title: Effects of fish-oil and folate supplementation of pregnant women on maternal and fetal plasma concentrations of docosahexaenoic acid and eicosapentaenoic acid: a European randomized multicenter trial.
abstract: BACKGROUND
  Pregnant women usually meet their increased energy needs but do not always meet their increased micronutrient requirements. The supply of both folic acid and docosahexaenoic acid (DHA) has been related to positive pregnancy and infant outcomes.
  
  
  OBJECTIVE
  We aimed to assess whether fish-oil (FO) supplementation with or without folate from gestation week 22 to birth improves maternal and fetal n-3 long-chain polyunsaturated fatty acid (n-3 LC-PUFA) status.
  
  
  METHODS
  We conducted a multicenter (Germany, Hungary, and Spain), randomized, double-blind, 2 x 2 factorial, placebo-controlled trial. From gestation week 22 until delivery, 311 pregnant women received daily a preparation with FO [0.5 g DHA and 0.15 g eicosapentaenoic acid (EPA)], 400 microg methyltetrahydrofolic acid (MTHF), FO with MTHF, or placebo. Outcome measures included maternal and cord plasma DHA and EPA contents at gestation weeks 20 and 30 and at delivery, indicators of pregnancy outcome, and fetal development.
  
  
  RESULTS
  FO significantly (P<0.001) increased maternal DHA and EPA (% by wt), as shown by 3-factor repeated-measures ANOVA (ie, MTHF, FO, and time) with adjustment for maternal baseline DHA and EPA. In addition, FO significantly (P<0.001) increased cord blood DHA (% by wt; 2-factor ANOVA). MTHF was significantly (P=0.046) associated with increased maternal DHA (% by wt). There was no FO x MTHF interaction for the time course of DHA or EPA (P=0.927 and 0.893). Pregnancy outcomes and fetal development did not differ significantly among the intervention groups.
  
  
  CONCLUSIONS
  FO supplementation from gestation week 22 until delivery improves fetal n-3 LC-PUFA status and attenuates depletion of maternal stores. MTHF may further enhance maternal n-3 LC-PUFA proportions.
authors.affiliation: Clinical Cooperation Group Pediatric Immune Regulation, Ludwig Maximilians University, Munich, Germany.
authors.forename: Susanne
authors.initials: S
authors.lastname: Krauss-Etschmann
authors.forename: Rania
authors.initials: R
authors.lastname: Shadid
authors.forename: Cristina
authors.initials: C
authors.lastname: Campoy
authors.forename: Eva
authors.initials: E
authors.lastname: Hoster
authors.forename: Hans
authors.initials: H
authors.lastname: Demmelmair
authors.forename: Margarita
authors.initials: M
authors.lastname: Jiménez
authors.forename: Angel
authors.initials: A
authors.lastname: Gil
authors.forename: Montserrat
authors.initials: M
authors.lastname: Rivero
authors.forename: Béla
authors.initials: B
authors.lastname: Veszprémi
authors.forename: Tamas
authors.initials: T
authors.lastname: Decsi
authors.forename: Berthold V
authors.initials: BV
authors.lastname: Koletzko
mesh_terms: D000293:Adolescent; D000328:Adult; D000704:Analysis of Variance; D019587:Dietary Supplements; D004281:Docosahexaenoic Acids / Q000097:blood; D004311:Double-Blind Method; D015118:Eicosapentaenoic Acid / Q000097:blood; D015525:Fatty Acids, Omega-3 / Q000097:blood*; D005260:Female; D005312:Fetal Blood / Q000737:chemistry*; D047109:Fetal Development / Q000187:drug effects*; D005395:Fish Oils / Q000008:administration & dosage / Q000737:chemistry; D005492:Folic Acid / Q000008:administration & dosage* / Q000031:analogs & derivatives / Q000097:blood; D006801:Humans; D039382:Maternal Nutritional Physiological Phenomena; D008431:Maternal-Fetal Exchange; D011247:Pregnancy; D011256:Pregnancy Outcome; D011262:Pregnancy Trimester, Second; D011263:Pregnancy Trimester, Third; D014803:Vitamin B Complex / Q000008:administration & dosage*
chemical_list: D015525:Fatty Acids, Omega-3; D005395:Fish Oils; D014803:Vitamin B Complex; D004281:Docosahexaenoic Acids; C032418:5,11-methenyltetrahydrohomofolate; D005492:Folic Acid; D015118:Eicosapentaenoic Acid