Omega-3s in preterm birth prevention
Talking Nutrition Editors
A need for intervention
- A new Cochrane review, published late last year, suggests that supplementation with 1000 mg/day omega-3 long chain polyunsaturated fatty acids (LCPUFA), docosahexaenoic acid (DHA) and eicosapentaenoic acid (EPA), during pregnancy could reduce the risk of preterm delivery.
- Viewed as the ‘gold standard’ by policy makers and healthcare practitioners, the review prompted the development of new practice guidelines for healthcare practitioners and guidance for the consumer. This is the first publication of its type to provide omega-3 LCPUFA recommendations to reduce the risk of preterm birth based on a vast bank of scientific evidence.
- Intervention using omega-3 LCPUFA supplementation could prove easily accessible, cost-effective and acceptable to women, with influential publications indicating that there could also be significant healthcare cost savings.
Highlighting the potential for supplementation
Preterm infants – born before 37 weeks' gestation – often need prolonged hospital treatment. In addition to the health risks this can bring to infants, and the emotional toll on their families, premature births can also incur extensive healthcare costs. Since preterm birth is one of the leading causes of infant death worldwide, there is a need for effective, accessible, safe, and acceptable interventions to reduce the risk of early labor with the added benefit of reductions in healthcare spending. Three influential publications have indicated that omega-3 DHA and EPA supplementation hold the potential to reduce the risk of preterm birth, highlighting the opportunity to not only improve public health, but also save in-hospital and national costs.
Reviewing the evidence
Early preterm infants often require extensive intensive care for prematurity-related morbidity and long-term support for associated health problems. Healthcare costs can therefore be high; one key study estimates that each child born before 34 weeks' gestation costs the UK National Health Service (NHS) about £60,000, and in the US this figure reaches US $150,000 per child born prematurely. Gestational age at delivery is also important – delaying premature births by a week could potentially save £260 million a year in the UK. The review, published in November 2018, examines current management strategies for the prevention of preterm birth and found that existing methods, such as the administration of progesterone and cervical cerclage, have limitations when it comes to, availability, and safety. Drawing from 70 scientific studies, the review resulted in the development of clinical practice recommendations for pregnant women to incorporate omega-3 LCPUFA supplementation, including a minimum of 500 mg DHA, into their daily routines, since Western diets often have intakes as low as 15 mg/day.
Taking the research further, a study published in Prostaglandins, Leukotrienes and Essential Fatty Acids conducted a cost benefit analysis to determine if omega-3 DHA supplementation during pregnancy may reduce pregnancy-related in-patient hospital costs. The results were compared to similar data on the impact of smoking, drinking, maternal age and BMI during pregnancy. Figures showed that in-patient costs could decrease by AUD$92 on average per singleton pregnancy with DHA supplementation, potentially leading to savings of AUD$15-51 million per year for the Australian public hospital system.
Since the incidence of early preterm labor is even higher in the US than Australia, and the number of US pregnancies is growing each year, a further review published in Prostaglandins, Leukotrienes and Essential Fatty Acids examined the national hospital costs and net savings following DHA supplementation in the US. As part of the Kansas University DHA Outcomes Study (KUDOS), women were supplemented with 600 mg algal DHA per day for 26 weeks of pregnancy. The results suggested that net savings of US $1,484 per infant could be achieved and that, overall, omega-3 DHA supplementation could lead to potential hospital savings of US $6 billion and net savings of US $5.84 billion nationally (based on an average of four million births per year).
Increasing omega-3 LCPUFA supplementation during pregnancy
There is strong evidence to suggest that omega-3 LCPUFA supplementation, including a minimum of 500 mg DHA, could be a safe, accessible and cost-effective intervention strategy to reduce the risk of preterm births as part of future healthcare plans. However, as there are no current official US guidelines in place for omega-3 LCPUFA supplementation during pregnancy to reduce the risk of prematurity, this is an important first step in developing national guidelines for supplementation. Further research needs to be carried out to determine the best way to be certain that women have access to, and understand the importance of, omega-3 LCPUFAs and what supplementation means to the health of their newborn baby.
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S. Kar et al., ‘Effects of omega-3 fatty acids in prevention of early preterm delivery: a systematic review and meta-analysis of randomized’, European Journal of Obstetrics & Gynaecology and Reproductive Biology, vol. 198, pg. 40-46, 2016.
S. Ahmed et al., ‘Analysis of hospital cost outcome of DHA-rich fish oil supplementation in pregnancy: evidence from a randomized controlled trial’, Prostaglandins, Leukotrienes and Essential Fatty Acids’, 2015, p.102-103.
T. Shireman et al., ‘Docosahexaenoic acid supplementation (DHA) and the return on investment in pregnancy outcomes’, Prostaglandins, Leukotrienes and Essential Fatty Acids’, vol. 111, 2016, p.8-10.
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