Plasma Concentrations of Long Chain N-3 Fatty Acids in Early and Mid-Pregnancy and Risk of Early Preterm Birth

Abstract

Background Fish oil supplementation has been shown to delay spontaneous delivery, but the levels and clinical significance remain uncertain. We examined the association between plasma fatty acids quantified in pregnancy and subsequent risk of early preterm birth. Methods In a case-control design nested in the Danish National Birth Cohort, we identified 376 early preterm cases (<34 gestational weeks, excluding preeclampsia cases) and 348 random controls. Plasma eicosapentaenoic acid plus docosahexaenoic acid (EPA+DHA% of total fatty acids), were measured twice in pregnancy, at gestation weeks 9 and 25 (medians). Odds ratios and 95% confidence intervals (CI's) for associations between EPA+DHA and early preterm risk were estimated by logistic regression, adjusted for the woman's age, height, pre-pregnancy BMI, parity, smoking, and socioeconomic factors. Hypotheses and analytical plan were defined and archived a priori . Findings Analysis using restricted cubic splines of the mean of 1st and 2nd sample measurements showed a strong and significant non-linear association ( p < 0.0001) in which the risk of early preterm birth steeply increased when EPA+DHA concentrations were lower than 2% and flattened out at higher levels. Women in the lowest quintile (EPA+DHA < 1.6%) had 10.27 times (95% confidence interval 6.80–15.79, p < 0.0001) increased risk, and women in the second lowest quintile had 2.86 (95% CI 1.79–4.59, p < 0.0001) times increased risk, when compared to women in the three aggregated highest quintiles (EPA+DHA ≥ 1.8%). Interpretation Low plasma concentration of EPA and DHA during pregnancy is a strong risk factor for subsequent early preterm birth in Danish women.

Nutritional Gaps and Supplementation in the First 1000 Days

“…Early studies showed that low consumption of seafood was a strong risk factor for preterm delivery and LBW [190]. This group also showed that maternal plasma concentrations of EPA and DHA during early and mid-pregnancy were strongly associated with early preterm birth, with lower levels of the lipids leading to higher risk [191]. DHA supplementation during pregnancy resulted in longer gestation duration, fewer preterm births, greater mean birth weight, length and head circumference, significantly fewer infants who were admitted to an intensive care unit, and shorter hospital stays for infants born preterm [192][193][194].…”

Omega-3 Fatty Acids in Pregnancy—The Case for a Target Omega-3 Index

“…Clinical effects correlate less well with intake than with blood levels. An example is premature birth before week 34 of pregnancy, which is more likely with low levels than with high levels of EPA and DHA, with risk for preterm birth correlating inversely with levels in erythrocytes, whole blood, or plasma [11][12][13][14]. Data derived from assessments of intake of EPA and DHA showed smaller risks, if at all detected, and no association with dose [15].…”

Verwirrung um die Wirkung von Omega-3-Fettsäuren

“…EPA und DHA haben sowohl individuelle als auch gemeinsame biologische Aktivitäten, die aber nicht von α-Linolensäure ersetzt werden können; so wird etwa die Endothelfunktion von EPA und DHA, nicht aber von α-Linolensäure gebessert. Hohe Spiegel von EPA und DHA, nicht aber hohe Spiegel von α-Linolensäure sind mit einer geringen Gesamtmortalität und geringen Raten an kardiovaskulären und anderen relevanten Erkrankungen, wie Frühgeburten oder Major-Depression, assoziiert [17,18,21,22,29,37].…”

“…Niedrige Spiegel von Omega-3-Fettsäuren sind kausal für Frühgeburten [27,29]. Mit Omega-3-Fettsäuren lassen sich die perinatale Mortalität, Frühgeburten und weitere perinatale Komplikationen für Kind und Mutter vermindern [27].…”