Women's & Children's Health Research Centre, North Adelaide, Australia.
Am J Clin Nutr. 2012 Jun;95(6):1378-84. doi: 10.3945/ajcn.111.033217. Epub 2012 May 2.
There is uncertainty regarding the efficacy of increasing n-3 long-chain PUFA (LCPUFA) intake during pregnancy in reducing the risk of gestational diabetes mellitus (GDM) and preeclampsia.
The objective was to determine whether n-3 LCPUFA supplementation in pregnancy reduces the incidence of GDM or preeclampsia. A secondary objective was to assess the effect of n-3 LCPUFA supplementation on perinatal complications.
This was a double-blind, multicenter randomized control trial-the DHA to Optimize Mother Infant Outcome (DOMInO) trial. Pregnant women (n = 2399) of <21 wk gestation were randomly assigned to receive DHA-enriched fish oil (800 mg/d) or vegetable oil capsules without DHA from trial entry to birth. The presence of GDM or preeclampsia was assessed through a blinded audit of medical records. Birth outcomes and prenatal complications were also assessed.
The overall incidences of GDM and preeclampsia were 8% and 5%, respectively, based on clinical diagnosis. The RR of GDM was 0.97 (95% CI: 0.74, 1.27) and of preeclampsia was 0.87 (95% CI: 0.60, 1.25), and they did not differ significantly between the groups. Birth weight, length, and head circumference z scores also did not differ between the groups. There were 12 perinatal deaths and 5 neonatal convulsions in the control group compared with 3 perinatal deaths and no neonatal convulsions in the DHA group (P = 0.03 in both cases).
DHA supplementation of 800 mg/d in the second half of pregnancy does not reduce the risk of GDM or preeclampsia. Whether supplementation reduces the risk of perinatal death and neonatal convulsions requires further investigation. The DOMInO trial was registered with the Australian New Zealand Clinical Trials Registry as TRN12605000569606.
在妊娠期间增加 n-3 长链多不饱和脂肪酸（LCPUFA）的摄入量以降低妊娠糖尿病（GDM）和子痫前期的风险方面，其疗效尚不确定。
本研究旨在确定妊娠期间补充 n-3 LCPUFA 是否会降低 GDM 或子痫前期的发生率。次要目标是评估 n-3 LCPUFA 补充对围产期并发症的影响。
这是一项双盲、多中心随机对照试验——DHA 优化母婴结局（DOMInO）试验。<21 孕周的孕妇（n=2399）随机分为两组，从入组到分娩时分别接受富含 DHA 的鱼油（800 mg/d）或不含 DHA 的植物油胶囊。通过对病历的盲审来评估 GDM 或子痫前期的发生情况。还评估了出生结局和产前并发症。
根据临床诊断，GDM 和子痫前期的总发生率分别为 8%和 5%。GDM 的 RR 为 0.97（95%CI：0.74，1.27），子痫前期的 RR 为 0.87（95%CI：0.60，1.25），两组间无显著差异。两组的出生体重、身长和头围 z 评分也无差异。对照组有 12 例围产儿死亡和 5 例新生儿惊厥，而 DHA 组有 3 例围产儿死亡和无新生儿惊厥（两者均 P=0.03）。
妊娠后半期补充 800 mg/d 的 DHA 不能降低 GDM 或子痫前期的风险。补充是否能降低围产儿死亡和新生儿惊厥的风险还需要进一步研究。DOMInO 试验已在澳大利亚和新西兰临床试验注册中心注册，注册号为 TRN12605000569606。
