Prenatal Omega-3 Supplementation and Eczema Risk Among Offspring at Age 36 Months

Abstract

Background Long-term follow-up was completed in 84 mother-infant pairs of 118 women who completed a randomized controlled trial of prenatal supplementation with EPA- or DHA-rich fish oil or soy oil placebo. The goal of this study was to determine whether prenatal omega-3 fatty acid supplementation protects offspring against development of early childhood allergies. Methods and Findings Assessment of childhood allergic/atopic disease among offspring at age 36 months was performed by maternal interview using the National Health Interview Survey (NHIS) questions for childhood digestive allergies, wheezing, eczema or skin allergy, and respiratory allergy. Multiple logistic regressions examined the association between prenatal supplementation and childhood outcomes, adjusted for covariates. Eczema was reported in 26/84 (31%) of offspring at age 36 months, and was significantly more prevalent in the omega-3 supplementation groups vs. placebo: EPA 13/31 (41.9%); DHA 10/26 (38.5%); placebo 3/27 (11.1%), p=0.019. Compared to placebo, EPA and DHA were associated with ≥5 times risk of offspring eczema [odds ratios (ORs): EPA 5.8 (95% CI 1.4–23.3); DHA 5.0 (95% CI 1.2–21.0)]. After adjusting for other potential risk factors (race, birth weight, vaginal/Cesarean delivery, and maternal eczema) the magnitudes of association for omega-3 supplementation increased: EPA OR 8.1 (95% CI 1.4–45.6); DHA OR 9.6 (95% CI 1.6–58.5). Maternal eczema was also significantly associated with offspring eczema in the adjusted model: OR 10.8 (95% CI 2.1–54.3) Conclusion Contrary to our hypothesis, acids supplementation compared to soy oil was associated with a substantial increase in risk of childhood eczema. This association was not observed on childhood respiratory or digestive outcomes. It is unclear if these findings were driven by unfavorable effects of omega-3s, or whether there may have been unanticipated protective effects of the soy-based placebo with regards to eczema.

ω-3 LCPUFA supplementation during pregnancy and risk of allergic outcomes or sensitization in offspring

“…After removal of duplicates and title/abstract screening, the remaining 79 full text papers were assessed against the eligibility criteria for this systematic review. Ten publications from nine unique RCTs were included in the final analyses, including a total of 3,637 children (21,28,30,32,34,38,43,47,48,50) . In the case of one trial (29) , both the reports of an earlier (28) as well as latest follow-up data (47) were included, since some of the allergic outcomes of interest for this systematic review were reported only in the earlier published paper of this trial i.e.…”

“…The trial by Olsen (30) included intervention, placebo and no oil groups and for the purpose of this review, only the intervention and placebo arms were included in meta-analyses. The other trial by Berman (50) included two intervention groups of EPA, DHA and placebo. For this review, the two intervention arms were combined and compared versus the control group.…”

“…Four trials were conducted on high-risk (atopy) populations (21,32,34,38) and the remainder (28,30,43,47,48,50) were carried out on sample with low-risk allergies. The sample size of studies at randomisation were also varied, from 98 (21) to 1,094 (43) pregnant women.…”

“…Seven of the included trials used ω-3 LCPUFA (combination of EPA, DHA and/or both) (21,28,32,38,43,47,48,50) , one used oily fish (34) and the other used black currant seed oil (BCSO) (30) . Six (21,28,34,38,43,47,50) trials supplemented women only during pregnancy and in three trials (30,32,48) , the intervention was continued postnatally (Table 1).…”

“…Allergic outcomes were diagnosed by a physician or nurse in 6 trials (21,30,32,34,38,48) and the remainder (28,43,50) used validated or semi-validated questionnaires. The definitions and diagnosis method for each outcome included in meta-analyses are presented in Table 2.…”