Maternal Docosahexaenoic Acid Supplementation and Infant Neurodevelopmental Outcomes at Twelve Months: A Randomized, Placebo-Controlled Trial
DOI:
https://doi.org/10.5281/zenodo.22343522Keywords:
docosahexaenoic acid, maternal supplementation, infant neurodevelopment, pregnancy nutrition, visual acuityAbstract

Background: Docosahexaenoic acid (DHA) accumulates rapidly in the fetal and infant brain and retina, and maternal intake
during pregnancy and lactation is often below recommended levels. Objective: To synthesise published evidence on maternal DHA
supplementation and infant neurodevelopmental outcomes around twelve months. Methods: Narrative review of randomised
trials, systematic reviews and meta-analyses, and mechanistic studies identified through PubMed and Cochrane Library searches.
Findings: Trials show consistent improvements in visual acuity and modest, inconsistent gains in cognitive and psychomotor
scores, moderated by dose, timing, and baseline status. Conclusions: Maternal DHA supplementation supports visual maturation,
but cognitive benefits at twelve months remain heterogeneous across trials.
References
Makrides M, Gibson RA, McPhee AJ, Yelland L, Quinlivan J, Ryan P. Effect of DHA supplementation during pregnancy on maternal depression and neurodevelopment of young children: a randomized controlled trial. JAMA. 2010;304(15):1675-1683. doi:10.1001/jama.2010.1507. PMID:20959577.
Gould JF, Smithers LG, Makrides M. The effect of maternal omega-3 (n-3) LCPUFA supplementation during pregnancy on early childhood cognitive and visual development: a systematic review and meta-analysis of randomized controlled trials. Am J Clin Nutr. 2013;97(3):531-544. doi:10.3945/ajcn.112.045781. PMID:23364006.
Innis SM. Dietary (n-3) fatty acids and brain development. J Nutr. 2007;137(4):855-859. doi:10.1093/jn/137.4.855. PMID:17374644.
Uauy R, Hoffman DR, Peirano P, Birch DG, Birch EE. Essential fatty acids in visual and brain development. Lipids. 2001;36(9):885-895. doi:10.1007/s11745-001-0798-1. PMID:11724460.
Koletzko B, Lien E, Agostoni C, Böhles H, Campoy C, Cetin I, Decsi T, Dudenhausen JW, Dupont C, Forsyth S, Hoesli I, Holzgreve W, Lapillonne A, Putet G, Secher NJ, Symonds M, Szajewska H, Willatts P, Uauy R. The roles of long-chain polyunsaturated fatty acids in pregnancy, lactation and infancy: review of current knowledge and consensus recommendations. J Perinat Med. 2008;36(1):5-14. doi:10.1515/JPM.2008.001. PMID:18184094.
Helland IB, Smith L, Saarem K, Saugstad OD, Drevon CA. 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):e39-44. doi:10.1542/peds.111.1.e39. PMID:12509593.
Judge MP, Harel O, Lammi-Keefe CJ. Maternal consumption of a docosahexaenoic acid-containing functional food during pregnancy: benefit for infant performance on problem-solving but not on recognition memory tasks at age 9 mo. Am J Clin Nutr. 2007;85(6):1572-1577. doi:10.1093/ajcn/85.6.1572. PMID:17556695.
Helland IB, Smith L, Blomén B, Saarem K, Saugstad OD, Drevon CA. Effect of supplementing pregnant and lactating mothers with n-3 very-long-chain fatty acids on children's IQ and body mass index at 7 years of age. Pediatrics. 2008;121(6):e1522-1530. doi:10.1542/peds.2007-2762. PMID:18676533.
Colombo J, Carlson SE, Cheatham CL, Shaddy DJ, Kerling EH, Thodosoff JM, Gustafson KM, Brez C. Long-term effects of LCPUFA supplementation on childhood cognitive outcomes. Am J Clin Nutr. 2013;98(2):403-412. doi:10.3945/ajcn.112.040766. PMID:23803884.
Colombo J, Gustafson KM, Gajewski BJ, Shaddy DJ, Kerling EH, Thodosoff JM, Doty T, Brez CC, Carlson SE. Prenatal DHA supplementation and infant attention. Pediatr Res. 2016;80(5):656-662. doi:10.1038/pr.2016.134. PMID:27362506.
Gould JF, Treyvaud K, Yelland LN, Anderson PJ, Smithers LG, McPhee AJ, Makrides M. Seven-year follow-up of children born to women in a randomized trial of prenatal DHA supplementation. JAMA. 2017;317(11):1173-1175. doi:10.1001/jama.2016.21303. PMID:28324081.
Judge MP, Harel O, Lammi-Keefe CJ. A docosahexaenoic acid-functional food during pregnancy benefits infant visual acuity at four but not six months of age. Lipids. 2007;42(2):117-122. doi:10.1007/s11745-006-3007-3. PMID:17393217.
Khandelwal S, Kondal D, Chaudhry M, Patil K, Swamy MK, Metgud D, Jogalekar S, Kamate M, Divan G, Gupta R, Prabhakaran D, Tandon N, Ramakrishnan U, Stein AD. Effect of Maternal Docosahexaenoic Acid (DHA) Supplementation on Offspring Neurodevelopment at 12 Months in India: A Randomized Controlled Trial. Nutrients. 2020;12(10):3041. doi:10.3390/nu12103041. PMID:33023067.
Ramakrishnan U, Stein AD, Parra-Cabrera S, Wang M, Imhoff-Kunsch B, Juárez-Márquez S, Rivera J, Martorell R. Effects of docosahexaenoic acid supplementation during pregnancy on gestational age and size at birth: randomized, double-blind, placebo-controlled trial in Mexico. Food Nutr Bull. 2010;31(2 Suppl):S108-116. doi:10.1177/15648265100312S203. PMID:20715595.
Krauss-Etschmann S, Shadid R, Campoy C, Hoster E, Demmelmair H, Jiménez M, Gil A, Rivero M, Veszprémi B, Decsi T, Koletzko BV. Effects of fish-oil and folate supplementation of pregnant women on maternal and fetal plasma concentrations of docosahexaenoic acid and eicosapentaenoic acid: a European randomized multicenter trial. Am J Clin Nutr. 2007;85(5):1392-1400. doi:10.1093/ajcn/85.5.1392. PMID:17490978.
Escolano-Margarit MV, Ramos R, Beyer J, Csábi G, Parrilla-Roure M, Cruz F, Perez-Garcia M, Hadders-Algra M, Gil A, Decsi T, Koletzko BV, Campoy C. Prenatal DHA status and neurological outcome in children at age 5.5 years are positively associated. J Nutr. 2011;141(6):1216-1223. doi:10.3945/jn.110.129635. PMID:21525247.
Malcolm CA, McCulloch DL, Montgomery C, Shepherd A, Weaver LT. Maternal docosahexaenoic acid supplementation during pregnancy and visual evoked potential development in term infants: a double blind, prospective, randomised trial. Arch Dis Child Fetal Neonatal Ed. 2003;88(5):F383-390. doi:10.1136/fn.88.5.f383. PMID:12937042.
Birch EE, Castañeda YS, Wheaton DH, Birch DG, Uauy RD, Hoffman DR. Visual maturation of term infants fed long-chain polyunsaturated fatty acid-supplemented or control formula for 12 mo. Am J Clin Nutr. 2005;81(4):871-879. doi:10.1093/ajcn/81.4.871. PMID:15817866.
Lucas A, Stafford M, Morley R, Abbott R, Stephenson T, MacFadyen U, Elias-Jones A, Clements H. Efficacy and safety of long-chain polyunsaturated fatty acid supplementation of infant-formula milk: a randomised trial. Lancet. 1999;354(9194):1948-1954. doi:10.1016/S0140-6736(99)02314-4. PMID:10622297.
Dunstan JA, Simmer K, Dixon G, Prescott SL. Cognitive assessment of children at age 2(1/2) years after maternal fish oil supplementation in pregnancy: a randomised controlled trial. Arch Dis Child Fetal Neonatal Ed. 2008;93(1):F45-50. doi:10.1136/adc.2006.099085. PMID:17185423.
Meldrum SJ, D'Vaz N, Simmer K, Dunstan JA, Hird K, Prescott SL. Maternal fish oil supplementation in pregnancy: a 12 year follow-up of a randomised controlled trial. Nutrients. 2015;7(3):2061-2067. doi:10.3390/nu7032061. PMID:25803546.
Birch EE, Garfield S, Hoffman DR, Uauy R, Birch DG. A randomized controlled trial of early dietary supply of long-chain polyunsaturated fatty acids and mental development in term infants. Dev Med Child Neurol. 2000;42(3):174-181. doi:10.1017/s0012162200000311. PMID:10755457.
Jasani B, Simmer K, Patole SK, Rao SC. Long chain polyunsaturated fatty acid supplementation in infants born at term. Cochrane Database Syst Rev. 2017;3(3):CD000376. doi:10.1002/14651858.CD000376.pub4. PMID:28281303.
Middleton P, Gomersall JC, Gould JF, Shepherd E, Olsen SF, Makrides M. Omega-3 fatty acid addition during pregnancy. Cochrane Database Syst Rev. 2018;11(11):CD003402. doi:10.1002/14651858.CD003402.pub3. PMID:30480773.
Carlson SE, Gajewski BJ, Valentine CJ, Kerling EH, Weiner CP, Cackovic M, Buhimschi CS, Rogers LK, Sands SA, Brown AR, Mudaranthakam DP, Crawford SA, DeFranco EA. Higher dose docosahexaenoic acid supplementation during pregnancy and early preterm birth: a randomised, double-blind, adaptive-design superiority trial. EClinicalMedicine. 2021;36:100905. doi:10.1016/j.eclinm.2021.100905. PMID:34308309.
Basak S, Mallick R, Duttaroy AK. Maternal Docosahexaenoic Acid Status during Pregnancy and Its Impact on Infant Neurodevelopment. Nutrients. 2020;12(12):3615. doi:10.3390/nu12123615. PMID:33255561.
Lauritzen L, Brambilla P, Mazzocchi A, Harsløf LB, Ciappolino V, Agostoni C. DHA Effects in Brain Development and Function. Nutrients. 2016;8(1):6. doi:10.3390/nu8010006. PMID:26742060.


