Lancet ; Crit Rev Food Sci Nutr ; An open trial of omega-3 fatty acids for depression in pregnancy. Acta Neuropsychiatr ; Acta Psychiatr Scand ; J Affect Disord ;—29 Child Dev ;— Pediatrics ;— J Allergy Clin Immunol ;— Clin Exp Allergy ;— Prostaglandins Leukot Essent Fatty Acids ;— Measurement of mercury levels in concentrated over-the-counter fish oil preparations: Is fish oil healthier than fish?
Arch Pathol Lab Med ;— Measurement of organochlorines in commercial over-the-counter fish oil preparations: Implications for dietary and therapeutic recommendations for omega-3 fatty acids and a review of the literature. Food and Drug Administration.
Fish: What pregnant women and parents should know. Can I get pregnant if…? Dietary fat intakes for pregnant and lactating women. The British journal of nutrition. Prostaglandins, leukotrienes, and essential fatty acids.
Food and Drug Administration. Advice about Eating Fish. Journal of the Academy of Nutrition and Dietetics. Prenatal mercury exposure, fish intake and neurocognitive development during first three years of life: Prospective cohort mothers and Children's environmental health MOCEH study. The Science of the total environment. Low-level gestational exposure to mercury and maternal fish consumption: Associations with neurobehavior in early infancy.
Neurotoxicology and teratology. American journal of epidemiology. Polyunsaturated fatty acids in the diet and breast milk of lactating icelandic women with traditional fish and cod liver oil consumption.
A randomized controlled trial of the effect of fish oil supplementation in late pregnancy and early lactation on the n-3 fatty acid content in human breast milk. If her level was below the WWA 0. To assist with this, a table showing the DHA and mercury content of a variety of seafood and supplements was included with the report Additional file 1 ; Fish intake.
A second breast milk sample was collected and returned with another brief questionnaire 4 weeks after the first sample was taken.
One-page surveys were voluntarily filled out and returned by participants in pre-paid, return mail envelopes. The baseline survey collected information about demographic and pregnancy characteristics, average servings of fish per month and the use of a DHA containing supplement Additional file 2 ; Baseline questionnaire.
Data are presented as medians Interquartile Range [IQR]; 25 th percentile, 75 th percentile due to the non-normal distribution for most variables. Categorical variables, i. Mann-Whitney test was used to compare baseline continuous variables, including DHA levels, between independent groups. Wilcoxon signed-rank test was used to compare the difference between baseline and follow-up DHA levels in participants who provided a follow-up sample after being informed of their initial DHA level.
Baseline data were available from 84 women. Of them, 20 did not return their follow-up sample and questionnaire Fig. For six women, email difficulties prevented them from receiving their baseline breast milk DHA results apparently due to spam email filters. Four of these six women still sent in their follow-up sample despite not receiving their baseline report, but this data was not used in the main analyses as they were unable to make an informed decision about whether to change their DHA intakes without baseline information.
The reasons why the other 20 mothers including two who did not receive their baseline results did not send follow up samples are unknown. Therefore, 60 women were included in the follow-up analyses. Of them, 13 reported taking a DHA supplement. Group medians compared with Mann-Whitney statistical test. Symbols dots represent individual participant data, bar represents median, lines represent IQR.
Worldwide average breast milk DHA level from Brenna et al [ 10 ] is indicated by the dashed line. Milk DHA levels at baseline 0. Group medians compared with the Wilcoxon statistical test. Worldwide average breast milk DHA level from Brenna et al. There were two primary findings of this study.
This finding is disconcerting given guidelines to increase DHA provision during pregnancy and lactation for the health of both mother and her baby [ 14 ]. The second finding of this study is that when women were provided with information about their breast milk DHA levels and information on the recommended intake for lactating mothers, they responded with a modest increase in milk DHA content within about 1 month.
For the pregnant woman, DHA status is directly associated with the length of gestation [ 19 ] and fetal growth [ 20 ] and is indirectly associated with anxiety [ 21 ] and postpartum depressive symptoms [ 5 ].
Indeed, supplementation during pregnancy may even decrease healthcare costs [ 22 ]. For the baby, DHA supports vision, brain development, memory [ 23 ], attention [ 24 ] and immunological status [ 25 ]. Indeed, improved DHA status during infancy may have lasting effects on learning [ 26 ] and is associated with less atopic disease [ 5 , 25 ].
There are very few outcomes based studies conducted in infants who are exclusively breastfed with varying levels of DHA when compared to studies conducted in infants who are fed formula with varying DHA content.
Thus, the optimal breast milk DHA level has yet to be determined. There is evidence to suggest that breast milk DHA levels of 0. This variability in DHA levels is based on many factors, including maternal age [ 28 ], genetic variation, race, gestation, body mass index, parity, smoking, duration of lactation, and most importantly, maternal diet [ 1 , 29 — 35 ].
Increasing intake of alpha-linolenic acid, the plant-based precursor to DHA, does not significantly increase breast milk DHA levels [ 37 ]. Although compliance and average daily DHA doses were asked for from our study participants, these specific response rates were low making it difficult to draw any insight about optimal supplementation doses. Similarly, formal dietary assessment was not conducted in this study, so background dietary intake of DHA cannot be ascertained.
Since DHA levels in mature milk typically remain the same or decline over time [ 30 , 33 , 34 ], we believe the observed increase was due to increased nutritional DHA intake primarily from supplements and not to other biological factors.
Other influences associated with maternal DHA status such as race, gestation, and body weight [ 33 , 45 , 46 ] did not change within our study population.
We also concur that testing and informing mothers about their breast milk DHA levels could be a novel and cost-effective way to improve DHA status and would provide measurable values necessary to guide ongoing adjustment in the recommended daily dose of DHA during pregnancy and lactation to optimize outcomes for both mother and baby. A limitation of this study was that the cohort was racially homogeneous and relatively well-educated, which undoubtedly introduced some selection bias.
All mothers in this study lived in the upper Midwest of the USA and in a single community a review of past studies [Table 1 ] suggests that single city studies are the norm in this research arena. Another limitation is that follow up was not complete in all participants.
Several mothers did not return a second test within a month of getting the report on their breast milk DHA levels. Accordingly, we cannot properly determine the extent to which providing this education motivated change since the group of women who did send a second sample may not be representative of all women in the study. However, baseline characteristics of those who did and did not submit a follow up sample were similar.
An additional study limitation was our dependence on self-report for demographic, dietary and supplement use information. The questionnaire was simple and did not include a validated food diary or the timing of sample collection during the feed before, during or after a breastfeed.
The use of a validated food diary would provide valuable information about maternal diet, but may have hindered participation and compliance. Possible misunderstandings of certain items in the baseline questionnaire e.
Strengths of the study include that it is a relatively large sample size for this type of project being the second largest of the 17 studies included in Table 1. This is the only study to our knowledge that explores the effects of informing the subjects of their own personal levels on breast milk DHA levels. We also used a novel and validated dried milk spot method to collect and measure milk DHA content.
The test is simple to use, with little to no risk and is commercially available; whether the cost outweighs the benefit remains to be seen. However, breast milk DHA content can be increased with personalized testing and the provision of information about safe ways to attain the recommended daily DHA intake during lactation. Effect of docosahexaenoic acid supplementation of lactating women on the fatty acid composition of breast milk lipids and maternal and infant plasma phospholipids. Am J Clin Nutr.
Effect of increasing breast milk docosahexaenoic acid on plasma and erythrocyte phospholipid fatty acids and neural indices of exclusively breast fed infants. American Academy of Pediatrics. Bantam Books, Mosby, Riordan J, Wambach K. Breastfeeding and Human Lactation Fourth Edition. Jones and Bartlett Learning, Your Privacy Rights. To change or withdraw your consent choices for VerywellFamily. At any time, you can update your settings through the "EU Privacy" link at the bottom of any page.
These choices will be signaled globally to our partners and will not affect browsing data. We and our partners process data to: Actively scan device characteristics for identification. I Accept Show Purposes. Was this page helpful?
0コメント