From:  Omega-3 fatty acids and fetal brain development: implications for maternal nutrition, mechanisms of cognitive function, and pediatric depression

 Key insights and considerations in omega-3 supplementation for maternal and fetal health

SectionKey insightsEvidence/ExamplesImplicationsReferences
Role in pregnancyEPA and DHA levels critically influence maternal and fetal health.

  • Low blood levels associated with preterm births (especially < 34 weeks).

  • Blood-based measurements (e.g., erythrocytes, whole blood, plasma) show strong inverse correlation with preterm birth risk.

  • Dietary data shows weaker or negligible associations.

Monitoring blood EPA and DHA levels is essential for reducing adverse pregnancy outcomes.[22, 23]
Dietary intake vs. blood levelsBlood levels are better predictors of outcomes than dietary intake.

  • Dietary intake may not reflect bioavailability due to variability (e.g., fat content of meals enhances absorption up to 13-fold).

  • Obesity further reduces the response to omega-3 supplementation.

Blood measurements offer a more accurate guide for clinical decisions and intervention strategies.[24, 25]
Bioavailability factorsBioavailability varies greatly among individuals.

  • Interindividual variation in omega-3 uptake (up to 13-fold).

  • Dietary interactions can alter bioavailability by up to 10-fold.

Tailored supplementation is required to address individual differences in omega-3 uptake.[26, 27]
Measurement methodsAccurate evaluation of omega-3 status relies on blood assessments.

  • Omega-3 Index: Reliable long-term marker with low biological variability.

  • HS-Omega-3 Index®: Standardized and validated as the gold standard.

  • Short-term indicators (e.g., plasma) reflect recent dietary changes but show high biological variability.

Regular blood testing provides precise data for monitoring and optimizing omega-3 status.[28–30]
Maternal-fetal transferDHA transfer via the placenta supports fetal development.

  • Fetal erythrocyte membranes reach DHA levels of 8–9%, depleting maternal stores.

  • Longer pregnancies correlate with higher fetal DHA levels.

Ensuring adequate maternal DHA levels is crucial for fetal health and development.[31, 32]
Breast milk compositionMaternal DHA status directly impacts breast milk composition.

  • Optimal Omega-3 Index (8%) corresponds to ~1% EPA and DHA in breast milk.

  • Many women fail to meet recommended levels (e.g., German pregnant women: average Omega-3 Index = 6.23).

Targeted supplementation improves maternal DHA status and breast milk quality, benefitting infants.[33–35]
Challenges in vegetarian and vegan dietsPlasma EPA and DHA levels are lower in vegetarians and vegans.

  • These groups face greater challenges in meeting recommended omega-3 levels.

Supplementation and monitoring are vital for these populations.[36, 37]
Intervention trials and challengesOmega-3 studies face unique ethical and methodological challenges.

  • Cannot ethically deprive participants of omega-3 (minimum Omega-3 Index ~2% necessary for survival).

  • Baseline variability and bioavailability differences complicate trial outcomes.

Standardized methods and tailored interventions enhance trial effectiveness and clinical relevance.[29]
Future research directionsAddressing methodological gaps can unlock the full potential of EPA and DHA.

  • Studies with standardized blood measurements show more consistent results.

  • Personalized supplementation strategies offer promise, especially for vulnerable populations like pregnant women.

Improved methodologies can maximize the health benefits of EPA and DHA supplementation.[38, 39]
Return to article view

EPA: eicosapentaenoic acid; DHA: docosahexaenoic acid