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.
BACKGROUND
There is growing interest in the potential role of anti-inflammatory n-3 polyunsaturated fatty acids (n-3 PUFAs) in the prevention of allergic disease.


OBJECTIVE
We sought to determine whether maternal dietary supplementation with n-3 PUFAs during pregnancy could modify immune responses in infants.


METHODS
In a randomized, controlled trial 98 atopic, pregnant women received fish oil (3.7 g n-3 PUFAs per day) or placebo from 20 weeks' gestation until delivery. Neonatal PUFA levels and immunologic response to allergens were measured at birth.


RESULTS
Eighty-three women completed the study. Fish oil supplementation (n = 40) achieved significantly higher proportions of n-3 PUFAs in neonatal erythrocyte membranes (mean +/- SD, 17.75% +/- 1.85% as a percentage of total fatty acids) compared with the control group (n = 43, 13.69% +/- 1.22%, P <.001). All neonatal cytokine (IL-5, IL-13, IL-10, and IFN-gamma) responses (to all allergens) tended to be lower in the fish oil group (statistically significant only for IL-10 in response to cat). Although this study was not designed to examine clinical effects, we noted that infants in the fish oil group were 3 times less likely to have a positive skin prick test to egg at 1 year of age (odds ratio, 0.34; 95% confidence interval, 0.11 to 1.02; P =.055). Although there was no difference in the frequency of atopic dermatitis at 1 year of age, infants in the fish oil group also had significantly less severe disease (odds ratio, 0.09; 95% confidence interval, 0.01 to 0.94; P =.045).


CONCLUSIONS
These data suggest a potential reduction in subsequent infant allergy after maternal PUFA supplementation. More detailed follow-up studies are required in larger cohorts to establish the robustness of these findings and to ascertain their significance in relation to longer-term modification of allergic disease in children.
Dunstan
Janet A
JA
School of Paediatrics and Child Health, University of Western Australia, Perth, Australia.
Mori
Trevor A
TA
Barden
Anne
A
Beilin
Lawrence J
LJ
Taylor
Angie L
AL
Holt
Patrick G
PG
Prescott
Susan L
SL
D000328:Adult; D000485:Allergens / Q000276:immunology*; D000917:Antibody Formation / Q000276:immunology; D001249:Asthma / Q000188:drug therapy* / Q000276:immunology; D016207:Cytokines / Q000378:metabolism; D003876:Dermatitis, Atopic / Q000188:drug therapy* / Q000276:immunology; D004042:Dietary Fats, Unsaturated / Q000008:administration & dosage*; D019587:Dietary Supplements; D004910:Erythrocyte Membrane / Q000378:metabolism; D015525:Fatty Acids, Omega-3 / Q000378:metabolism; D005260:Female; D005312:Fetal Blood; D005395:Fish Oils / Q000008:administration & dosage*; D005865:Gestational Age; D006801:Humans; D007223:Infant; D008213:Lymphocyte Activation; D008431:Maternal-Fetal Exchange; D011247:Pregnancy; D012307:Risk Factors
D000485:Allergens; D016207:Cytokines; D004042:Dietary Fats, Unsaturated; D015525:Fatty Acids, Omega-3; D005395:Fish Oils