title: Omega-3 long-chain polyunsaturated fatty acids and fish oil supplementation during pregnancy: which evidence?
abstract: OBJECTIVE
  The aim of this study was to provide evidence-based recommendations for omega-3 supplementation during pregnancy through a systematic review of level-1 data published on this topic.
  
  
  METHODS
  We reviewed all randomized-controlled trials (RCTs) including women who were randomized to treatment with either omega-3 supplementation or control (placebo or no treatment) during pregnancy and analyzed all the outcomes reported in the trials, separately. We planned to evaluate the effect of omega-3 on: preterm birth (PTB); pre-eclampsia (PE) and intrauterine growth restriction (IUGR); gestational diabetes; perinatal mortality; small for gestational age (SGA) and birth weight; infant eye and brain development; and postpartum depression.
  
  
  RESULTS
  We identified 34 RCTs including 14 106 singletons and 2578 twins. These level-1 data showed that omega-3 was not associated with prevention of PTB, PE, IUGR, gestational diabetes, SGA, post-partum depression or better children development. Data about birth weight, perinatal mortality and childhood cognitive outcome were limited. Women with gestational diabetes who received omega-3 had significantly lower serum C-reactive protein concentrations, low incidence of hyperbilirubinemia in newborns and decreased newborns' hospitalization rate.
  
  
  CONCLUSIONS
  There was not enough evidence to support the routine use of omega-3 supplementation during pregnancy. Given the 73% significant decrease in perinatal death in the singleton gestations who started omega-3 supplementation ≤ 20 weeks, further research is needed. Large RCTs in multiple gestations and longer follow-up are also required.
authors.affiliation: a Department of Neuroscience , Reproductive Sciences and Dentistry, School of Medicine, University of Naples Federico II , Naples , Italy .
authors.forename: Gabriele
authors.initials: G
authors.lastname: Saccone
authors.affiliation: b Department of Pharmacy , University of Naples Federico II , Naples , Italy , and.
authors.forename: Irene
authors.initials: I
authors.lastname: Saccone
authors.affiliation: c Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology , Sidney Kimmel Medical College of Thomas Jefferson University , Philadelphia , PA , USA.
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Berghella
mesh_terms: D019587:Dietary Supplements; D015525:Fatty Acids, Omega-3 / Q000008:administration & dosage*; D005260:Female; D005395:Fish Oils / Q000008:administration & dosage*; D006801:Humans; D007231:Infant, Newborn; D054238:Perinatal Mortality; D011247:Pregnancy; D011248:Pregnancy Complications / Q000517:prevention & control*
chemical_list: D015525:Fatty Acids, Omega-3; D005395:Fish Oils
keywords: Meta-analysis; nutrition; perinatal death; pre-eclampsia; preterm birth; supplement; systematic review