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Randomized Controlled Trial
. 2012 Jan 30:344:e184.
doi: 10.1136/bmj.e184.

Effect of n-3 long chain polyunsaturated fatty acid supplementation in pregnancy on infants' allergies in first year of life: randomised controlled trial

D J Palmer  1 , T Sullivan, M S Gold, S L Prescott, R Heddle, R A Gibson, M Makrides
Affiliations
Randomized Controlled Trial

Effect of n-3 long chain polyunsaturated fatty acid supplementation in pregnancy on infants' allergies in first year of life: randomised controlled trial

D J Palmer et al. BMJ. .

Abstract

Objective: To determine whether dietary n-3 long chain polyunsaturated fatty acid (LCPUFA) supplementation of pregnant women with a fetus at high risk of allergic disease reduces immunoglobulin E associated eczema or food allergy at 1 year of age.

Design: Follow-up of infants at high hereditary risk of allergic disease in the Docosahexaenoic Acid to Optimise Mother Infant Outcome (DOMInO) randomised controlled trial.

Setting: Adelaide, South Australia.

Participants: 706 infants at high hereditary risk of developing allergic disease whose mothers were participating in the DOMInO trial.

Interventions: The intervention group (n=368) was randomly allocated to receive fish oil capsules (providing 900 mg of n-3 LCPUFA daily) from 21 weeks' gestation until birth; the control group (n=338) received matched vegetable oil capsules without n-3 LCPUFA.

Main outcome measure: Immunoglobulin E associated allergic disease (eczema or food allergy with sensitisation) at 1 year of age.

Results: No differences were seen in the overall percentage of infants with immunoglobulin E associated allergic disease between the n-3 LCPUFA and control groups (32/368 (9%) v 43/338 (13%); unadjusted relative risk 0.68, 95% confidence interval 0.43 to 1.05, P=0.08; adjusted relative risk 0.70, 0.45 to 1.09, P=0.12), although the percentage of infants diagnosed as having atopic eczema (that is, eczema with associated sensitisation) was lower in the n-3 LCPUFA group (26/368 (7%) v 39/338 (12%); unadjusted relative risk 0.61, 0.38 to 0.98, P=0.04; adjusted relative risk 0.64, 0.40 to 1.02, P=0.06). Fewer infants were sensitised to egg in the n-3 LCPUFA group (34/368 (9%) v 52/338 (15%); unadjusted relative risk 0.61, 0.40 to 0.91, P=0.02; adjusted relative risk 0.62, 0.41 to 0.93, P=0.02), but no difference between groups in immunoglobulin E associated food allergy was seen.

Conclusion: n-3 LCPUFA supplementation in pregnancy did not reduce the overall incidence of immunoglobulin E associated allergies in the first year of life, although atopic eczema and egg sensitisation were lower. Longer term follow-up is needed to determine if supplementation has an effect on respiratory allergic diseases and aeroallergen sensitisation in childhood.

Trial registration: Australian New Zealand Clinical Trials Registry ACTRN12610000735055 (DOMInO trial: ACTRN12605000569606).

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Conflict of interest statement

Competing interests: All authors have completed the ICMJE uniform disclosure form at www.icmje.org/coi_disclosure.pdf (available on request from the corresponding author) and declare: all authors had support from the National Health and Medical Research Council (NHMRC) of Australia and the Australian Egg Corporation for the submitted work; MSG has received honorariums from Nutricia; SLP has received grants from the NHMRC and honorariums from the Nestlé Nutrition Institute and Fonterra and has been paid for lectures by the World Allergy Association and the American Academy of Asthma, Allergy and Immunology; RH has been paid for expert testimony from Analysis Plus and Rodika Research Services and has received grants from Commonwealth Serum Laboratories, Vaxine, GlaxoSmithKline, and Healthed; RAG has received grants from the NHMRC and honorariums from Fonterra; MM has received grants from the NHMRC and honorariums from Fonterra, Nestlé Nutrition Institute, and Nutricia.

Figures

None
Flow diagram of trial. DOMInO=Docosahexaenoic Acid to Optimise Mother Infant Outcome; LCPUFA=long chain polyunsaturated fatty acids. *Death was stillbirth and unrelated to objective of study
See this image and copyright information in PMC

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