Epidemiology Branch, Division of Population Health Research, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD.
University of Maryland Baltimore County, Baltimore, MD.
Am J Obstet Gynecol. 2023 Feb;228(2):224.e1-224.e16. doi: 10.1016/j.ajog.2022.08.007. Epub 2022 Aug 8.
Prenatal omega-3 fatty acid supplementation, particularly docosahexaenoic acid and eicosapentaenoic acid, has been associated with greater birthweight in clinical trials; however, its effect on fetal growth throughout gestation is unknown.
This study aimed to examine the association between first-trimester docosahexaenoic acid and eicosapentaenoic acid supplementation and growth trajectories of estimated fetal weight and specific fetal biometrics measured longitudinally from the second trimester of pregnancy to delivery.
In a multisite, prospective cohort of racially diverse, low-risk pregnant women, we used secondary data analysis to examine fetal growth trajectories in relation to self-reported (yes or no) first-trimester docosahexaenoic acid and eicosapentaenoic acid supplementation. Fetal ultrasonographic measurements, including abdominal circumference, biparietal diameter, femur length, head circumference, and humerus length, were measured at enrollment (8-13 weeks) and up to 5 follow-up visits. Estimated fetal weight and head circumference-to-abdominal circumference ratio (a measure of growth symmetry) were calculated. Fetal growth trajectories were modeled for each measure using a linear mixed model with cubic splines. If significant differences in fetal growth trajectories between groups were observed (global P<.05), weekly comparisons were performed to determine when in gestation these differences emerged. Analyses were adjusted for maternal sociodemographics, parity, infant sex, total energy consumption, and diet quality score. All analyses were repeated using dietary docosahexaenoic acid and eicosapentaenoic acid intake, dichotomized at the recommended cutoff for pregnant and lactating women (≥0.25 vs <0.25 g/d), among women who did not report supplement intake in the first trimester of pregnancy were repeated.
Among 1535 women, 143 (9%) reported docosahexaenoic acid and eicosapentaenoic acid supplementation in the first trimester of pregnancy. Overall, first-trimester docosahexaenoic acid and eicosapentaenoic acid supplementation was associated with statistically significant differences (P-value <.05) in fetal growth trajectories during pregnancy. Specifically, estimated fetal weight was larger among women with docosahexaenoic acid and eicosapentaenoic acid supplementation than among those without supplementation (global P=.028) with significant weekly differences in median estimated fetal weight most apparent between 38 to 41 weeks of gestation (median estimated fetal weight difference at 40 weeks of gestation, 114 g). Differences in fetal growth trajectories for abdominal circumference (P=.003), head circumference (P=.003), and head circumference-to-abdominal circumference ratio (P=.0004) were also identified by supplementation status. In weekly comparisons, docosahexaenoic acid and eicosapentaenoic acid supplement use was associated with larger median abdominal circumference (changed from 2 to 9 mm) in midpregnancy onward (19 to 41 weeks), larger median head circumference between 30 to 33 weeks of gestation, and smaller median head circumference-to-abdominal circumference ratio in the second and third trimesters of pregnancy. There was no specific weekly difference in fetal femur length or humerus length by docosahexaenoic acid and eicosapentaenoic acid supplementation. First-trimester dietary sources of docosahexaenoic acid and eicosapentaenoic acid among women with no first-trimester docosahexaenoic acid and eicosapentaenoic acid supplementation (n=1392) were associated with differences in fetal biparietal diameter (P=.043), but not other metrics of fetal growth. At the recommended dietary docosahexaenoic acid and eicosapentaenoic acid levels compared with below-recommended levels, biparietal diameter was larger between 38 to 41 weeks of gestation.
In this racially diverse pregnancy cohort, first-trimester docosahexaenoic acid and eicosapentaenoic acid supplementation was associated with significant increases in fetal growth, specifically greater estimated fetal abdominal circumference in the second and third trimesters of pregnancy.
临床研究表明，产前补充欧米伽-3 脂肪酸，特别是二十二碳六烯酸（DHA）和二十碳五烯酸（EPA），与更大的出生体重有关；然而，其对整个孕期胎儿生长的影响尚不清楚。
本研究旨在检查妊娠早期 DHA 和 EPA 补充与从妊娠中期到分娩的估计胎儿体重和特定胎儿生物测量的纵向生长轨迹之间的关联。
在一个多地点、种族多样化的低风险孕妇前瞻性队列中，我们使用二次数据分析检查了与自我报告（是或否）妊娠早期 DHA 和 EPA 补充有关的胎儿生长轨迹。在入组时（8-13 周）和多达 5 次随访时测量胎儿超声测量值，包括腹围、双顶径、股骨长、头围和肱骨长。计算估计胎儿体重和头围-腹围比（衡量生长对称性的指标）。使用具有三次样条的线性混合模型为每个指标建模胎儿生长轨迹。如果观察到组间胎儿生长轨迹存在显著差异（全局 P<.05），则每周进行比较，以确定在妊娠的哪个阶段出现这些差异。分析调整了产妇社会人口统计学特征、产次、婴儿性别、总能量摄入和饮食质量评分。在妊娠早期未报告补充摄入的女性中，所有分析均重复使用膳食 DHA 和 EPA 摄入量，将其分为孕妇和哺乳期妇女的推荐摄入量（≥0.25 与 <0.25 g/d）。
在 1535 名女性中，有 143 名（9%）报告在妊娠早期补充了 DHA 和 EPA。总体而言，妊娠早期 DHA 和 EPA 补充与孕期胎儿生长轨迹存在统计学显著差异（P 值<.05）。具体而言，与未补充的女性相比，DHA 和 EPA 补充的女性估计胎儿体重更大（整体 P=.028），在妊娠 38 至 41 周时，中位数估计胎儿体重的每周差异最为明显（40 周时估计胎儿体重的差异为 114 g）。在补充状态下，也发现了胎儿生长轨迹的差异，包括腹围（P=.003）、头围（P=.003）和头围-腹围比（P=.0004）。在每周比较中，DHA 和 EPA 补充与妊娠中期（19 至 41 周）以后的中位数腹围增加（从 2 毫米增加到 9 毫米）、妊娠 30 至 33 周之间的中位数头围增加以及妊娠第二和第三阶段的中位数头围-腹围比减小有关。DHA 和 EPA 补充与胎儿股骨长或肱骨长无特定的每周差异。在妊娠早期未补充 DHA 和 EPA 的女性（n=1392）中，膳食 DHA 和 EPA 的来源与胎儿双顶径的差异有关（P=.043），但与其他胎儿生长指标无关。与推荐的膳食 DHA 和 EPA 水平相比，低于推荐水平时，妊娠 38 至 41 周时双顶径更大。
在这个种族多样化的妊娠队列中，妊娠早期 DHA 和 EPA 补充与胎儿生长的显著增加有关，特别是在妊娠的第二和第三阶段，估计胎儿的腹围更大。
