DHA prenatal supplementation during the last half of pregnancy positively affects infant attention and behavioral state (fussiness) across the first year of life

By Sheila Gautier

A number of research studies have demonstrated the positive effects of docosahexaenoic acid (DHA) supplementation during pregnancy on maternal and infant health (Koletzko 2008), including such benefits as a reduction in the risk of early preterm birth (Carlson 2013, Kar 2016), improved birth weight, and positive effects on aspects of immune function and allergy (Koletzko 2014). Randomized controlled trials (RCTs) investigating the effects of DHA supplementation during and after pregnancy on infant cognition have had mixed results (Colombo 2016). Differences in the measurement of cognitive function may in part account for the inconsistent results. Global standardized tests such as the Bayley Scales of Infant Development lack the sensitivity to detect the effects of DHA on specific cognitive domains. However, more targeted tests of attention based on constructs of information processing have been shown to correlate better with cognitive function later in childhood (Colombo 2012).

In this Phase III double-blind, placebo-controlled RCT, behavioral measures of visual attention were assessed at four, six, and nine months of age – periods of maximum developmental sensitivity. Those infants born to mothers prenatally supplemented with 600 mg DHA during the last half of pregnancy maintained higher levels of sustained attention and positive effects on behavioral state (fussiness) across the first year of life. The maintenance of sustained attention across the first year has previously been associated with higher preschool vocabulary at four years of age (Colombo 2009).

The primary dietary source of DHA is fatty fish. In many parts of the world, intakes of DHA are suboptimal during this critical period of time with many women failing to meet minimum recommendations of 200 mg DHA per day during pregnancy. Estimated dietary intake per capita for DHA in 47 developed and 128 developing countries demonstrate that 64% of these countries have a dietary DHA intake of less than 200 mg per day (Forsyth et al 2016).

Subjects from this Phase III RCT were recruited from term infants born to women who participated in the Kansas University DHA Outcomes Study (KUDOS). The KUDOS study was comprised of 230 subjects, with the intervention group given a daily dose of 600 mg DHA per day or an equivalent number of capsules containing half soy bean and half corn oil during the second half of pregnancy until delivery. The primary aim of the original study was to report the effect of prenatal DHA on gestation length and birth weight. The second goal was to determine the effects of prenatal DHA on the development of infants born to participating mothers. The current publication focuses on behavioral measures of visual attention and visual habituation and heart rate. Visual habituation is a well-known measure of non-associative visual learning measured during repeated presentations of stimuli on a screen with observers simultaneously coding infant looking and recording heart rate. Look duration reflects learning and memory, and declines over time (habituations); heart rate reflects the quality of attention during looking. A deceleration of heart rate during looking is associated with engagement and active processing. DHA supplementation did not affect some of the parameters such as heart rate, but infants of supplemented mothers maintained higher levels of sustained attention compared to the placebo group. The supplemented group also demonstrated significantly reduced attrition on tasks with less fussiness and crying at six and nine months of age.

The new study by Colombo et al. (1) demonstrates the positive effects of prenatal supplementation with DHA on sustained attention and behavioral state throughout the first year of life. This suggests an early programming effect resulting from DHA supplementation during pregnancy. These findings add to a growing body of evidence demonstrating the benefit of prenatal supplementation with DHA.

1. Colombo J, Gustafson KM, Gajewski BJ, Shaddy DJ, Kerling EH, Thodosoff JM, Doty T, Brez CC, Carlson SE, Kim DH, Sabour S, Sagar UN et al. “Prenatal DHA Supplementation and Infant Attention”. Pediatr Res. 2016 Jun 30. doi: 10.1038/pr.2016.134. [Epub ahead of print]
2. 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”. World Association of Perinatal Medicine Dietary Guidelines Working Group. J Perinat Med. 2008; 36(1): 5–14. doi: 10.1515/JPM.2008.001
3. Carlson SE, Colombo J, Gajewski BJ, Gustafson KM, Mundy D, Yeast J, Georgieff MK, Markley LA, Kerling EH, Shaddy DJ. “DHA supplementation and pregnancy outcomes”. Am J Clin Nutr. 2013 Apr; 97(4): 808–15. doi: 10.3945/ajcn.112.050021. Epub 2013 Feb 20.
4. Kar S, Wong M, Rogozinska E, Thangaratinam S. “Effects of omega-3 fatty acids in prevention of early preterm delivery: a systematic review and meta-analysis of randomized studies”. Eur J Obstet Gynecol Reprod Biol. 2016 Mar; 198: 40–6. doi: 10.1016/j.ejogrb.2015.11.033. Epub 2015 Nov 30. PMID: 26773247
5. Koletzko B, Boey CC, Campoy C, Carlson SE, Chang N, Guillermo-Tuazon MA, Joshi S, Prell C, Quak SH, Sjarif DR, Su Y, Supapannachart S, Yamashiro Y, Osendarp SJ. “Current information and Asian perspectives on long-chain polyunsaturated fatty acids in pregnancy, lactation, and infancy: systematic review and practice recommendations from an early nutrition academy workshop”. Ann Nutr Metab. 2014; 65(1): 49–80. doi: 10.1159/000365767. Epub 2014 Sep 16.
6. Colombo J, Carlson SE. “Is the measure the message: the BSID and nutritional interventions”. Pediatrics. 2012 Jun; 129(6): 1166–7. doi: 10.1542/peds.2012-0934. Epub 2012 May 28. No abstract available. PMID: 22641756
7. Colombo J, Shaddy DJ, Blaga OM, Anderson CJ, Kannass KN, Richman WA. “Early attentional predictors of vocabulary in childhood”. In: Colombo J, McCardle P, Freund L, eds. Infant pathways to language: Methods, models, and research directions. New York, NY, US: Psychology Press; 2009: 143–67.
8. Forsyth S, Gautier S, Salem N Jr. “Global Estimates of Dietary Intake of Docosahexaenoic Acid and Arachidonic Acid in Developing and Developed Countries”. Ann Nutr Metab. 2016 Jun 9; 68(4): 258–267.