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Meta-Analysis
. 2015 Jul 14;2015(7):CD007901.
doi: 10.1002/14651858.CD007901.pub3.

Supplementation with long chain polyunsaturated fatty acids (LCPUFA) to breastfeeding mothers for improving child growth and development

Mario F Delgado-Noguera  1 , Jose Andres Calvache, Xavier Bonfill Cosp, Eleni P Kotanidou, Assimina Galli-Tsinopoulou
Affiliations
Meta-Analysis

Supplementation with long chain polyunsaturated fatty acids (LCPUFA) to breastfeeding mothers for improving child growth and development

Mario F Delgado-Noguera et al. Cochrane Database Syst Rev. .

Abstract

Background: Long chain polyunsaturated fatty acids (LCPUFA), especially docosahexaenoic acid (DHA), are the most abundant fatty acids in the brain and are necessary for growth and maturation of an infant's brain and retina. LCPUFAs are named "essential" because they cannot be synthesised efficiently by the human body and come from maternal diet. It remains controversial whether LCPUFA supplementation to breastfeeding mothers is beneficial for the development of their infants.

Objectives: To assess the effectiveness and safety of supplementation with LCPUFA in breastfeeding mothers in the cognitive and physical development of their infants as well as safety for the mother and infant.

Search methods: We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (6 August 2014), CENTRAL (Cochrane Library 2014, Issue 8), PubMed (1966 to August 2014), EMBASE (1974 to August 2014), LILACS (1982 to August 2014), Google Scholar (August 2014) and reference lists of published narrative and systematic reviews.

Selection criteria: Randomised controlled trials or cluster-randomised controlled trials evaluating the effects of LCPUFA supplementation on breastfeeding mothers (including the pregnancy period) and their infants.

Data collection and analysis: Two review authors independently assessed eligibility and trial quality, performed data extraction and evaluated data accuracy.

Main results: We included eight randomised controlled trials involving 1567 women. All the studies were performed in high-income countries. The longest follow-up was seven years.We report the results from the longest follow-up time point from included studies. Overall, there was moderate quality evidence as assessed using the GRADE approach from these studies for the following outcomes measured beyond 24 months age of children: language development and child weight. There was low-quality evidence for the outcomes: Intelligence or solving problems ability, psychomotor development, child attention, and child visual acuity.We found no significant difference in children's neurodevelopment at long-term follow-up beyond 24 months: language development (standardised mean difference (SMD) -0.27, 95% confidence interval (CI) -0.56 to 0.02; two trials, 187 participants); intelligence or problem-solving ability (three trials, 238 participants; SMD 0.00, 95% CI -0.36 to 0.36); psychomotor development (SMD -0.11, 95% CI -0.48 to 0.26; one trial, 113 participants); motor development (SMD -0.23, 95% CI -0.60 to 0.14; one trial, 115 participants), or in general movements (risk ratio, RR, 1.12, 95% CI 0.58 to 2.14; one trial, 77 participants; at 12 weeks of life). However, child attention scores were better at five years of age in the group of children whose mothers had received supplementation with fatty acids (mean difference (MD) 4.70, 95% CI 1.30 to 8.10; one study, 110 participants)). In working memory and inhibitory control, we found no significant difference (MD -0.02 95% CI -0.07 to 0.03 one trial, 63 participants); the neurological optimality score did not present any difference (P value: 0.55).For child visual acuity, there was no significant difference (SMD 0.33, 95% CI -0.04 to 0.71; one trial, 111 participants).For growth, there were no significant differences in length (MD -0.39 cm, 95% CI -1.37 to 0.60; four trials, 441 participants), weight (MD 0.13 kg, 95% CI -0.49 to 0.74; four trials, 441 participants), and head circumference (MD 0.15 cm, 95% CI -0.27 to 0.58; three trials, 298 participants). Child fat mass and fat mass distribution did not differ between the intervention and control group (MD 2.10, 95% CI -0.48 to 4.68; one trial, 115 participants, MD -0.50, 95% CI -1.69 to 0.69; one trial, 165 participants, respectively).One study (117 infants) reported a significant difference in infant allergy at short-term follow-up (risk ratio (RR) 0.13, 95% CI 0.02 to 0.95), but not at medium-term follow-up (RR 0.52, 95% CI 0.17 to 1.59).We found no significant difference in two trials evaluating postpartum depression. Data were not possible to be pooled due to differences in the describing of the outcome. One study (89 women) did not find any significant difference between the LCPUFA supplementation and the control group at four weeks postpartum (MD 1.00, 95%CI -1.72 to 3.72).No adverse effects were reported.

Authors' conclusions: Based on the available evidence, LCPUFA supplementation did not appear to improve children's neurodevelopment, visual acuity or growth. In child attention at five years of age, weak evidence was found (one study) favouring the supplementation. Currently, there is inconclusive evidence to support or refute the practice of giving LCPUFA supplementation to breastfeeding mothers in order to improve neurodevelopment or visual acuity.

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Conflict of interest statement

The authors declare that they have no conflict of interest.

Figures

1
1
Methodological quality graph: review authors' judgements about each methodological quality item presented as percentages across all included studies.
2
2
Methodological quality summary: review authors' judgements about each methodological quality item for each included study.
1.1
1.1. Analysis
Comparison 1 Fatty acid supplementation versus placebo, Outcome 1 Language development.
1.2
1.2. Analysis
Comparison 1 Fatty acid supplementation versus placebo, Outcome 2 Intelligence or problem‐solving ability.
1.3
1.3. Analysis
Comparison 1 Fatty acid supplementation versus placebo, Outcome 3 Psychomotor development.
1.4
1.4. Analysis
Comparison 1 Fatty acid supplementation versus placebo, Outcome 4 Motor development.
1.5
1.5. Analysis
Comparison 1 Fatty acid supplementation versus placebo, Outcome 5 General movements.
1.6
1.6. Analysis
Comparison 1 Fatty acid supplementation versus placebo, Outcome 6 Child attention.
1.7
1.7. Analysis
Comparison 1 Fatty acid supplementation versus placebo, Outcome 7 Working memory and inhibitory control.
1.9
1.9. Analysis
Comparison 1 Fatty acid supplementation versus placebo, Outcome 9 Child visual acuity.
1.10
1.10. Analysis
Comparison 1 Fatty acid supplementation versus placebo, Outcome 10 Child weight [grams].
1.11
1.11. Analysis
Comparison 1 Fatty acid supplementation versus placebo, Outcome 11 Child length.
1.12
1.12. Analysis
Comparison 1 Fatty acid supplementation versus placebo, Outcome 12 Child head circumference.
1.13
1.13. Analysis
Comparison 1 Fatty acid supplementation versus placebo, Outcome 13 Child BMI.
1.14
1.14. Analysis
Comparison 1 Fatty acid supplementation versus placebo, Outcome 14 Child fat mass.
1.15
1.15. Analysis
Comparison 1 Fatty acid supplementation versus placebo, Outcome 15 Fat mass distribution.
1.16
1.16. Analysis
Comparison 1 Fatty acid supplementation versus placebo, Outcome 16 Infant allergy.
1.17
1.17. Analysis
Comparison 1 Fatty acid supplementation versus placebo, Outcome 17 Postpartum depression.
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References to ongoing studies

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References to other published versions of this review

Delgado‐Noguera 2010
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