High dose omega-3 recommended to reduce preterm birth risk

Summary

• Globally, 1 in 10 babies are born preterm (before 37 weeks of pregnancy) and rates are rising in many countries.¹ Preterm birth is a leading cause of death among infants, and often comes with significant and enduring health issues for survivors – as well as emotional distress for mothers.
• A growing body of scientific evidence demonstrates that increased consumption of docosahexaenoic acid (DHA), an omega-3 fatty acid, before and during pregnancy can help to reduce the risk of preterm birth.
• dsm-Firmenich addressed this important issue at the FIGO World Congress of obstetrics and gynecology (9 October), where we sponsored a symposium titled “DHA Reduces Preterm Birth Risk: New Expert Recommendations and Clinical Application”. The seminar delivered the latest evidence behind DHA’s role in pregnancy along with new clinical practice guidelines and strategies for DHA supplementation throughout the motherhood journey.

Preterm births are rising independent from socioeconomic backgrounds

When it comes to birth, every day counts.

Worldwide, 10% of all births are preterm, but rates are rising in many countries.¹ Although premature births remain a problem in the developed world, it is especially burdensome in low and middle income countries², with World Health Organization (WHO) figures demonstrating rates as high as 18% in some regions.¹

Preterm births come with significant complications. Of the estimated 13.4 million preterm births in 2020, an alarming one million babies died as a result of difficulties directly related to their preterm delivery.¹ In addition to an elevated likelihood of mortality, infants born too soon also face an increased risk of disability and delays in their development.

Yet despite the alarming figures, preterm birth rates are on the rise. For example, in 2021, preterm birth affected approximately 1 of every 10 infants born in the US. However, this rate rose by 4% in 2021 (from 10.1% in 2020 to 10.5% in 2021).³ Many factors contribute to the risk of preterm birth, including inadequate docosahexaenoic acid (DHA) intake. Women who have low DHA intake or status early in pregnancy are at an increased risk of having a preterm birth compared to women with adequate intakes.⁴ This suggests that supplementing with DHA prior to becoming pregnant may be an effective strategy to reduce a woman’s risk of giving birth too soon.¹

Adequate DHA intake before and during pregnancy can reduce the risk of preterm delivery

It is well established that omega-3 fatty acids, such as DHA, have positive benefits on both maternal health and fetal development. However, supplementation during pregnancy remains low despite recommendations by leading experts that DHA supplementation can lower the risk of preterm birth.

It was first observed almost 40 years ago that populations of women with high fish intake had longer gestations.⁵ One study spanning 184 countries worldwide concluded that preterm birth rates decreased directly in proportion to an increase in omega-3 fatty acid consumption.⁶  Similarly, a 2018 Cochrane systematic review analyzing data from almost 20,000 women globally found strong evidence that the incidence of preterm birth (before 37 weeks) and early preterm birth (before 34 weeks) was 11% and 42% lower (respectively) in women supplemented with omega-3 fatty acid compared to those who were not.⁷  

What are the new expert recommendations for DHA intake before and during pregnancy?

The World Congress of Gynecology and Obstetrics (FIGO) is the largest of its kind worldwide, with experts from every continent gathering to present the latest breakthroughs and scientific developments in the women’s health arena; and inspire the next generation of solutions in the field.

As a purpose-led organization that champions maternal health through the power of nutrition, dsm-firmenich sponsored a symposium during the event titled “DHA Reduces Preterm Birth Risk: Expert Recommendations and Clinical Application”. During the session, Prof. Dr. Berthold Koletzko, Dr. Susan Carlson and Dr. Irene Cetin shared new clinical practice guidelines from a global panel of 24 leading obstetricians, nutrition scientists and pediatricians with expertise in maternal nutrition. The expert panel operated independent of industry and was sponsored by the Child Health Foundation at LMU Univ. Hospitals Munich. For the first time ever, the panel offered recommendations for omega-3 intake specifically for women of childbearing age to reduce their risk of preterm birth. Additionally, they concluded that the amount of omega-3 commonly recommended for pregnant women (~200-250 mg/day) is not enough, especially for women with low intakes early in pregnancy.

Below are summarize the key conclusions from the expert panel:

• All women of childbearing age should consume at least 250 mg of DHA+EPA per day (this intake can be met with DHA alone).
• Pregnant women should consume at least 350-450 mg of DHA+EPA per day, with at least 100-200 mg coming from DHA specifically (as above, all of this intake can come from DHA alone).
• Pregnant women with low DHA intake and/or blood status at the beginning of pregnancy should consume 600-1000 mg DHA+EPA (or DHA) daily.
  -        A food frequency questionnaire (like the one here) is an effective way to identify women with low DHA intake.
• Intakes of up to 1000 mg DHA+EPA (or DHA) per day does not raise safety concerns in pregnant women.

Improving choice for better birth outcomes

With omega-3 oil traditionally derived from oily fish, there are often dietary and taste barriers that can make it difficult to achieve adequate DHA intake in pregnancy. For example, vegetarians and vegans are typically excluded from traditional supplements, while the fishy aftertaste associated with omega-3 products is off-putting for many consumers. Most importantly, the low DHA levels naturally found in fish oil make the size and number of supplement servings challenging to adhere to, especially for pregnant women.

dsm-firmenich is the preferred end-to-end partner for innovation in the maternal supplement arena. Drawing upon years of expertise and the most extensive range of nutritional lipids obtained from fermentation processes, we possess a deep understanding of target applications and consumer preferences. This enables us to provide customized solutions that seamlessly complement our customers' current product offerings. These solutions range from unique nutritional lipids under the life'sDHA^® brand to differentiated market ready solutions. For example, life'sDHA^® offers concentrated DHA in a smaller vegetarian-based capsule.