The Influence of Prenatal DHA Supplementation on Individual Domains of Behavioral Functioning in School-Aged Children: Follow-Up of a Randomized Controlled Trial.

Jacqueline F Gould, Peter J Anderson, Lisa N Yelland, Robert A Gibson, Maria Makrides

Journal: Nutrients 2021;13(9):2996

PMID: 34578873

Plain Language Summary

Omega-3 fatty acids such as docosahexaenoic acid (DHA) are thought to be beneficial for the development of the fetal brain. Women with a singleton pregnancy at <21 weeks’ gestation enrolled in this multicentre, double-blind, randomised controlled trial to assess the fetal neurodevelopment effects of 800 mg/day, which they took until the birth of their children. A follow-up assessment was arranged when the children reached age seven to evaluate their neurodevelopment. Children of women who took DHA supplements showed increased risk scores on hyperactivity, behavioural problems that may impact daily activities, ADHD, peer relationships, Metacognition Indexes, Shift, Inhibit, Monitor, Working Memory, and Organization of Materials scales. Supplementing with high doses of DHA during pregnancy might not have any protective effects on neurodevelopment in women with high baseline DHA levels. However, further robust studies are required to confirm the results to determine the clinical applicability of DHA supplementation in pregnant women. Healthcare professionals can use the results of this study to understand the dose-dependent therapeutic application of DHA and its impact on fetal neurodevelopment.

Abstract

Docosahexaenoic acid (DHA) accumulates in the fetal brain during pregnancy and is thought to have a role in supporting neurodevelopment. We conducted a multicenter, double-blind, randomized controlled trial in women with a singleton pregnancy who were <21 weeks' gestation at trial entry. Women were provided with 800 mg DHA/day or a placebo supplement from trial entry until birth. When children reached seven years of age, we invited parents to complete the Strengths and Difficulties Questionnaire (SDQ), the Behavior Rating Inventory of Executive Function (BRIEF), and the Conners 3rd Edition Attention-Deficit Hyperactivity Disorder (ADHD) Index to assess child behavior and behavioral manifestations of executive dysfunction. There were 543 parent-child pairs (85% of those eligible) that participated in the follow-up. Scores were worse in the DHA group than the placebo group for the BRIEF Global Executive, Behavioral Regulation and Metacognition Indexes, and the Shift, Inhibit, Monitor, Working Memory, and Organization of Materials scales, as well as for the Conners 3 ADHD index, and the SDQ Total Difficulties score, Hyperactivity/Inattention score, and Peer Relationship Problems score. In this healthy, largely term-born sample of children, prenatal DHA supplementation conferred no advantage to childhood behavior, and instead appeared to have an adverse effect on behavioral functioning, as assessed by standardized parental report scales.

Address: Women and Kids, South Australian Health and Medical Research Institute, 72 King William Road, Adelaide 5006, Australia.; School of Psychology & Discipline of Paediatrics, Faculty of Health and Medical Sciences, The University of Adelaide, North Terrace, Adelaide 5000, Australia.; Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Melbourne 3800, Australia.; Clinical Sciences, Murdoch Children's Research Institute, Melbourne 3052, Australia.; School of Public Health, Faculty of Health and Medical Sciences, The University of Adelaide, North Terrace, Adelaide 5000, Australia.; School of Agriculture, Food and Wine, Waite Campus, University of Adelaide, Adelaide 5000, Australia.; Discipline of Paediatrics, Faculty of Health and Medical Sciences, The University of Adelaide, North Terrace, Adelaide 5000, Australia.

DOI: 10.3390/nu13092996

Patient Centred Factor

Triggers: Docosahexaenoic acid (DHA)

Physical Environment

Psychosocial influences

Clinical Imbalances

Neurological

Modifiable Lifestyle Factors

Diet Psychological

Jadad Score

Allocation Concealment

Nutrition Evidence Keywords

Pregnancy Cognition Omega-3 fatty acids Fetal neurodevelopment Docosahexaenoic acid ADHD Behavioural issues Behavioural functioning Cognitive functioning Motor or language abilities Peer relationships Metacognition Indexes Shift Inhibit Monitor BRIEF Global Executive Conners 3 ADHD index SDQ Total Difficulties score Working Memory Hyperactivity/Inattention score Organization of Materials scales

Bioactive Substances

Docosahexaenoic acid (DHA)

Link outs

Free resources

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Medical:

https://medlineplus.gov/dietarysupplements.html

MeSH Terms: Attention Deficit Disorder with Hyperactivity, Child, Child Behavior, Dietary Supplements, Docosahexaenoic Acids, Double-Blind Method, Female, Follow-Up Studies, Humans, Male, Pregnancy, Prenatal Exposure Delayed Effects