Prenatal supplementation with DHA improves attention at 5 y of age: a randomized controlled trial.
Docosahexanoic acid (DHA) is an important constituent of the brain. Evidence from well-designed intervention trials of the long-term benefits of increasing DHA intake during pregnancy has been sparse.



We evaluated global cognition, behavior, and attention at age 5 y in the offspring of Mexican women who participated in a randomized controlled trial of prenatal DHA supplementation.



A total of 1094 women were randomly assigned to receive 400 mg of either DHA or placebo/d from 18 to 22 wk of pregnancy until delivery. We assessed cognitive development and behavioral and executive functioning, including attention, in 797 offspring at age 5 y (82% of 973 live births) with the use of the McCarthy Scales of Children's Abilities (MSCA), the parental scale of the Behavioral Assessment System for Children, Second Edition (BASC-2), and the Conners' Kiddie Continuous Performance Test (K-CPT). We compared the groups on raw scores, T-scores, and standardized scores, as appropriate. We examined heterogeneity by the quality of the home environment, maternal intelligence, and socioeconomic status.



There were no group differences for MSCA scores (P > 0.05), but the positive effect of the home environment at 12 mo on general cognitive abilities was attenuated in the DHA group compared with in the placebo group (P-interaction < 0.05). There were no differences between groups on the BASC-2. On the K-CPT, offspring in the DHA group showed improved mean ± SD T-scores compared with those of the placebo group for omissions (DHA: 47.6 ± 10.3; placebo: 49.6 ± 11.2; P < 0.01) with no differences (P > 0.05) for the other K-CPT scores or of the proportion who were clinically at risk of attention deficit hyperactivity disorders after Bonferroni correction for multiple comparisons.



Prenatal exposure to DHA may contribute to improved sustained attention in preschool children. This trial was registered at clinicaltrials.gov as NCT00646360.
Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA; uramakr@emory.edu.
Usha
U
Ramakrishnan
Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA.
Ines
I
Gonzalez-Casanova
Division of Public Health, National Institute of Perinatology, Mexico City, Mexico.
Lourdes
L
Schnaas
Center of Excellence for Children's Behavioral Health, Georgia Health Policy Center, Georgia State University, Atlanta, GA.
Ann
A
DiGirolamo
Health and Nutrition Research Center, National Institute of Public Health, Cuernavaca, Mexico; and.
Amado D
AD
Quezada
Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA.
Beth C
BC
Pallo
Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA.
Wei
W
Hao
Global Alliance for Improved Nutrition, Geneva, Switzerland.
Lynnette M
LM
Neufeld
Health and Nutrition Research Center, National Institute of Public Health, Cuernavaca, Mexico; and.
Juan A
JA
Rivera
Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA.
Aryeh D
AD
Stein
Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA.
Reynaldo
R
Martorell
D000328:Adult; D001288:Attention / Q000187:drug effects*; D001289:Attention Deficit Disorder with Hyperactivity / Q000517:prevention & control; D002652:Child Behavior; D002657:Child Development / Q000187:drug effects*; D002675:Child, Preschool; D003071:Cognition / Q000187:drug effects*; D019587:Dietary Supplements; D004281:Docosahexaenoic Acids / Q000494:pharmacology* / Q000627:therapeutic use; D005260:Female; D006801:Humans; D007360:Intelligence; D008297:Male; D008800:Mexico; D009035:Mothers; D011247:Pregnancy; D011295:Prenatal Care; D039401:Prenatal Nutritional Physiological Phenomena; D011581:Psychological Tests; D012923:Social Class; D055815:Young Adult
D004281:Docosahexaenoic Acids
attention; child development; fatty acids; omega-3 fatty acids; prenatal supplementation; preschool cognitive development