Should Pregnant and Breastfeeding Women Take DHA?

“Should Pregnant & Breastfeeding
Women Take DHA?” One of the reasons breastfed infants
may have better cognitive and visual development is
because human milk contains long chain polyunsaturated fatty
acids like the omega 3 DHA, while most available
infant formulas did not, based on data like this where infants
given control formula without DHA didn’t do as well as those
given DHA-fortified formula. Neither did as well as the breast-fed infants,
who serve as the gold standard. But this was enough to convince formula
manufacturers to start adding DHA to their infant formula
starting back in 2002. The question then became
how much to add? Easy, right? Just add however much
is naturally found in breast milk. However, the DHA level in breast
milk is extremely variable, depending on what
the mom is eating. For example, there’s all these healthy
populations that don’t eat any seafood, and have much lower levels in
their milk and they seem fine, so that makes it difficult to determine
the optimal amount to add to formula. Or for that matter what to recommend
for pregnant and breastfeeding women. Consensus guidelines recommend
that women should aim to consume an average of 200 mg per day
of DHA during pregnancy. Of course, this isn’t as simple as
encouraging women to eat more fish because of the toxic pollutants such
as mercury, such that for most fish, such as tuna, the brain damage caused by the mercury
would exceed the benefit from the DHA. And some pollutants like PCBs can
get stuck in our bodies for decades and so it’s not enough to just
eat clean during pregnancy. What about purified fish oil? The methods supplement
manufacturers use, like distillation, leave considerable amounts of PCBs
and other pollutants in the products, so much so that taken as directed,
salmon, herring, and tuna oils would exceed the tolerable
daily intake of toxicity. Thankfully one can get the benefits
without the risks by getting DHA from algae instead,
which is where the fish get it from, and so pregnant and breastfeeding moms
can cut out the middle-fish and get DHA directly from the source:
at the bottom of the food chain where we don’t have to worry
about toxic pollutants. But until recently, we thought everyone
should take these long chain omega 3’s for their heart. But the balance
of evidence is now such that doctors should no longer
be recommending fish oil intake or fish consumption solely for prevention
of coronary heart disease. But what about for expectant
and breastfeeding mothers? What’s the latest science show? Put all the studies together and it
turns out adding DHA to formula does not appear to help infant
cognition after all, similar to other recent compilations of evidence
that showed no significant benefit. In fact, at least four meta-analyses
or systematic reviews have reached a similar conclusion. Now these were mostly based on
a standard series of measurements known as the Bayley Scales
for Infant Development. Maybe if other tests were used
there’d be different results? But so far, no luck. Giving women DHA supplements during
pregnancy did not appear to help with other outcomes like attention
span or working memory either. Although there may be no significant
benefits for infant cognition, what about other things like vision? Six trials have been done to date
supplementing pregnant women. Four showed no effect, and the two that
showed benefit had some problems. And so we really don’t
know at this point. But hey, if all the studies so far
show either nothing or benefit, why not just take them to err
on the side of caution? Yeah, no demonstrable clear
and consistent benefits, but there’s new studies on this
coming out all the time. If it’s harmless, maybe women should
just take it to be on the safe side. The problem is that it may not be
harmless in large doses. In a study in which women were given
a whopping 800 mg of DHA a day during pregnancy, infant girls exposed
to the higher-dose DHA in the womb had lower language scores
and were more likely to have delayed language development than
girls from women in the control group. So the absence of clear positive effects, along with the possible presence
of negative effects in the children, raised the question whether DHA
supplementation is justifiable. But it was a really large dose, suggesting
that there may be an optimal DHA level, below and above which DHA might be
detrimental to the developing brain. So maybe too much is detrimental.
What about too little? I’ll cover that next.

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