By: Talking Nutrition Editors
The Australian government is taking a leadership role in utilizing the latest scientific evidence to help reduce the risk of premature birth. Recently published guidelines advise pregnant women with low omega-3 status to supplement with omega-3 long-chain polyunsaturated fatty acids (LC-PUFA) – 800 mg DHA and 100 mg EPA per day – to help reduce the risk of birth occurring prior to 37 weeks.4
This guidance is the result of an intensive review of the literature around the role of supplemental omega-3 fatty acids on the duration of pregnancy. Several key publications contributed to the establishment of these guidelines, including a 2018 Cochrane Review,1 led by Professor Maria Makrides, the leader for the South Australian Health and Medical Research Institute’s (SAHMRI) Women and Kids Theme and Professor of Human Nutrition at the Adelaide Medical School.
Professor Makrides explains: “The Australian Pregnancy Care Guidelines were recently updated by our federal Department of Health and endorsed by the National Health and Medical Research Council. For the first time, they added an evidence-based guideline for the supplementation omega-3 fatty acids for women with a low status, as this may help reduce their risk of delivering prematurely.”
Professor Makrides – alongside her colleague Professor Gibson – has dedicated much of her career to understanding the role that fatty acids play in maternal and infant health. Here, she describes the most important findings from the 2018 Cochrane Review1 she led with a team of other researchers, conducted to investigate whether omega-3 LCPUFAs during pregnancy impact the duration of pregnancy.
She states: “In our Review, which included 70 randomized controlled trials involving 19,927 pregnant women, the rates of both preterm birth (birth <37 weeks) and early preterm birth (birth <34 weeks) were lower in women who consumed omega-3 LCPUFA compared to those who did not consume any omega-3, whether in food or supplement form. Early preterm birth (<34 weeks) was reduced by about 40% in women who consumed omega-3 fatty acids1, quite a compelling finding.”
While a significant discovery, the Cochrane Review was not able to identify which pregnant women would benefit most from supplemental omega-3 fatty acids. To help generate supplementation guidelines, additional studies were conducted.
The “Australian Omega-3 to Reduce the Incidence of Preterm Birth” (ORIP) trial and secondary findings from that study identified a significant relationship between maternal omega-3 status and risk of early preterm birth, as well as substantial reduction in the risk of early preterm birth in women with low omega-3 status when they supplemented with omega-3s.2,3
Makrides explains: “Our more recent studies add to the learnings from the Cochrane Review by providing an additional layer of information. Now we know that omega-3 status early in pregnancy can be used to identify who can benefit the most from supplemental omega-3 fatty acid intake. It allows the recommendations to be more personalized and tailored to an individual woman’s omega-3 status, which is powerful information.”
While scientists don’t completely understand what triggers each premature birth, several mechanisms have been explored. Professor Gibson sheds some light on this, explaining “We know that inflammation plays a role in triggering the initiation of labor. For example, proinflammatory prostaglandins – which are hormone-like compounds made of fats – like PGE2 are known to stimulate uterine contractions. We also know that the typical Western diet – which is pretty common around the world – is low in anti-inflammatory omega-3 fatty acids. This leads to a situation where there may be an abundance of proinflammatory compounds and insufficient anti-inflammatory compounds, making it easier for a pregnant woman to go into labor and deliver prematurely. Pregnancy and labor are incredibly complex, yet this hypothesis has been supported by some of the recent research in this field.”
A cross-sectional study conducted in Australia in 2014 reports that roughly just 1 in 10 of the women surveyed took a fish oil supplement during pregnancy,5 solidifying the need for surveillance of omega-3 status to help identify those at the highest risk for premature birth and who would benefit most from supplementation.
The implementation of Australia’s new Pregnancy Care Guidelines provides an opportunity for further study on the topic of omega-3 supplementation during pregnancy. Professor Makrides outlines the research plan: “New research is underway in South Australia (SA) to evaluate the implementation of this guideline. To do this, we’ve partnered with SA Pathology to add an omega-3 screening test to the standard antenatal screening program. Additionally, we’re providing training for healthcare professionals so they can give tailored advice based on the woman’s result. We’re studying the uptake of the program by women and healthcare professionals alike.”
In addition to studying the roll-out of the program, data on the rate of preterm birth will also be assessed; this will illustrate the impact of the guidelines on rates of prematurity in a real-world setting.
With the new Pregnancy Care Guideline and ongoing evaluation of the screening program, Australia is leading the way to better healthcare practices. Hoping that these practices become more widespread, Professor Gibson provides some insight: “Other countries and medical organizations have an opportunity to learn from the implementation example South Australia has set for the world. The omega-3 screening is relatively simple to implement alongside existing pregnancy testing. Better still, if an expectant mother is found to have a low omega-3 status, the intervention is also quite simple and very attainable – to supplement daily with omega-3 fatty acids.”
Professor Gibson continues, “This simple public health intervention has the potential to improve the lives of countless infants and women. Our evaluation of the screening program will assess the uptake by women and health professionals and assess the rates of prematurity using de-identified data linkage to see if we can reduce rates of early birth in real world settings. With these data, we hope to see more widespread application of the recent learnings around this very important topic.”
Finally, Professor Makrides shares the impact of seeing the Guidelines implemented: “As a researcher who has spent a great deal of my career investigating this very topic, it’s extremely gratifying to see the work we’ve done truly come to life. I’m proud there has been independent verification that the evidence we now have is sufficient to support a clinical guideline recommendation in Australia.”
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07 December 2021
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