For this study, 2399 pregnant women at less than 21 weeks' gestation were enrolled between October 2005 and January 2008 at 1 of 5 Australian maternity hospitals. The women were then randomly assigned to receive either 800 mg daily of DHA-rich fish oil capsules (n = 1197) or matching vegetable oil capsules without DHA (placebo/control group, n = 1202) at baseline, continuing until they gave birth.
The mean age for both groups was 29.9 years, and the median gestational age at trial entry for both groups was 19.0 weeks.
Assessments for adverse gastrointestinal or bleeding events were conducted by telephone at 22, 28, and 36 weeks' gestation.
At 6 weeks and at 6 months postpartum, the mothers were assessed for depressive symptoms using the self-administered Edinburgh Postnatal Depression Scale. The study's primary maternal outcome was a high level of depressive symptoms, which was defined as "a score of more than 12."
Follow-ups were conducted with 694 of the children at the age of 18 months (DHA group, n = 333; placebo group, n = 361). The investigators used the Bayley Scales of Infant and Toddler Development, Third Edition, to evaluate both cognitive and language development.
Neurodevelopment was the study's primary childhood outcome. Secondary outcome measures included an evaluation scale of gross and fine motor functioning and parental report scales of social–emotional behavior and adaptive behavior.
Little to No Effect
Results showed that 96.7% of the enrolled women completed the study.
During the first 6 months postpartum, high levels of depressive symptoms in those taking the DHA capsules (9.67%) and those taking the placebo (11.19%) did not differ significantly (adjusted relative risk [RR], 0.85; 95% confidence interval [CI], 0.70 - 1.02; P = .09).
"Interestingly, our data did suggest a 3% to 4% reduction in depressive symptoms in the subgroup of women who had a previous history of depression," said Dr. Makrides. "It may be that these women [would] benefit from supplementation, but other studies are needed to confirm this."
However, "the percentage of women with a new medical diagnosis for depression during the trial or a diagnosis requiring treatment did not differ between groups," write the study authors.
There were also no significant differences in mean cognitive composite scores for the children of mothers in the DHA group vs those in the control group (adjusted mean difference, 0.01; 95% CI, −1.36 to 1.37; P = .99).
However, fewer infants in the DHA group had scores indicating delayed cognitive development than did those in the control group (2.71% vs 6.64%; P = .007).
Although there were no overall between-group differences in mean language composite scores (adjusted mean difference, −1.42; 95% CI, −3.07 to 0.22; P = .09), or between boys in both treatment groups, the girls in the DHA group had a lower mean language score (P < .001) and an increased risk for delayed language development (P = .03) than did the girls in the control group.
No overall between-group differences were found for motor development, social–emotional behavior, and adaptive behavior. However, the girls in the DHA group had poorer mean adaptive behavior scores than did those in the control group (P = .003).
The DHA-treated group had fewer preterm births of less than 34 weeks' gestation (1.09%) compared with those treated with placebo (2.25%; adjusted RR, 0.49; P = .03), but the DHA group had "more postterm births requiring obstetric intervention," including inductions or cesarean deliveries (17.59% vs 13.72%; adjusted RR, 1.28; P = .01).
"Clearly these trade-offs are important to consider, and it may be that DHA supplementation may be most useful to women at risk of having a preterm baby," noted Dr. Makrides.
Finally, at least 1 serious adverse event was reported for 36 of the DHA-group infants vs 54% of those in the control group (RR, 0.67; P = .06). Eructations were reported by more women in the DHA group than in the control group at both 28 weeks' (43.6% vs 25.6%) and 36 weeks' (41.5% vs 29.2%) gestation (P < .001 for both time points).
"This is the largest and most well-conducted study of its type, [and] we have a conclusive result about the fact that there is little or no effect of DHA supplementation during normal pregnancy on postpartum depression or early childhood neurodevelopment in the first 18 months of life," summarized Dr. Makrides.
No Benefit of DHA Fish Oil for Postpartum Depression, Child Neurodevelopment
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