Disease Proof

Does omega-3 supplementation during pregnancy prevent postpartum depression? Improve baby's brain development?

Omega-3 fats are essential – we must take them in from our diets because our body cannot synthesize them. These fats are extremely important for many facets of our health, especially the health of the brain and cardiovascular system.[1] Omega-3 fat is a major structural component of brain cell membranes and the retina – about 60% of the dry weight of the brain is made up of fat, and DHA is the most abundant fat in the brain. [2]
 

As such, DHA is an essential factor in early brain development, and maintaining adequate levels during pregnancy is believed to benefit the child’s cognitive development.[3] The current consensus is that pregnant women should consume at least 200 mg DHA each day to promote normal fetal brain development. Pregnant women are also urged to limit fish consumption because of mercury contamination, which is harmful to the brain of the developing baby.[4] Fish oil or vegan DHA supplements are therefore an attractive option for pregnant women.


In 2009, the results of three randomized controlled trials were pooled and showed that babies given supplemental DHA in formula scored higher on a problem solving test at 9 months of age than babies given control formula. However, there is some disagreement in the literature as to whether DHA supplementation during pregnancy and infancy actually improves cognitive development in the child.[5]


A recently published study in the Journal of the American Medical Association reported an unexpected finding: Pregnant women who took fish oil capsules (800 mg DHA and 100 mg EPA per day) compared to vegetable oil placebo capsules did not have lower incidence of postpartum depression, and their children did not have improved cognitive development at 18 months of age.[6]
Of course, this does not mean that pregnant women shouldn’t bother taking DHA. The developing baby’s only source of DHA for beginning to build its brain tissue is its mother’s dietary intake. DHA supplementation also reduces the risk of preterm birth – a factor known to be associated with compromised cognitive development in the infant and maternal depression.[7]
In reference to the lack of effect on symptoms of depression, the therapeutic effects of omega-3 supplements on depression are due mostly to EPA rather than DHA, according to a recent meta-analysis. [8] I recommend omega-3 supplementation including 1,000 mg of EPA to treat depression – the relatively low dose of EPA used in this trial may therefore be responsible for the lack of effect on depression in this study.


An editorial published in response to the study stated potential reasons why this outcome occurred – these comments also shed light on why there seem to be discrepancies in the medical literature on this subject. One possibility is that the criteria used to measure infant brain development in this study were not sufficiently sensitive to detect small but important differences in cognition in 18-month olds. The criteria used were based on global measures of cognition, and are not designed to detect differences in specific processes such as memory, attention, and problem-solving.[7] As mentioned above, previous studies have seen differences in problem solving in infants given supplemental DHA.[5] Furthermore, there are several cognitive functions that cannot be accurately measured until children reach preschool and school age – the editorial cites a smaller study of fish oil supplementation during pregnancy that found enhanced IQ scores in 4 year olds.[9] I agree that it isn’t possibly to reliably measure intelligence in an 18-month old, and that better results would come from studies that measure cognitive function once the children are in school.


DHA is a vital component of brain tissue, and pregnant women should take at least 200 mg each day to prevent preterm birth and support normal fetal brain development to assure maximum intelligence.

 

References:

1. Yurko-Mauro, K., Cognitive and cardiovascular benefits of docosahexaenoic acid in aging and cognitive decline. Curr Alzheimer Res, 2010. 7(3): p. 190-6.
2. Muskiet, F.A., et al., Is docosahexaenoic acid (DHA) essential? Lessons from DHA status regulation, our ancient diet, epidemiology and randomized controlled trials. J Nutr, 2004. 134(1): p. 183-6.
3. Ryan, A.S., et al., Effects of long-chain polyunsaturated fatty acid supplementation on neurodevelopment in childhood: a review of human studies. Prostaglandins Leukot Essent Fatty Acids, 2010. 82(4-6): p. 305-14.
4. Koletzko, B., I. Cetin, and J.T. Brenna, Dietary fat intakes for pregnant and lactating women. Br J Nutr, 2007. 98(5): p. 873-7.
5. Drover, J., et al., Three randomized controlled trials of early long-chain polyunsaturated Fatty Acid supplementation on means-end problem solving in 9-month-olds. Child Dev, 2009. 80(5): p. 1376-84.
6. Makrides, M., et al., Effect of DHA supplementation during pregnancy on maternal depression and neurodevelopment of young children: a randomized controlled trial. JAMA, 2010. 304(15): p. 1675-83.
7. Oken, E. and M.B. Belfort, Fish, fish oil, and pregnancy. JAMA, 2010. 304(15): p. 1717-8.
8. Martins, J.G., EPA but not DHA appears to be responsible for the efficacy of omega-3 long chain polyunsaturated fatty acid supplementation in depression: evidence from a meta-analysis of randomized controlled trials. J Am Coll Nutr, 2009. 28(5): p. 525-42.
9. Helland, I.B., et al., Maternal supplementation with very-long-chain n-3 fatty acids during pregnancy and lactation augments children's IQ at 4 years of age. Pediatrics, 2003. 111(1): p. e39-44.

 

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Comments (3) Read through and enter the discussion with the form at the end
Diane - November 7, 2010 9:13 PM

I have taken DHA (algae-based) for all three of my pregnancies, beginning 11 years ago. My husband is a marine biologist and understands the importance of DHA in development and insisted that I take supplements throughout each pregnancy. With our oldest I took 500mg daily (this was 11 years ago), 800mg daily with our second and between 1200-1600mg daily with our third (she is just 10 weeks old). Typically I take 1/2 in the morning and the other 1/2 in the evening (ie. 600mg and then another 600mg). Our children are all very bright; our oldest has participated in Johns Hopkins' Center for Talented Youth the past two years. When they were babies, we repeatedly heard comments about how alert and bright-eyed they were. Additionally I never had symptoms of postpartum depression. I recommend to all my pregnant friends the importance of taking DHA. Our children take DHA (algae-based) supplements each day and I continue taking 1200mg daily while nursing.

Cathy Jones - November 8, 2010 10:44 AM

I followed Dr. Fuhrman's recommendations on this with my third child and she is much more mentally developed than my two older children. In fact the other two children often comment about her vocabulary and advanced learning. She is in first grade reading at a late second grade level! I also did not experience any postpartum depression with her. It was a great experiment for the whole family! Thanks :)

Derek Sikes - April 12, 2012 3:08 PM

I'm curious about algal DHA pills that have no EPA in them. I currently take fish oil pills that have both DHA & EPA but would like to switch to algae-derived omega 3 sources, however, most of the algal pills available are DHA only... how important is the EPA? Should I pay more to get pills that have both DHA and EPA?? I've searched around to find the answer to this question but come up empty handed and hope you can help. Thanks!

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