The roles of long-chain polyunsaturated fatty acids in pregnancy, lactation and infancy: review of current knowledge and consensus recommendations

Abstract This paper reviews current knowledge on the role of the long-chain polyunsaturated fatty acids (LC-PUFA), docosahexaenoic acid (DHA, C22:6n-3) and arachidonic acid (AA, 20:4n-6), in maternal and term infant nutrition as well as infant development. Consensus recommendations and practice guidelines for health-care providers supported by the World Association of Perinatal Medicine, the Early Nutrition Academy, and the Child Health Foundation are provided. The fetus and neonate should receive LC-PUFA in amounts sufficient to support optimal visual and cognitive development. Moreover, the consumption of oils rich in n-3 LC-PUFA during pregnancy reduces the risk for early premature birth. Pregnant and lactating women should aim to achieve an average daily intake of at least 200 mg DHA. For healthy term infants, we recommend and fully endorse breastfeeding, which supplies preformed LC-PUFA, as the preferred method of feeding. When breastfeeding is not possible, we recommend use of an infant formula providing DHA at levels between 0.2 and 0.5 weight percent of total fat, and with the minimum amount of AA equivalent to the contents of DHA. Dietary LC-PUFA supply should continue after the first six months of life, but currently there is not sufficient information for quantitative recommendations.

[1]  Zhang Wei-qu.  Infant and Young Child Nutrition 620 Cases of Anemia Related Factors , 2009 .

[2]  J. Dungan.  Maternal seafood consumption in pregnancy and neurodevelopmental outcomes in childhood (ALSPAC study): an observational cohort study , 2008 .

[3]  B. Koletzko,et al.  Dietary fat intakes for pregnant and lactating women , 2007, British Journal of Nutrition.

[4]  B. Koletzko,et al.  Effect of supplementation of women in high-risk pregnancies with long-chain polyunsaturated fatty acids on pregnancy outcomes and growth measures at birth: a meta-analysis of randomized controlled trials , 2007, British Journal of Nutrition.

[5]  E. Birch,et al.  Visual acuity and cognitive outcomes at 4 years of age in a double-blind, randomized trial of long-chain polyunsaturated fatty acid-supplemented infant formula. , 2007, Early human development.

[6]  B. Koletzko,et al.  Effect of fish oil supplementation on fatty acid status, coordination, and fine motor skills in children with phenylketonuria. , 2007, The Journal of pediatrics.

[7]  E. Hoster,et al.  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. , 2007, The American journal of clinical nutrition.

[8]  T. Cole,et al.  Infant nutrition and stereoacuity at age 4-6 y. , 2007, The American journal of clinical nutrition.

[9]  B. Koletzko,et al.  Placental transfer of long-chain polyunsaturated fatty acids (LC-PUFA) , 2007, Journal of perinatal medicine.

[10]  B. Bondy,et al.  Expression pattern of fatty acid transport protein-1 (FATP-1), FATP-4 and heart-fatty acid binding protein (H-FABP) genes in human term placenta. , 2006, Early human development.

[11]  E. Lien,et al.  Human milk fatty acid composition from nine countries varies most in DHA , 2006, Lipids.

[12]  M. Hadders‐Algra,et al.  Neurologic Condition of Healthy Term Infants at 18 Months: Positive Association With Venous Umbilical DHA Status and Negative Association With Umbilical Trans-fatty Acids , 2006, Pediatric Research.

[13]  L. Duley,et al.  Marine oil, and other prostaglandin precursor, supplementation for pregnancy uncomplicated by pre-eclampsia or intrauterine growth restriction. , 2006, The Cochrane database of systematic reviews.

[14]  B. Koletzko,et al.  Effect of n-3 long-chain polyunsaturated fatty acid supplementation of women with low-risk pregnancies on pregnancy outcomes and growth measures at birth: a meta-analysis of randomized controlled trials. , 2006, The American journal of clinical nutrition.

[15]  L. Palmer,et al.  Common genetic variants of the FADS1 FADS2 gene cluster and their reconstructed haplotypes are associated with the fatty acid composition in phospholipids. , 2006, Human molecular genetics.

[16]  M. Hadders‐Algra,et al.  Relationship Between Umbilical Cord Essential Fatty Acid Content and the Quality of General Movements of Healthy Term Infants at 3 Months , 2006, Pediatric Research.

[17]  B. Koletzko,et al.  Effect of n – 3 long-chain polyunsaturated fatty acid supplementation of women with low-risk pregnancies on pregnancy outcomes and growth measures at birth : a meta-analysis of randomized controlled trials 1 , 2 , 2006 .

[18]  Berthold Koletzko,et al.  Global standard for the composition of infant formula: recommendations of an ESPGHAN coordinated international expert group. , 2010, Journal of pediatric gastroenterology and nutrition.

[19]  C. Agostoni,et al.  Reduced docosahexaenoic acid synthesis may contribute to growth restriction in infants born to mothers who smoke. , 2005, The Journal of pediatrics.

[20]  H. Weiler,et al.  Maternal and Cord Blood Long-Chain Polyunsaturated Fatty Acids Are Predictive of Bone Mass at Birth in Healthy Term-Born Infants , 2005, Pediatric Research.

[21]  P. Calder,et al.  Conversion of alpha-linolenic acid to longer-chain polyunsaturated fatty acids in human adults. , 2005, Reproduction, nutrition, development.

[22]  K. Michaelsen,et al.  Maternal fish oil supplementation in lactation: effect on developmental outcome in breast-fed infants. , 2005, Reproduction, nutrition, development.

[23]  Bruce N. Ames,et al.  Is docosahexaenoic acid, an n−3 long-chain polyunsaturated fatty acid, required for development of normal brain function? An overview of evidence from cognitive and behavioral tests in humans and animals , 2005 .

[24]  R. Voigt,et al.  Effects of maternal docosahexaenoic acid intake on visual function and neurodevelopment in breastfed term infants. , 2005, The American journal of clinical nutrition.

[25]  S. Prescott,et al.  Does fish oil supplementation in pregnancy reduce the risk of allergic disease in infants? , 2005, Current opinion in allergy and clinical immunology.

[26]  K. Kleinman,et al.  Maternal Fish Consumption, Hair Mercury, and Infant Cognition in a U.S. Cohort , 2005, Environmental health perspectives.

[27]  R. Gibson,et al.  Supplementation of infant formula with long-chain polyunsaturated fatty acids does not influence the growth of term infants. , 2005, The American journal of clinical nutrition.

[28]  M. Fleith,et al.  Dietary PUFA for Preterm and Term Infants: Review of Clinical Studies , 2005, Critical reviews in food science and nutrition.

[29]  S. Innis,et al.  Essential fatty acid transfer and fetal development. , 2005, Placenta.

[30]  M. Hadders‐Algra,et al.  Long‐chain polyunsaturated fatty acids and neurological developmental outcome at 18 months in healthy term infants , 2005, Acta paediatrica.

[31]  J. Dobbing,et al.  The later development of the brain and its vulnerability , 1982, Journal of Inherited Metabolic Disease.

[32]  B. Ames,et al.  Is docosahexaenoic acid, an n-3 long-chain polyunsaturated fatty acid, required for development of normal brain function? An overview of evidence from cognitive and behavioral tests in humans and animals. , 2005, The American journal of clinical nutrition.

[33]  E. Birch,et al.  Maturation of visual acuity is accelerated in breast-fed term infants fed baby food containing DHA-enriched egg yolk. , 2004, The Journal of nutrition.

[34]  K. Michaelsen,et al.  Maternal fish oil supplementation in lactation: Effect on visual acuity and n−3 fatty acid content of infant erythrocytes , 2004, Lipids.

[35]  H. Bremer,et al.  Effects of dietary long-chain polyunsaturated fatty acids on the essential fatty acid status of premature infants , 2004, European Journal of Pediatrics.

[36]  P. Holt,et al.  Fish oil supplementation in pregnancy modifies neonatal allergen-specific immune responses and clinical outcomes in infants at high risk of atopy: a randomized, controlled trial. , 2003, The Journal of allergy and clinical immunology.

[37]  S. Wassall,et al.  Docosahexaenoic acid: membrane properties of a unique fatty acid. , 2003, Chemistry and physics of lipids.

[38]  C. Agostoni,et al.  Earlier smoking habits are associated with higher serum lipids and lower milk fat and polyunsaturated fatty acid content in the first 6 months of lactation , 2003, European Journal of Clinical Nutrition.

[39]  E. Birch,et al.  Term infant studies of DHA and ARA supplementation on neurodevelopment: results of randomized controlled trials. , 2003, The Journal of pediatrics.

[40]  J. Janowsky,et al.  Visual, cognitive, and language assessments at 39 months: a follow-up study of children fed formulas containing long-chain polyunsaturated fatty acids to 1 year of age. , 2003, Pediatrics.

[41]  M. Hadders‐Algra,et al.  Long-chain polyunsaturated fatty acids have a positive effect on the quality of general movements of healthy term infants. , 2003, The American journal of clinical nutrition.

[42]  E. Birch,et al.  Visual function in breast-fed term infants weaned to formula with or without long-chain polyunsaturates at 4 to 6 months: a randomized clinical trial. , 2003, The Journal of pediatrics.

[43]  P. Willatts,et al.  Long chain polyunsaturated fatty acid supplementation in infant formula and blood pressure in later childhood: follow up of a randomised controlled trial , 2003, BMJ : British Medical Journal.

[44]  F. Cockburn,et al.  Maternal and umbilical cord erythrocyte omega-3 and omega-6 fatty acids and haemorheology in singleton and twin pregnancies , 2003, Archives of disease in childhood. Fetal and neonatal edition.

[45]  Kristin Saarem,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. , 2003, Pediatrics.

[46]  D. McCulloch,et al.  prospective , randomised trial development in term infants : a double blind , during pregnancy and visual evoked potential Maternal docosahexaenoic acid supplementation , 2003 .

[47]  F. Muskiet,et al.  Estimated biological variation of the mature human milk fatty acid composition. , 2002, Prostaglandins, leukotrienes, and essential fatty acids.

[48]  C. Agostoni,et al.  Polyunsaturated fatty acids in maternal plasma and in breast milk. , 2002, Prostaglandins, leukotrienes, and essential fatty acids.

[49]  J. Hibbeln.  Seafood consumption, the DHA content of mothers' milk and prevalence rates of postpartum depression: a cross-national, ecological analysis. , 2002, Journal of affective disorders.

[50]  P. Haggarty.  Placental regulation of fatty acid delivery and its effect on fetal growth--a review. , 2002, Placenta.

[51]  Brennan Jt.  Efficiency of conversion of alpha-linolenic acid to long chain n-3 fatty acids in man. , 2002 .

[52]  P. Wainwright.  Dietary essential fatty acids and brain function: a developmental perspective on mechanisms , 2002, Proceedings of the Nutrition Society.

[53]  J. Brenna.  Efficiency of conversion of alpha-linolenic acid to long chain n-3 fatty acids in man. , 2002, Current opinion in clinical nutrition and metabolic care.

[54]  B. Koletzko,et al.  Fish oil supplementation improves visual evoked potentials in children with phenylketonuria , 2001, Neurology.

[55]  J. Werker,et al.  Are human milk long-chain polyunsaturated fatty acids related to visual and neural development in breast-fed term infants? , 2001, The Journal of pediatrics.

[56]  A. Lapillonne,et al.  Polyunsaturated fatty acids and infant growth , 2001, Lipids.

[57]  R. Uauy,et al.  Long chain polyunsaturated fatty acids (LC‐PUFA) and perinatal development , 2001, Acta paediatrica.

[58]  K. Michaelsen,et al.  The essentiality of long chain n-3 fatty acids in relation to development and function of the brain and retina. , 2001, Progress in lipid research.

[59]  K. Michaelsen,et al.  Is There a Relation between Docosahexaenoic Acid Concentration in Mothers' Milk and Visual Development in Term Infants? , 2001, Journal of pediatric gastroenterology and nutrition.

[60]  A. Lapillonne,et al.  The Use of Low-EPA Fish Oil for Long-Chain Polyunsaturated Fatty Acid Supplementation of Preterm Infants , 2000, Pediatric Research.

[61]  E. Birch,et al.  Impact of Early Dietary Intake and Blood Lipid Composition of Long-Chain Polyunsaturated Fatty Acids on Later Visual Development , 2000, Journal of pediatric gastroenterology and nutrition.

[62]  C. Agostoni,et al.  Effects of long-chain polyunsaturated fatty acid supplementation on fatty acid status and visual function in treated children with hyperphenylalaninemia. , 2000, The Journal of pediatrics.

[63]  C. Field,et al.  Lower Proportion of CD45R0+ Cells and Deficient Interleukin-10 Production by Formula-Fed Infants, Compared With Human-Fed, Is Corrected With Supplementation of Long-Chain Polyunsaturated Fatty Acids , 2000, Journal of pediatric gastroenterology and nutrition.

[64]  B. Koletzko,et al.  Docosahexaenoic acid transfer into human milk after dietary supplementation: a randomized clinical trial. , 2000, Journal of lipid research.

[65]  G. Colditz,et al.  Dietary essential fatty acids, long-chain polyunsaturated fatty acids, and visual resolution acuity in healthy fullterm infants: a systematic review. , 2000, Early human development.

[66]  B. Jeffrey,et al.  A randomized trial of different ratios of linoleic to alpha-linolenic acid in the diet of term infants: effects on visual function and growth. , 2000, The American journal of clinical nutrition.

[67]  R. Uauy,et al.  Long Chain Polyunsaturated Fatty Acid Formation in Neonates: Effect of Gestational Age and Intrauterine Growth , 2000, Pediatric Research.

[68]  A. Dutta-Roy,et al.  Transport mechanisms for long-chain polyunsaturated fatty acids in the human placenta. , 2000, The American journal of clinical nutrition.

[69]  N. Brossard,et al.  Erythrocyte fatty acid composition in term infants fed human milk or a formula enriched with a low eicosapentanoic acid fish oil for 4 months , 2000, European Journal of Pediatrics.

[70]  B. Koletzko,et al.  Long-chain polyunsaturated fatty acids and eicosanoids in infants-physiological and pathophysiological aspects and open questions , 1999, Lipids.

[71]  S. Carlson,et al.  Polyunsaturated fatty acid status and neurodevelopment: A summary and critical analysis of the literature , 1999, Lipids.

[72]  F. Mimouni,et al.  Effect of DHA‐containing formula on growth of preterm infants to 59 weeks postmenstrual age , 1999, American journal of human biology : the official journal of the Human Biology Council.

[73]  C. Agostoni,et al.  Long-chain polyunsaturated fatty acids, infant formula, and breastfeeding , 1998, The Lancet.

[74]  E. Birch,et al.  Visual Acuity and the Essentiality of Docosahexaenoic Acid and Arachidonic Acid in the Diet of Term Infants , 1998, Pediatric Research.

[75]  P. Nathanielsz,et al.  Brain Docosahexaenoate Accretion in Fetal Baboons: Bioequivalence of Dietary α-Linolenic and Docosahexaenoic Acids , 1997, Pediatric Research.

[76]  D. Teller,et al.  First glances: the vision of infants. the Friedenwald lecture. , 1997, Investigative ophthalmology & visual science.

[77]  R. Gibson,et al.  Effect of increasing breast milk docosahexaenoic acid on plasma and erythrocyte phospholipid fatty acids and neural indices of exclusively breast fed infants , 1997, European Journal of Clinical Nutrition.

[78]  A. Kester,et al.  Essential fatty acid status in plasma phospholipids of mother and neonate after multiple pregnancy. , 1997, Prostaglandins, leukotrienes, and essential fatty acids.

[79]  C. L. Jensen,et al.  Intermediates in endogenous synthesis of C22:6 omega 3 and C20:4 omega 6 by term and preterm infants. , 1997, Pediatric research.

[80]  C. Blanco,et al.  Central venous oxygen saturation (ScvO2) at different ranges of arterial oxygenation in newborn infants with respiratory insufficiency.† 1086 , 1997, Pediatric Research.

[81]  C. L. Jensen,et al.  Intermediates in Endogenous Synthesis of C22:6ω3 and C20:4ω6 by Term and Preterm Infants , 1997, Pediatric Research.

[82]  Cindy Farquhar,et al.  3 The Cochrane Library , 1996 .

[83]  P. Sauer,et al.  The Very Low Birth Weight Premature Infant Is Capable of Synthesizing Arachidonic and Docosahexaenoic Acids from Linoleic and Linolenic Acids , 1996, Pediatric Research.

[84]  S. Carlson,et al.  Effect of long-chain n-3 fatty acid supplementation on visual acuity and growth of preterm infants with and without bronchopulmonary dysplasia. , 1996, The American journal of clinical nutrition.

[85]  R. Uauy,et al.  Arachidonic and docosahexaenoic acids are biosynthesized from their 18-carbon precursors in human infants. , 1996, Proceedings of the National Academy of Sciences of the United States of America.

[86]  C. L. Jensen,et al.  Biochemical effects of dietary linoleic/alpha-linolenic acid ratio in term infants. , 1996, Lipids.

[87]  B. Koletzko,et al.  Estimation of Arachidonic Acid Synthesis in Full Term Neonates Using Natural Variation of 13C Content , 1995, Journal of pediatric gastroenterology and nutrition.

[88]  A. Lapillonne,et al.  Red blood cell fatty acid composition in low‐birth‐weight infants fed either human milk or formula during the first months of life , 1994, Acta paediatrica (Oslo, Norway : 1992). Supplement.

[89]  M. Martinez,et al.  Polyunsaturated fatty acids in the developing human brain, red cells and plasma: influence of nutrition and peroxisomal disease. , 1994, World review of nutrition and dietetics.

[90]  R. Gibson,et al.  Essential Fatty Acids and Eicosanoids: Invited Papers from the Third International Congress , 1993 .

[91]  M. Martinez,et al.  Tissue levels of polyunsaturated fatty acids during early human development. , 1992, The Journal of pediatrics.

[92]  E. Shinwell,et al.  Pseudohypoaldosteronism in a preterm infant: intrauterine presentation as hydramnios. , 1992, The Journal of pediatrics.

[93]  R. Gibson,et al.  Weaning foods cannot replace breast milk as sources of long-chain polyunsaturated fatty acids. , 1989, The American journal of clinical nutrition.

[94]  T. Heim,et al.  Extrauterine fatty acid accretion in infant brain: implications for fatty acid requirements. , 1980, Early human development.