercury, dioxins, polychlorinated biphenyls and estrogens. Many researchers recommend purified fish oils that have been tested and found to be free of contaminants. Gallagher states that women can safely commence omega-3 intake in early pregnancy to allow the full benefits of it to be incorporated into the body and preprogram the babys cell membranes for optimum lifelong wellness.8Untainted fish oils containing abundant levels of Omega-3 fatty acids should be a routine supplement during pregnancy and lactation.
Dr. Dan Murphy graduated magna cum laude from Western States Chiropractic College in 1978. He received Diplomat status in Chiropractic Orthopedics in 1986. Since 1982, Dr. Murphy has served part-time as undergraduate faculty at Life Chiropractic College West, currently teaching classes to seniors in the management of spinal disorders. He has taught more than 2000 postgraduate continuing education seminars. Dr. Murphy is a contributing author to both editions of the book Motor Vehicle Collision Injuries and to the book Pediatric Chiropractic.
1. Genuis S J and Schwalfenberg G K. Time for an oil check: the role of essential omega-3 fatty acids in maternal and pediatric health. Journal of Perinatology May 4, 200 26: 359-365
2. Joseph R. Hibbeln, Laboratory of Membrane Biophysics and Biochemistry, National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health. Seafood consumption, the DHA content of mothers milk and prevalence rates of postpartum depression: a cross-national, ecological analysis. Journal of Affective Disorders May 2002 Volume 69 Issues 1-3 15-29
3. Ingrid B. Helland, MD, Lars Smith, PhD, Kristin Saarem, PhD, Ola D. Maternal Supplementation with Very-Long-Chain n-3 Fatty Acids During Pregnancy and Lactation Augments Children’s IQ at 4 Years of Age. Pediatrics January 2003; Vol. 111, No. 1: e39-e44
4. Richardson A J and Montgomery P. The Oxford-Durham Study: A Randomized, Controlled Trial of Dietary Supplementation with Fatty Acids in Children with Developmental Coordination Disorder. Pediatrics, Vol. 115 No. 5, May 2005, pp.1360-1366
5. Lloyd A Horrocks, Young K Yeo. Health Benefits of Docosahexaenoic Acid. Pharmacological Research 1999 Sep;40(3):211-25
6. Dunstan JA, Mori TA, Barden A, Beilin LJ, Taylor AL, Hoit PG, Prescott SL. Fish Oil Supplementation in Pregnancy Modifies Neonatal Allergen-Specific Immune Responses and Clinical Outcomes in Infants at Higher Risk of Atopy: a Randomized, Controlled Trial. Journal of Allergy Clinical Immunology December 2003;112(6):1178-84
7. Logan A C, Lesperance F. Primary nocturnal enuresis: Omega-3 fatty acids may be of therapeutic value. Medical Hypothesis Volume 64, Issue 6, 2005, pages 1188-1191
8. Gallagher S. Omega-3 oils and pregnancy. Midwifery Today International Midwife Spring 2004;(69):26-31