World Prematurity Day 2021: Taking action for babies born too soon

By:  Talking Nutrition Editors

November 17, 2021 is World Prematurity Day

  • World Prematurity Day – celebrated on 17 November – is one of the most important days of the year for raising awareness of the challenges and burdens of preterm birth.
  • Research continues to reinforce the critical role that nutrition plays in maternal and neonatal health and pregnancy outcomes. In particular, long-chain polyunsaturated fatty acids (LCPUFAs) have been studied for their ability to impact pregnancy duration and reduce the risk of early premature birth, or preterm birth <34 weeks gestation.1-3
  • DSM remains a proud partner of the European Foundation for the Care of Newborn Infants (EFCNI) and supporter of World Prematurity Day.

Premature birth is common: 1 of every 10 babies is born too soon

The European Foundation for the Care of Newborn Infants (EFCNI) established World Prematurity Day in 2008 to raise awareness around the challenges of preterm birth and increase the standards for preconception, maternal, and newborn care. Unfortunately, premature birth is common worldwide, with 1 in every 10 babies – or 15 million babies per year – born too soon.4,5

There are many complications associated with premature birth, however, advances in medical care and nutrition have improved the outcomes for preterm infants.6,7 Maternal and neonatal nutrition have been known to play critical roles during pregnancy and the post-partum period.8-10 Recent research adds to this evidence, while also identifying an instrumental role for omega-3 fatty acids during pregnancy.

The risk of premature birth can be significantly reduced with omega-3 fatty acids

During the last trimester of pregnancy, the placenta preferentially transfers docosahexaenoic acid (DHA), an omega-3 LCPUFA, to the fetus.11 The fact that this particular omega-3 is prioritized over other fatty acids signals its importance in fetal development. Certainly, research suggests DHA is required for optimal brain development and nervous system functioning.12 Further, in some studies, maternal supplementation of DHA has been shown to positively impact visual attention during the first year of life.13

Moving beyond fetal development, scientists have enhanced our awareness of the importance of fatty acids on pregnancy duration via several recent studies. In 2018, a Cochrane Review provided compelling evidence to link omega-3 LCPUFA supplementation during pregnancy with a lower risk of preterm birth.1

The systematic review – which included data from 70 randomized controlled trials – established that early preterm birth (EPB), or birth that occurs before 34 weeks gestation, can be reduced by about 40% when omega-3 fatty acids are supplemented from the beginning of the second trimester.1

While an important and compelling finding, in this review, researchers were not able to identify if a specific dose of omega-3 nor if a particular type of omega-3 fatty acid might be most effective at reducing early birth. Since the 2018 Cochrane Review, two influential studies have shed more light on this topic.

DHA dose and DHA status influence pregnancy duration

The “Australian Omega-3 to Reduce the Incidence of Preterm Birth” (ORIP)2,14 and the “Assessment of DHA on Reducing Early Preterm Birth” (ADORE)3 studies have answered some critical questions on the specifics of how omega-3 fatty acids,  should be supplemented during pregnancy.

The ADORE trial, led by Dr. Susan Carlson at the University of Kansas Medical Center, established that daily supplementation with DHA at 1,000 mg per day significantly reduces the risk of EPB, compared to supplementation at a lower dose of 200 mg per day.3

The researchers also found a relationship between maternal DHA status and DHA dosing. Dr. Carlson explains, “The trial found that a woman’s baseline DHA status, which is highly related to her DHA intake from diet or a prenatal supplement, made a difference. Women with low DHA status at enrollment and who were randomized to the high dose of DHA had half the incidence of EPB compared to those on the lower dose.” Those women who started the trial with a high omega-3 status had very low rates of early preterm birth, regardless of which dose they took during the trial.  The authors conclude that women known to have a low DHA status could benefit from high dose supplementation with DHA.

Evidence for a significant relationship between maternal DHA status, DHA dosing, and pregnancy duration aligns with exploratory findings from the ORIP trial.2,14 Similarly, this study was able to identify that women with a low omega-3 status early in pregnancy are at increased risk for preterm birth, and therefore, these women are most likely to benefit a high dose of supplemental omega-3s.2,14

New evidence on DHA has influenced health policy in Australia

The findings from these studies have already helped shape clinical practice as well as national guidelines for DHA intake during pregnancy. Just recently, the Australian Pregnancy Care Guidelines endorsed by the National Health and Medical Research Council were updated to address the role omega-3 fatty acids may play in decreasing premature birth.   

For the first time, there is an evidence-based guideline recommending omega-3 supplementation during pregnancy, based on the data that this may help reduce prematurity risk in women with low status.15 Taking a leadership role, the Australian government is advising pregnant women with low omega-3 status to supplement with omega-3 LCPUFAs  – 800 mg DHA and 100 mg EPA per day – to help reduce the risk of birth occurring prior to 37 weeks.15

DSM supports pregnancy outcomes with a high-quality, omega-3 supplements

Reflecting DSM’s commitment to supporting the health of the ones who need it most, and in alignment with its support of EFCNI in advancing the care of preterm infants across the globe, DSM offers both fish oil and plant-based solutions to support maternal nutrition with omega-3 fatty acids.

MEG-3® fish oil is sustainably sourced from clean, omega-3 rich ocean fish. It is concentrated for potency, and is a highly trusted source of DHA and EPA from fish oil. The latest addition to DSM’s nutritional lipids portfolio is a high-potency plant-based DHA oil, life’sDHA® SF55-O200DS - the only 550 mg/g natural triglyceride DHA intended for use in maternal nutrition. To learn more about how DSM’s DHA supplements help give expecting moms peace of mind, read here.

As experts in maternal nutrition and essential solutions for early life, DSM is committed to supporting manufacturers in the development of high-quality, reliable DHA solutions that can help shape healthier futures. DSM prioritizes educating and building awareness around nutritional solutions to help reduce the risk of preterm birth and supports optimal nutrition for preterm and newborn care. 

Help set preterm infants on a path to a long, healthy life

World Prematurity Day brings together parents, healthcare professionals, experts in neonatology, and scientists who have the common goal of improving the long-term health of infants born prematurely. It is celebrated with national and local events, educational campaigns, marches, and a call to take action for moms and babies. Participants are asked to commit to helping address preterm birth and working towards improving outcomes for preterm babies and their families. For more information, visit www.efcni.org.  

Join the World Prematurity Day movement and conversations online. 

#WorldPrematurityDay 

Published on

12 November 2021

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References

  1. Middleton P, Gomersall JC, Gould JF, Shepherd E, Olsen SF, Makrides M. Omega-3 fatty acid addition during pregnancy. Cochrane Database Syst Rev. 2018;11(11):Cd003402.
  2. Makrides M, Best K, Yelland L, et al. A Randomized Trial of Prenatal n-3 Fatty Acid Supplementation and Preterm Delivery. N Engl J Med. 2019;381(11):1035-1045.
  3. Carlson SE, Gajewski BJ, Valentine CJ, et al. Higher dose docosahexaenoic acid supplementation during pregnancy and early preterm birth: A randomised, double-blind, adaptive-design superiority trial. EClinicalMedicine. 2021.
  4. Kumar RK, Singhal A, Vaidya U, Banerjee S, Anwar F, Rao S. Optimizing Nutrition in Preterm Low Birth Weight Infants-Consensus Summary. Front Nutr. 2017;4:20.
  5. Liu L, Oza S, Hogan D, et al. Global, regional, and national causes of under-5 mortality in 2000-15: an updated systematic analysis with implications for the Sustainable Development Goals. Lancet. 2016;388(10063):3027-3035.
  6. Thornton S. Preterm Birth: Causes, Consequences and Prevention. The Obstetrician & Gynaecologist. 2008;10(4):280-280.
  7. Kaempf J, Morris M, Steffen E, Wang L, Dunn M. Continued improvement in morbidity reduction in extremely premature infants. Arch Dis Child Fetal Neonatal Ed. 2020.
  8. Wiechers C, Bernhard W, Goelz R, Poets CF, Franz AR. Optimizing Early Neonatal Nutrition and Dietary Pattern in Premature Infants. Int J Environ Res Public Health. 2021;18(14).
  9. Samuel TM, Sakwinska O, Makinen K, Burdge GC, Godfrey KM, Silva-Zolezzi I. Preterm Birth: A Narrative Review of the Current Evidence on Nutritional and Bioactive Solutions for Risk Reduction. Nutrients. 2019;11(8).
  10. Massari M, Novielli C, Mandò C, et al. Multiple Micronutrients and Docosahexaenoic Acid Supplementation during Pregnancy: A Randomized Controlled Study. Nutrients. 2020;12(8).
  11. Larqué E, Demmelmair H, Berger B, Hasbargen U, Koletzko B. In vivo investigation of the placental transfer of (13)C-labeled fatty acids in humans. J Lipid Res. 2003;44(1):49-55.
  12. Beluska-Turkan K, Korczak R, Hartell B, et al. Nutritional Gaps and Supplementation in the First 1000 Days. Nutrients. 2019;11(12).
  13. Colombo J, Gustafson KM, Gajewski BJ, et al. Prenatal DHA supplementation and infant attention. Pediatr Res. 2016;80(5):656-662.
  14. Simmonds LA, Sullivan TR, Skubisz M, et al. Omega-3 fatty acid supplementation in pregnancy-baseline omega-3 status and early preterm birth: exploratory analysis of a randomised controlled trial. Bjog. 2020;127(8):975-981.
  15. Department of Health (2020) Clinical Practice Guidelines: Pregnancy Care. Canberra: Australian Government Department of Health.

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