堪萨斯大学二十二碳六烯酸结局研究（KUDOS）临床试验：产前二十二碳六烯酸补充对行为影响的长期随访
The Kansas University DHA Outcomes Study (KUDOS) clinical trial: long-term behavioral follow-up of the effects of prenatal DHA supplementation.
机构信息
Department of Psychology and Schiefelbusch Institute for Life Span Studies, University of Kansas, Lawrence, KS.
Department of Dietetics and Nutrition, University of Kansas Medical Center, Kansas City, KS.
出版信息
Am J Clin Nutr. 2019 May 1;109(5):1380-1392. doi: 10.1093/ajcn/nqz018.
BACKGROUND
Docosahexaenoic acid (DHA) is a long-chain polyunsaturated fatty acid that has been linked to improved vision and cognition in postnatal feeding studies and has been consistently associated with reduction of early preterm birth in prenatal supplementation trials. This is a report of the first long-term follow-up of infants from mothers receiving prenatal DHA supplementation in a US cohort.
OBJECTIVE
Our objective was to evaluate the efficacy of the prenatal supplementation on both global and granular longitudinal assessments of cognitive and behavioral development.
METHODS
In a randomized double-blind clinical trial, mothers received either 600 mg/d of DHA or a placebo beginning at 14.5 weeks of gestation and capsules were provided until delivery. Children from those pregnancies were followed by cognitive and behavioral assessments administered from 10 mo through 6 y of age. From 301 mothers in the initial study, ∼200 infants completed the longitudinal schedule.
RESULTS
Although this intervention had been shown to reduce high-risk pregnancies and improve visual attention in infants during the first year, only a few positive long-term effects of prenatal DHA supplementation emerged from analyses of this follow-up. Increases in maternal blood DHA during pregnancy were related to verbal and full scale intelligence quotient (IQ) scores at 5 and 6 y, but these effects disappeared after controlling for SES. Maternal blood DHA concentrations at delivery were unrelated to outcomes, although maternal DHA at enrollment was related to productive vocabulary at 18 mo.
CONCLUSIONS
Although prenatal DHA supplementation substantially reduced early preterm birth and improved visual attention in infancy in this sample, no consistent long-term benefits were observed into childhood. Increases in maternal blood DHA concentration in pregnancy were related to higher IQs but this effect was confounded with SES and disappeared when SES was statistically controlled. This trial was registered at http://www.clinicaltrials.gov as NCT00266825 and NCT02487771.
背景
二十二碳六烯酸（DHA）是一种长链多不饱和脂肪酸，已被证明在产后喂养研究中改善了视力和认知能力，并在产前补充试验中一致与减少早产有关。这是一项关于美国队列中接受产前 DHA 补充的母亲所生婴儿的首次长期随访报告。
目的
我们的目的是评估产前补充剂对认知和行为发展的整体和颗粒状纵向评估的功效。
方法
在一项随机、双盲临床试验中，母亲从 14.5 孕周开始每天接受 600 毫克 DHA 或安慰剂，直至分娩。来自这些妊娠的儿童通过认知和行为评估进行随访，从 10 个月龄到 6 岁龄进行评估。在最初的研究中，有 301 名母亲，约 200 名婴儿完成了纵向研究。
结果
尽管该干预措施已被证明可以减少高危妊娠并改善婴儿在第一年的视觉注意力，但从该随访分析中仅得出了产前 DHA 补充的一些积极的长期影响。怀孕期间母亲血液 DHA 的增加与 5 岁和 6 岁时的言语和全量表智商（IQ）评分相关，但在控制 SES 后这些影响消失了。分娩时母亲血液 DHA 浓度与结果无关，但入组时母亲 DHA 与 18 个月时的生产性词汇量有关。
结论
尽管在该样本中，产前 DHA 补充剂大量减少了早产并改善了婴儿期的视觉注意力，但在儿童期并未观察到一致的长期益处。怀孕期间母亲血液 DHA 浓度的增加与更高的智商相关，但这种影响与 SES 混淆，当 SES 被统计控制时，这种影响就消失了。该试验在 http://www.clinicaltrials.gov 上注册为 NCT00266825 和 NCT02487771。
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