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Meta-Analysis
. 2018 Nov 15;11(11):CD003402.
doi: 10.1002/14651858.CD003402.pub3.

Omega-3 fatty acid addition during pregnancy

Philippa Middleton  1 , Judith C Gomersall, Jacqueline F Gould, Emily Shepherd, Sjurdur F Olsen, Maria Makrides
Affiliations
Meta-Analysis

Omega-3 fatty acid addition during pregnancy

Philippa Middleton et al. Cochrane Database Syst Rev. .

Abstract

Background: Higher intakes of foods containing omega-3 long-chain polyunsaturated fatty acids (LCPUFA), such as fish, during pregnancy have been associated with longer gestations and improved perinatal outcomes. This is an update of a review that was first published in 2006.

Objectives: To assess the effects of omega-3 LCPUFA, as supplements or as dietary additions, during pregnancy on maternal, perinatal, and neonatal outcomes and longer-term outcomes for mother and child.

Search methods: For this update, we searched Cochrane Pregnancy and Childbirth's Trials Register, ClinicalTrials.gov, the WHO International Clinical Trials Registry Platform (ICTRP) (16 August 2018), and reference lists of retrieved studies.

Selection criteria: Randomised controlled trials (RCTs) comparing omega-3 fatty acids (as supplements or as foods, stand-alone interventions, or with a co-intervention) during pregnancy with placebo or no omega-3, and studies or study arms directly comparing omega-3 LCPUFA doses or types. Trials published in abstract form were eligible for inclusion.

Data collection and analysis: Two review authors independently assessed study eligibility, extracted data, assessed risk of bias in trials and assessed quality of evidence for prespecified birth/infant, maternal, child/adult and health service outcomes using the GRADE approach.

Main results: In this update, we included 70 RCTs (involving 19,927 women at low, mixed or high risk of poor pregnancy outcomes) which compared omega-3 LCPUFA interventions (supplements and food) compared with placebo or no omega-3. Overall study-level risk of bias was mixed, with selection and performance bias mostly at low risk, but there was high risk of attrition bias in some trials. Most trials were conducted in upper-middle or high-income countries; and nearly half the trials included women at increased/high risk for factors which might increase the risk of adverse maternal and birth outcomes.Preterm birth < 37 weeks (13.4% versus 11.9%; risk ratio (RR) 0.89, 95% confidence interval (CI) 0.81 to 0.97; 26 RCTs, 10,304 participants; high-quality evidence) and early preterm birth < 34 weeks (4.6% versus 2.7%; RR 0.58, 95% CI 0.44 to 0.77; 9 RCTs, 5204 participants; high-quality evidence) were both lower in women who received omega-3 LCPUFA compared with no omega-3. Prolonged gestation > 42 weeks was probably increased from 1.6% to 2.6% in women who received omega-3 LCPUFA compared with no omega-3 (RR 1.61 95% CI 1.11 to 2.33; 5141 participants; 6 RCTs; moderate-quality evidence).For infants, there was a possibly reduced risk of perinatal death (RR 0.75, 95% CI 0.54 to 1.03; 10 RCTs, 7416 participants; moderate-quality evidence: 62/3715 versus 83/3701 infants) and possibly fewer neonatal care admissions (RR 0.92, 95% CI 0.83 to 1.03; 9 RCTs, 6920 participants; moderate-quality evidence - 483/3475 infants versus 519/3445 infants). There was a reduced risk of low birthweight (LBW) babies (15.6% versus 14%; RR 0.90, 95% CI 0.82 to 0.99; 15 trials, 8449 participants; high-quality evidence); but a possible small increase in large-for-gestational age (LGA) babies (RR 1.15, 95% CI 0.97 to 1.36; 6 RCTs, 3722 participants; moderate-quality evidence, for omega-3 LCPUFA compared with no omega-3. Little or no difference in small-for-gestational age or intrauterine growth restriction (RR 1.01, 95% CI 0.90 to 1.13; 8 RCTs, 6907 participants; moderate-quality evidence) was seen.For the maternal outcomes, there is insufficient evidence to determine the effects of omega-3 on induction post-term (average RR 0.82, 95% CI 0.22 to 2.98; 3 trials, 2900 participants; low-quality evidence), maternal serious adverse events (RR 1.04, 95% CI 0.40 to 2.72; 2 trials, 2690 participants; low-quality evidence), maternal admission to intensive care (RR 0.56, 95% CI 0.12 to 2.63; 2 trials, 2458 participants; low-quality evidence), or postnatal depression (average RR 0.99, 95% CI 0.56 to 1.77; 2 trials, 2431 participants; low-quality evidence). Mean gestational length was greater in women who received omega-3 LCPUFA (mean difference (MD) 1.67 days, 95% CI 0.95 to 2.39; 41 trials, 12,517 participants; moderate-quality evidence), and pre-eclampsia may possibly be reduced with omega-3 LCPUFA (RR 0.84, 95% CI 0.69 to 1.01; 20 trials, 8306 participants; low-quality evidence).For the child/adult outcomes, very few differences between antenatal omega-3 LCPUFA supplementation and no omega-3 were observed in cognition, IQ, vision, other neurodevelopment and growth outcomes, language and behaviour (mostly low-quality to very low-quality evidence). The effect of omega-3 LCPUFA on body mass index at 19 years (MD 0, 95% CI -0.83 to 0.83; 1 trial, 243 participants; very low-quality evidence) was uncertain. No data were reported for development of diabetes in the children of study participants.

Authors' conclusions: In the overall analysis, preterm birth < 37 weeks and early preterm birth < 34 weeks were reduced in women receiving omega-3 LCPUFA compared with no omega-3. There was a possibly reduced risk of perinatal death and of neonatal care admission, a reduced risk of LBW babies; and possibly a small increased risk of LGA babies with omega-3 LCPUFA.For our GRADE quality assessments, we assessed most of the important perinatal outcomes as high-quality (e.g. preterm birth) or moderate-quality evidence (e.g. perinatal death). For the other outcome domains (maternal, child/adult and health service outcomes) GRADE ratings ranged from moderate to very low, with over half rated as low. Reasons for downgrading across the domain were mostly due to design limitations and imprecision.Omega-3 LCPUFA supplementation during pregnancy is an effective strategy for reducing the incidence of preterm birth, although it probably increases the incidence of post-term pregnancies. More studies comparing omega-3 LCPUFA and placebo (to establish causality in relation to preterm birth) are not needed at this stage. A further 23 ongoing trials are still to report on over 5000 women, so no more RCTs are needed that compare omega-3 LCPUFA against placebo or no intervention. However, further follow-up of completed trials is needed to assess longer-term outcomes for mother and child, to improve understanding of metabolic, growth and neurodevelopment pathways in particular, and to establish if, and how, outcomes vary by different types of omega-3 LCPUFA, timing and doses; or by characteristics of women.

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Conflict of interest statement

Philippa Middleton: none known.

Judith C Gomersall: none known.

Emily Shepherd: none known.

Sjurdur F Olsen: Sjurdur Olsen’s institution has received grant funding from the Innovation Fund Denmark (grant no. 09‐067124, Centre for Fetal Programming) and from the March of Dimes Foundation (6‐FY‐96‐0240, 6‐FY97‐0553, 6‐FY97‐0521, 6‐FY00‐407). Sjurdur Olsen was the principal investigator of three trials included in the review: Olsen 1992, Olsen 2000 and Knudsen 2006.

Maria Makrides: Maria Makrides’ institution has received grant funding (NHMRC Fellowship 1061704 Improving the outcomes of mothers and babies through nutritional interventions and NHMRC 1146806 Efficacy and safety of omega‐3 DHA supplementation in preterm infants: childhood follow‐up of the N3RO trial); and honorarium money from Fonterra (for advice relating to maternal and child nutrition) to fund ECR and MCR conference travel. Professor Makrides is the principal investigator of the DOMInO trial (included) and the ORIP (ongoing) trial trials. She was on the Scientific Advisory Board of Fonterra (to September 2018); and she is President Elect of the International Society for the Study of Fatty Acids and Lipids (ISSFAL).

Jacqueline Gould is an investigator on some of the DOMInO follow‐up studies. She has received honoraria from the Nestle Nutrition Institute ‐ these have been paid to Dr Gould’s institution to support conference travel.

Dr Gould is an investigator in a clinical trial of high‐dose DHA supplementation during pregnancy that was eligible for inclusion in this review. Dr Gould's institute has received project grant funding and a fellowship from the NHMRC and WCH Foundation for work unrelated to this review. She has received honoraria from the Nestle Nutrition Institute and Fonterra ‐ these have been paid to Dr Gould’s institution to support conference travel.

Sjurdur Olsen, Maria Makrides and Jacqueline Gould were not involved in any decisions relating to the above studies and assessment for inclusion/exclusions, risk of bias, data extraction, etc. was carried out by other members of the review team who were not directly involved in these studies.

Figures

1
1
Study flow diagram.
2
2
Risk of bias summary: review authors' judgements about each risk of bias item for each included study.
3
3
Risk of bias graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.
4
4
Funnel plot of comparison: 1 Omega‐3 versus placebo/no omega‐3: OVERALL, outcome: 1.7 Preterm birth (< 37 weeks).
5
5
Funnel plot of comparison: 1 Omega‐3 versus placebo/no omega‐3: OVERALL, outcome: 1.4 Pre‐eclampsia (hypertension with proteinuria).
6
6
Funnel plot of comparison: 1 Omega‐3 versus placebo/no omega‐3: OVERALL, outcome: 1.16 Caesarean section.
7
7
Funnel plot of comparison: 1 Omega‐3 versus placebo/no omega‐3: OVERALL, outcome: 1.20 Gestational diabetes.
8
8
Funnel plot of comparison: 1 Overall: omega‐3 versus no omega‐3, outcome: 1.23 Gestational weight gain (kg).
9
9
Funnel plot of comparison: 1 OVERALL omega‐3 versus placebo/no omega‐3, outcome: 1.31 Length of gestation (days).
10
10
Funnel plot of comparison: 1 OVERALL omega‐3 versus no omega‐3, outcome: 1.32 Perinatal death.
11
11
Funnel plot of comparison: 1 Omega‐3 versus placebo/no omega‐3: OVERALL, outcome: 1.32 Stillbirth.
12
12
Funnel plot of comparison: 1 Omega‐3 versus placebo/no omega‐3: OVERALL, outcome: 1.38 Low birthweight (< 2500 g).
13
13
Funnel plot of comparison: 1 Omega‐3 versus placebo/no omega‐3: OVERALL, outcome: 1.41 Birthweight (g).
14
14
Funnel plot of comparison: 1 Omega‐3 versus placebo/no omega‐3: OVERALL, outcome: 1.43 Birth length (cm).
15
15
Funnel plot of comparison: 1 Omega‐3 versus placebo/no omega‐3: OVERALL, outcome: 1.45 Head circumference at birth (cm).
1.1
1.1. Analysis
Comparison 1 Overall: omega‐3 versus no omega‐3, Outcome 1 Preterm birth (< 37 weeks).
1.2
1.2. Analysis
Comparison 1 Overall: omega‐3 versus no omega‐3, Outcome 2 Early preterm birth (< 34 weeks).
1.3
1.3. Analysis
Comparison 1 Overall: omega‐3 versus no omega‐3, Outcome 3 Prolonged gestation (> 42 weeks).
1.4
1.4. Analysis
Comparison 1 Overall: omega‐3 versus no omega‐3, Outcome 4 Maternal death.
1.5
1.5. Analysis
Comparison 1 Overall: omega‐3 versus no omega‐3, Outcome 5 Pre‐eclampsia (hypertension with proteinuria).
1.6
1.6. Analysis
Comparison 1 Overall: omega‐3 versus no omega‐3, Outcome 6 High blood pressure (without proteinuria).
1.7
1.7. Analysis
Comparison 1 Overall: omega‐3 versus no omega‐3, Outcome 7 Eclampsia.
1.8
1.8. Analysis
Comparison 1 Overall: omega‐3 versus no omega‐3, Outcome 8 Maternal antepartum hospitalisation.
1.9
1.9. Analysis
Comparison 1 Overall: omega‐3 versus no omega‐3, Outcome 9 Mother's length of stay in hospital (days).
1.10
1.10. Analysis
Comparison 1 Overall: omega‐3 versus no omega‐3, Outcome 10 Maternal anaemia.
1.11
1.11. Analysis
Comparison 1 Overall: omega‐3 versus no omega‐3, Outcome 11 Miscarriage (< 24 weeks).
1.12
1.12. Analysis
Comparison 1 Overall: omega‐3 versus no omega‐3, Outcome 12 Antepartum vaginal bleeding.
1.13
1.13. Analysis
Comparison 1 Overall: omega‐3 versus no omega‐3, Outcome 13 Rupture of membranes (PPROM; PROM).
1.14
1.14. Analysis
Comparison 1 Overall: omega‐3 versus no omega‐3, Outcome 14 Maternal admission to intensive care.
1.15
1.15. Analysis
Comparison 1 Overall: omega‐3 versus no omega‐3, Outcome 15 Maternal adverse events.
1.16
1.16. Analysis
Comparison 1 Overall: omega‐3 versus no omega‐3, Outcome 16 Caesarean section.
1.17
1.17. Analysis
Comparison 1 Overall: omega‐3 versus no omega‐3, Outcome 17 Induction (post‐term).
1.18
1.18. Analysis
Comparison 1 Overall: omega‐3 versus no omega‐3, Outcome 18 Blood loss at birth (mL).
1.19
1.19. Analysis
Comparison 1 Overall: omega‐3 versus no omega‐3, Outcome 19 Postpartum haemorrhage.
1.20
1.20. Analysis
Comparison 1 Overall: omega‐3 versus no omega‐3, Outcome 20 Gestational diabetes.
1.21
1.21. Analysis
Comparison 1 Overall: omega‐3 versus no omega‐3, Outcome 21 Maternal insulin resistance (HOMA‐IR).
1.22
1.22. Analysis
Comparison 1 Overall: omega‐3 versus no omega‐3, Outcome 22 Excessive gestational weight gain.
1.23
1.23. Analysis
Comparison 1 Overall: omega‐3 versus no omega‐3, Outcome 23 Gestational weight gain (kg).
1.24
1.24. Analysis
Comparison 1 Overall: omega‐3 versus no omega‐3, Outcome 24 Depression during pregnancy: thresholds.
1.25
1.25. Analysis
Comparison 1 Overall: omega‐3 versus no omega‐3, Outcome 25 Depression during pregnancy: scores.
1.26
1.26. Analysis
Comparison 1 Overall: omega‐3 versus no omega‐3, Outcome 26 Anxiety during pregnancy.
1.27
1.27. Analysis
Comparison 1 Overall: omega‐3 versus no omega‐3, Outcome 27 Difficult life circumstances (maternal).
1.28
1.28. Analysis
Comparison 1 Overall: omega‐3 versus no omega‐3, Outcome 28 Stress (maternal).
1.29
1.29. Analysis
Comparison 1 Overall: omega‐3 versus no omega‐3, Outcome 29 Depressive symptoms postpartum: threshold.
1.30
1.30. Analysis
Comparison 1 Overall: omega‐3 versus no omega‐3, Outcome 30 Depressive symptoms postpartum: scores.
1.31
1.31. Analysis
Comparison 1 Overall: omega‐3 versus no omega‐3, Outcome 31 Gestational length (days).
1.32
1.32. Analysis
Comparison 1 Overall: omega‐3 versus no omega‐3, Outcome 32 Perinatal death.
1.33
1.33. Analysis
Comparison 1 Overall: omega‐3 versus no omega‐3, Outcome 33 Stillbirth.
1.34
1.34. Analysis
Comparison 1 Overall: omega‐3 versus no omega‐3, Outcome 34 Neonatal death.
1.35
1.35. Analysis
Comparison 1 Overall: omega‐3 versus no omega‐3, Outcome 35 Infant death.
1.36
1.36. Analysis
Comparison 1 Overall: omega‐3 versus no omega‐3, Outcome 36 Large‐for‐gestational age.
1.37
1.37. Analysis
Comparison 1 Overall: omega‐3 versus no omega‐3, Outcome 37 Macrosomia.
1.38
1.38. Analysis
Comparison 1 Overall: omega‐3 versus no omega‐3, Outcome 38 Low birthweight (< 2500 g).
1.39
1.39. Analysis
Comparison 1 Overall: omega‐3 versus no omega‐3, Outcome 39 Small‐for‐gestational age/IUGR.
1.40
1.40. Analysis
Comparison 1 Overall: omega‐3 versus no omega‐3, Outcome 40 Birthweight (g).
1.41
1.41. Analysis
Comparison 1 Overall: omega‐3 versus no omega‐3, Outcome 41 Birthweight Z score.
1.42
1.42. Analysis
Comparison 1 Overall: omega‐3 versus no omega‐3, Outcome 42 Birth length (cm).
1.43
1.43. Analysis
Comparison 1 Overall: omega‐3 versus no omega‐3, Outcome 43 Head circumference at birth (cm).
1.44
1.44. Analysis
Comparison 1 Overall: omega‐3 versus no omega‐3, Outcome 44 Head circumference at birth Z score.
1.45
1.45. Analysis
Comparison 1 Overall: omega‐3 versus no omega‐3, Outcome 45 Length at birth Z score.
1.46
1.46. Analysis
Comparison 1 Overall: omega‐3 versus no omega‐3, Outcome 46 Baby admitted to neonatal care.
1.47
1.47. Analysis
Comparison 1 Overall: omega‐3 versus no omega‐3, Outcome 47 Infant length of stay in hospital (days).
1.48
1.48. Analysis
Comparison 1 Overall: omega‐3 versus no omega‐3, Outcome 48 Congenital anomalies.
1.49
1.49. Analysis
Comparison 1 Overall: omega‐3 versus no omega‐3, Outcome 49 Retinopathy of prematurity.
1.50
1.50. Analysis
Comparison 1 Overall: omega‐3 versus no omega‐3, Outcome 50 Bronchopulmonary dysplasia.
1.51
1.51. Analysis
Comparison 1 Overall: omega‐3 versus no omega‐3, Outcome 51 Respiratory distress syndrome.
1.52
1.52. Analysis
Comparison 1 Overall: omega‐3 versus no omega‐3, Outcome 52 Necrotising enterocolitis (NEC).
1.53
1.53. Analysis
Comparison 1 Overall: omega‐3 versus no omega‐3, Outcome 53 Neonatal sepsis (proven).
1.54
1.54. Analysis
Comparison 1 Overall: omega‐3 versus no omega‐3, Outcome 54 Convulsion.
1.55
1.55. Analysis
Comparison 1 Overall: omega‐3 versus no omega‐3, Outcome 55 Intraventricular haemorrhage.
1.56
1.56. Analysis
Comparison 1 Overall: omega‐3 versus no omega‐3, Outcome 56 Neonatal/infant adverse events.
1.57
1.57. Analysis
Comparison 1 Overall: omega‐3 versus no omega‐3, Outcome 57 Neonatal/infant morbidity: cardiovascular.
1.58
1.58. Analysis
Comparison 1 Overall: omega‐3 versus no omega‐3, Outcome 58 Neonatal/infant morbidity: respiratory.
1.59
1.59. Analysis
Comparison 1 Overall: omega‐3 versus no omega‐3, Outcome 59 Neonatal/infant morbidity: due to pregnancy/birth events.
1.60
1.60. Analysis
Comparison 1 Overall: omega‐3 versus no omega‐3, Outcome 60 Neonatal/infant morbidity: other.
1.61
1.61. Analysis
Comparison 1 Overall: omega‐3 versus no omega‐3, Outcome 61 Infant/child morbidity.
1.62
1.62. Analysis
Comparison 1 Overall: omega‐3 versus no omega‐3, Outcome 62 Ponderal index.
1.63
1.63. Analysis
Comparison 1 Overall: omega‐3 versus no omega‐3, Outcome 63 Infant/child weight (kg).
1.64
1.64. Analysis
Comparison 1 Overall: omega‐3 versus no omega‐3, Outcome 64 Infant/child length/height (cm).
1.65
1.65. Analysis
Comparison 1 Overall: omega‐3 versus no omega‐3, Outcome 65 Infant/child head circumference (cm).
1.66
1.66. Analysis
Comparison 1 Overall: omega‐3 versus no omega‐3, Outcome 66 Infant/child length/height for age Z score (LAZ/HAZ).
1.67
1.67. Analysis
Comparison 1 Overall: omega‐3 versus no omega‐3, Outcome 67 Infant/child waist circumference (cm).
1.68
1.68. Analysis
Comparison 1 Overall: omega‐3 versus no omega‐3, Outcome 68 Infant/child weight‐for‐age Z score (WAZ).
1.69
1.69. Analysis
Comparison 1 Overall: omega‐3 versus no omega‐3, Outcome 69 Infant/child BMI Z score.
1.70
1.70. Analysis
Comparison 1 Overall: omega‐3 versus no omega‐3, Outcome 70 Infant/child weight for length/height Z score (WHZ).
1.71
1.71. Analysis
Comparison 1 Overall: omega‐3 versus no omega‐3, Outcome 71 Infant/child BMI percentile.
1.72
1.72. Analysis
Comparison 1 Overall: omega‐3 versus no omega‐3, Outcome 72 Child/adult BMI.
1.73
1.73. Analysis
Comparison 1 Overall: omega‐3 versus no omega‐3, Outcome 73 Infant/child body fat (%).
1.74
1.74. Analysis
Comparison 1 Overall: omega‐3 versus no omega‐3, Outcome 74 Infant/child total fat mass (kg).
1.75
1.75. Analysis
Comparison 1 Overall: omega‐3 versus no omega‐3, Outcome 75 Cognition: thresholds.
1.76
1.76. Analysis
Comparison 1 Overall: omega‐3 versus no omega‐3, Outcome 76 Cognition: scores.
1.77
1.77. Analysis
Comparison 1 Overall: omega‐3 versus no omega‐3, Outcome 77 Attention: scores.
1.78
1.78. Analysis
Comparison 1 Overall: omega‐3 versus no omega‐3, Outcome 78 Motor: thresholds.
1.79
1.79. Analysis
Comparison 1 Overall: omega‐3 versus no omega‐3, Outcome 79 Motor: scores.
1.80
1.80. Analysis
Comparison 1 Overall: omega‐3 versus no omega‐3, Outcome 80 Language: thresholds.
1.81
1.81. Analysis
Comparison 1 Overall: omega‐3 versus no omega‐3, Outcome 81 Language: scores.
1.82
1.82. Analysis
Comparison 1 Overall: omega‐3 versus no omega‐3, Outcome 82 Behaviour: thresholds.
1.83
1.83. Analysis
Comparison 1 Overall: omega‐3 versus no omega‐3, Outcome 83 Behaviour: scores.
1.84
1.84. Analysis
Comparison 1 Overall: omega‐3 versus no omega‐3, Outcome 84 Vision: visual acuity (cycles/degree).
1.85
1.85. Analysis
Comparison 1 Overall: omega‐3 versus no omega‐3, Outcome 85 Vision: VEP acuity.
1.86
1.86. Analysis
Comparison 1 Overall: omega‐3 versus no omega‐3, Outcome 86 Vision: VEP latency.
1.87
1.87. Analysis
Comparison 1 Overall: omega‐3 versus no omega‐3, Outcome 87 Hearing: brainstem auditory‐evoked responses.
1.88
1.88. Analysis
Comparison 1 Overall: omega‐3 versus no omega‐3, Outcome 88 Neurodevelopment: thresholds.
1.89
1.89. Analysis
Comparison 1 Overall: omega‐3 versus no omega‐3, Outcome 89 Neurodevelopment: scores.
1.90
1.90. Analysis
Comparison 1 Overall: omega‐3 versus no omega‐3, Outcome 90 Child Development Inventory.
1.91
1.91. Analysis
Comparison 1 Overall: omega‐3 versus no omega‐3, Outcome 91 Infant sleep behaviour (%).
1.92
1.92. Analysis
Comparison 1 Overall: omega‐3 versus no omega‐3, Outcome 92 Cerebral palsy.
2.1
2.1. Analysis
Comparison 2 Type of omega‐3 intervention, Outcome 1 Preterm birth (< 37 weeks).
2.2
2.2. Analysis
Comparison 2 Type of omega‐3 intervention, Outcome 2 Early preterm birth (< 34 weeks).
2.3
2.3. Analysis
Comparison 2 Type of omega‐3 intervention, Outcome 3 Prolonged gestation (> 42 weeks).
2.4
2.4. Analysis
Comparison 2 Type of omega‐3 intervention, Outcome 4 Maternal death.
2.5
2.5. Analysis
Comparison 2 Type of omega‐3 intervention, Outcome 5 Pre‐eclampsia (hypertension with proteinuria).
2.6
2.6. Analysis
Comparison 2 Type of omega‐3 intervention, Outcome 6 High blood pressure (without proteinuria).
2.7
2.7. Analysis
Comparison 2 Type of omega‐3 intervention, Outcome 7 Eclampsia.
2.8
2.8. Analysis
Comparison 2 Type of omega‐3 intervention, Outcome 8 Maternal antepartum hospitalisation.
2.9
2.9. Analysis
Comparison 2 Type of omega‐3 intervention, Outcome 9 Mother's length of stay in hospital (days).
2.10
2.10. Analysis
Comparison 2 Type of omega‐3 intervention, Outcome 10 Maternal anaemia.
2.11
2.11. Analysis
Comparison 2 Type of omega‐3 intervention, Outcome 11 Miscarriage (< 24 weeks).
2.12
2.12. Analysis
Comparison 2 Type of omega‐3 intervention, Outcome 12 Antepartum vaginal bleeding.
2.13
2.13. Analysis
Comparison 2 Type of omega‐3 intervention, Outcome 13 Preterm prelabour rupture of membranes.
2.14
2.14. Analysis
Comparison 2 Type of omega‐3 intervention, Outcome 14 Prelabour rupture of membranes.
2.15
2.15. Analysis
Comparison 2 Type of omega‐3 intervention, Outcome 15 Maternal admission to intensive care.
2.16
2.16. Analysis
Comparison 2 Type of omega‐3 intervention, Outcome 16 Maternal severe adverse effects (including cessation).
2.17
2.17. Analysis
Comparison 2 Type of omega‐3 intervention, Outcome 17 Caesarean section.
2.18
2.18. Analysis
Comparison 2 Type of omega‐3 intervention, Outcome 18 Induction (post‐term).
2.19
2.19. Analysis
Comparison 2 Type of omega‐3 intervention, Outcome 19 Blood loss at birth (mL).
2.20
2.20. Analysis
Comparison 2 Type of omega‐3 intervention, Outcome 20 Postpartum haemorrhage.
2.21
2.21. Analysis
Comparison 2 Type of omega‐3 intervention, Outcome 21 Gestational diabetes.
2.22
2.22. Analysis
Comparison 2 Type of omega‐3 intervention, Outcome 22 Maternal insulin resistance (HOMA‐IR).
2.23
2.23. Analysis
Comparison 2 Type of omega‐3 intervention, Outcome 23 Excessive gestational weight gain.
2.24
2.24. Analysis
Comparison 2 Type of omega‐3 intervention, Outcome 24 Gestational weight gain (kg).
2.25
2.25. Analysis
Comparison 2 Type of omega‐3 intervention, Outcome 25 Depression during pregnancy: scores.
2.26
2.26. Analysis
Comparison 2 Type of omega‐3 intervention, Outcome 26 Depression during pregnancy: thresholds.
2.27
2.27. Analysis
Comparison 2 Type of omega‐3 intervention, Outcome 27 Depressive symptoms postpartum: thresholds.
2.28
2.28. Analysis
Comparison 2 Type of omega‐3 intervention, Outcome 28 Depressive symptoms postpartum: scores.
2.29
2.29. Analysis
Comparison 2 Type of omega‐3 intervention, Outcome 29 Length of gestation (days).
2.30
2.30. Analysis
Comparison 2 Type of omega‐3 intervention, Outcome 30 Perinatal death.
2.31
2.31. Analysis
Comparison 2 Type of omega‐3 intervention, Outcome 31 Stillbirth.
2.32
2.32. Analysis
Comparison 2 Type of omega‐3 intervention, Outcome 32 Neonatal death.
2.33
2.33. Analysis
Comparison 2 Type of omega‐3 intervention, Outcome 33 Infant death.
2.34
2.34. Analysis
Comparison 2 Type of omega‐3 intervention, Outcome 34 Large‐for‐gestational age.
2.35
2.35. Analysis
Comparison 2 Type of omega‐3 intervention, Outcome 35 Macrosomia.
2.36
2.36. Analysis
Comparison 2 Type of omega‐3 intervention, Outcome 36 Low birthweight (< 2500 g).
2.37
2.37. Analysis
Comparison 2 Type of omega‐3 intervention, Outcome 37 Small‐for‐gestational age/IUGR.
2.38
2.38. Analysis
Comparison 2 Type of omega‐3 intervention, Outcome 38 Birthweight (g).
2.39
2.39. Analysis
Comparison 2 Type of omega‐3 intervention, Outcome 39 Birthweight Z score.
2.40
2.40. Analysis
Comparison 2 Type of omega‐3 intervention, Outcome 40 Birth length (cm).
2.41
2.41. Analysis
Comparison 2 Type of omega‐3 intervention, Outcome 41 Length at birth Z score.
2.42
2.42. Analysis
Comparison 2 Type of omega‐3 intervention, Outcome 42 Head circumference at birth (cm).
2.43
2.43. Analysis
Comparison 2 Type of omega‐3 intervention, Outcome 43 Head circumference at birth Z score.
2.44
2.44. Analysis
Comparison 2 Type of omega‐3 intervention, Outcome 44 Baby admitted to neonatal care.
2.45
2.45. Analysis
Comparison 2 Type of omega‐3 intervention, Outcome 45 Infant length of stay in hospital (days).
2.46
2.46. Analysis
Comparison 2 Type of omega‐3 intervention, Outcome 46 Congenital anomalies.
2.47
2.47. Analysis
Comparison 2 Type of omega‐3 intervention, Outcome 47 Retinopathy of prematurity.
2.48
2.48. Analysis
Comparison 2 Type of omega‐3 intervention, Outcome 48 Bronchopulmonary dysplasia.
2.49
2.49. Analysis
Comparison 2 Type of omega‐3 intervention, Outcome 49 Respiratory distress syndrome.
2.50
2.50. Analysis
Comparison 2 Type of omega‐3 intervention, Outcome 50 Necrotising enterocolitis (NEC).
2.51
2.51. Analysis
Comparison 2 Type of omega‐3 intervention, Outcome 51 Neonatal sepsis (proven).
2.52
2.52. Analysis
Comparison 2 Type of omega‐3 intervention, Outcome 52 Convulsion.
2.53
2.53. Analysis
Comparison 2 Type of omega‐3 intervention, Outcome 53 Intraventricular haemorrhage.
2.54
2.54. Analysis
Comparison 2 Type of omega‐3 intervention, Outcome 54 Neonatal/infant serious adverse events.
2.55
2.55. Analysis
Comparison 2 Type of omega‐3 intervention, Outcome 55 Neonatal/infant morbidity: cardiovascular.
2.56
2.56. Analysis
Comparison 2 Type of omega‐3 intervention, Outcome 56 Neonatal/infant morbidity: respiratory.
2.57
2.57. Analysis
Comparison 2 Type of omega‐3 intervention, Outcome 57 Neonatal/infant morbidity: caused by pregnancy/birth.
2.58
2.58. Analysis
Comparison 2 Type of omega‐3 intervention, Outcome 58 Ponderal index.
3.1
3.1. Analysis
Comparison 3 Dose (DHA/EPA) subgroups, Outcome 1 Preterm birth (< 37 weeks).
3.2
3.2. Analysis
Comparison 3 Dose (DHA/EPA) subgroups, Outcome 2 Early preterm birth (< 34 weeks).
3.3
3.3. Analysis
Comparison 3 Dose (DHA/EPA) subgroups, Outcome 3 Prolonged gestation (> 42 weeks).
3.4
3.4. Analysis
Comparison 3 Dose (DHA/EPA) subgroups, Outcome 4 Pre‐eclampsia (hypertension with proteinuria).
3.5
3.5. Analysis
Comparison 3 Dose (DHA/EPA) subgroups, Outcome 5 Caesarean section.
3.6
3.6. Analysis
Comparison 3 Dose (DHA/EPA) subgroups, Outcome 6 Length of gestation (days).
3.7
3.7. Analysis
Comparison 3 Dose (DHA/EPA) subgroups, Outcome 7 Perinatal death.
3.8
3.8. Analysis
Comparison 3 Dose (DHA/EPA) subgroups, Outcome 8 Stillbirth.
3.9
3.9. Analysis
Comparison 3 Dose (DHA/EPA) subgroups, Outcome 9 Neonatal death.
3.10
3.10. Analysis
Comparison 3 Dose (DHA/EPA) subgroups, Outcome 10 Low birthweight (< 2500 g).
3.11
3.11. Analysis
Comparison 3 Dose (DHA/EPA) subgroups, Outcome 11 Small‐for‐gestational age/IUGR.
3.12
3.12. Analysis
Comparison 3 Dose (DHA/EPA) subgroups, Outcome 12 Birthweight (g).
4.1
4.1. Analysis
Comparison 4 Timing subgroups, Outcome 1 Preterm birth (< 37 weeks).
4.2
4.2. Analysis
Comparison 4 Timing subgroups, Outcome 2 Early preterm birth (< 34 weeks).
4.3
4.3. Analysis
Comparison 4 Timing subgroups, Outcome 3 Prolonged gestation (> 42 weeks).
4.4
4.4. Analysis
Comparison 4 Timing subgroups, Outcome 4 Pre‐eclampsia (hypertension with proteinuria).
4.5
4.5. Analysis
Comparison 4 Timing subgroups, Outcome 5 Caesarean section.
4.6
4.6. Analysis
Comparison 4 Timing subgroups, Outcome 6 Length of gestation (days).
4.7
4.7. Analysis
Comparison 4 Timing subgroups, Outcome 7 Perinatal death.
4.8
4.8. Analysis
Comparison 4 Timing subgroups, Outcome 8 Stillbirth.
4.9
4.9. Analysis
Comparison 4 Timing subgroups, Outcome 9 Neonatal death.
4.10
4.10. Analysis
Comparison 4 Timing subgroups, Outcome 10 Low birthweight (< 2500 g).
4.11
4.11. Analysis
Comparison 4 Timing subgroups, Outcome 11 Small‐for‐gestational age/IUGR.
4.12
4.12. Analysis
Comparison 4 Timing subgroups, Outcome 12 Birthweight (g).
5.1
5.1. Analysis
Comparison 5 DHA/mixed subgroups, Outcome 1 Preterm birth (< 37 weeks).
5.2
5.2. Analysis
Comparison 5 DHA/mixed subgroups, Outcome 2 Early preterm birth (< 34 weeks).
5.3
5.3. Analysis
Comparison 5 DHA/mixed subgroups, Outcome 3 Prolonged gestation (> 42 weeks).
5.4
5.4. Analysis
Comparison 5 DHA/mixed subgroups, Outcome 4 Pre‐eclampsia (hypertension with proteinuria).
5.5
5.5. Analysis
Comparison 5 DHA/mixed subgroups, Outcome 5 Caesarean section.
5.6
5.6. Analysis
Comparison 5 DHA/mixed subgroups, Outcome 6 Gestational length (days).
5.7
5.7. Analysis
Comparison 5 DHA/mixed subgroups, Outcome 7 Perinatal death.
5.8
5.8. Analysis
Comparison 5 DHA/mixed subgroups, Outcome 8 Stillbirth.
5.9
5.9. Analysis
Comparison 5 DHA/mixed subgroups, Outcome 9 Neonatal death.
5.10
5.10. Analysis
Comparison 5 DHA/mixed subgroups, Outcome 10 Low birthweight (< 2500 g).
5.11
5.11. Analysis
Comparison 5 DHA/mixed subgroups, Outcome 11 Small‐for‐gestational age/IUGR.
5.12
5.12. Analysis
Comparison 5 DHA/mixed subgroups, Outcome 12 Birthweight (g).
6.1
6.1. Analysis
Comparison 6 Risk subgroups, Outcome 1 Preterm birth (< 37 weeks).
6.2
6.2. Analysis
Comparison 6 Risk subgroups, Outcome 2 Early preterm birth (< 34 weeks).
6.3
6.3. Analysis
Comparison 6 Risk subgroups, Outcome 3 Prolonged gestation (> 42 weeks).
6.4
6.4. Analysis
Comparison 6 Risk subgroups, Outcome 4 Pre‐eclampsia (hypertension with proteinuria).
6.5
6.5. Analysis
Comparison 6 Risk subgroups, Outcome 5 Caesarean section.
6.6
6.6. Analysis
Comparison 6 Risk subgroups, Outcome 6 Length of gestation (days).
6.7
6.7. Analysis
Comparison 6 Risk subgroups, Outcome 7 Perinatal death.
6.8
6.8. Analysis
Comparison 6 Risk subgroups, Outcome 8 Stillbirth.
6.9
6.9. Analysis
Comparison 6 Risk subgroups, Outcome 9 Neonatal death.
6.10
6.10. Analysis
Comparison 6 Risk subgroups, Outcome 10 Low birthweight (< 2500 g).
6.11
6.11. Analysis
Comparison 6 Risk subgroups, Outcome 11 Small‐for‐gestational age/IUGR.
6.12
6.12. Analysis
Comparison 6 Risk subgroups, Outcome 12 Birthweight (g).
7.1
7.1. Analysis
Comparison 7 Omega‐3 doses: direct comparisons, Outcome 1 Early preterm birth < 34 weeks.
7.2
7.2. Analysis
Comparison 7 Omega‐3 doses: direct comparisons, Outcome 2 Prolonged gestation > 42 weeks.
7.3
7.3. Analysis
Comparison 7 Omega‐3 doses: direct comparisons, Outcome 3 Pre‐eclampsia.
7.4
7.4. Analysis
Comparison 7 Omega‐3 doses: direct comparisons, Outcome 4 Induction (post‐term).
7.5
7.5. Analysis
Comparison 7 Omega‐3 doses: direct comparisons, Outcome 5 PROM.
7.6
7.6. Analysis
Comparison 7 Omega‐3 doses: direct comparisons, Outcome 6 PPROM.
7.7
7.7. Analysis
Comparison 7 Omega‐3 doses: direct comparisons, Outcome 7 Length of gestation.
7.8
7.8. Analysis
Comparison 7 Omega‐3 doses: direct comparisons, Outcome 8 Birthweight (g).
7.9
7.9. Analysis
Comparison 7 Omega‐3 doses: direct comparisons, Outcome 9 Length at birth (cm).
7.10
7.10. Analysis
Comparison 7 Omega‐3 doses: direct comparisons, Outcome 10 Head circumference at birth (cm).
8.1
8.1. Analysis
Comparison 8 Omega‐3 type: direct comparisons, Outcome 1 Gestational diabetes.
8.2
8.2. Analysis
Comparison 8 Omega‐3 type: direct comparisons, Outcome 2 Caesarean section.
8.3
8.3. Analysis
Comparison 8 Omega‐3 type: direct comparisons, Outcome 3 Adverse events: cessation.
8.4
8.4. Analysis
Comparison 8 Omega‐3 type: direct comparisons, Outcome 4 Pre‐eclampsia.
8.5
8.5. Analysis
Comparison 8 Omega‐3 type: direct comparisons, Outcome 5 Blood loss at birth (mL).
8.6
8.6. Analysis
Comparison 8 Omega‐3 type: direct comparisons, Outcome 6 Depressive symptoms postpartum: thresholds.
8.7
8.7. Analysis
Comparison 8 Omega‐3 type: direct comparisons, Outcome 7 Depressive symptoms postpartum: scores.
8.8
8.8. Analysis
Comparison 8 Omega‐3 type: direct comparisons, Outcome 8 Length of gestation (days).
8.9
8.9. Analysis
Comparison 8 Omega‐3 type: direct comparisons, Outcome 9 Baby admitted to neonatal care.
8.10
8.10. Analysis
Comparison 8 Omega‐3 type: direct comparisons, Outcome 10 Birthweight (g).
8.11
8.11. Analysis
Comparison 8 Omega‐3 type: direct comparisons, Outcome 11 Infant weight (kg).
8.12
8.12. Analysis
Comparison 8 Omega‐3 type: direct comparisons, Outcome 12 Infant height (cm).
8.13
8.13. Analysis
Comparison 8 Omega‐3 type: direct comparisons, Outcome 13 Infant head circumference (cm).
8.14
8.14. Analysis
Comparison 8 Omega‐3 type: direct comparisons, Outcome 14 Cognition: Scores.
8.15
8.15. Analysis
Comparison 8 Omega‐3 type: direct comparisons, Outcome 15 Motor: Scores.
8.16
8.16. Analysis
Comparison 8 Omega‐3 type: direct comparisons, Outcome 16 Neurodevelopment.
8.17
8.17. Analysis
Comparison 8 Omega‐3 type: direct comparisons, Outcome 17 Cerebral palsy.
9.1
9.1. Analysis
Comparison 9 Sensitivity analysis: omega‐3 versus no omega‐3, Outcome 1 Preterm birth (< 37 weeks).
9.2
9.2. Analysis
Comparison 9 Sensitivity analysis: omega‐3 versus no omega‐3, Outcome 2 Early preterm birth (< 34 weeks).
9.3
9.3. Analysis
Comparison 9 Sensitivity analysis: omega‐3 versus no omega‐3, Outcome 3 Prolonged gestation (> 42 weeks).
9.4
9.4. Analysis
Comparison 9 Sensitivity analysis: omega‐3 versus no omega‐3, Outcome 4 Pre‐eclampsia (hypertension with proteinuria).
9.5
9.5. Analysis
Comparison 9 Sensitivity analysis: omega‐3 versus no omega‐3, Outcome 5 Caesarean section.
9.6
9.6. Analysis
Comparison 9 Sensitivity analysis: omega‐3 versus no omega‐3, Outcome 6 Length of gestation (days).
9.7
9.7. Analysis
Comparison 9 Sensitivity analysis: omega‐3 versus no omega‐3, Outcome 7 Perinatal death.
9.8
9.8. Analysis
Comparison 9 Sensitivity analysis: omega‐3 versus no omega‐3, Outcome 8 Stillbirth.
9.9
9.9. Analysis
Comparison 9 Sensitivity analysis: omega‐3 versus no omega‐3, Outcome 9 Neonatal death.
9.10
9.10. Analysis
Comparison 9 Sensitivity analysis: omega‐3 versus no omega‐3, Outcome 10 Low birthweight (< 2500 g).
9.11
9.11. Analysis
Comparison 9 Sensitivity analysis: omega‐3 versus no omega‐3, Outcome 11 Small‐for‐gestational age/IUGR.
9.12
9.12. Analysis
Comparison 9 Sensitivity analysis: omega‐3 versus no omega‐3, Outcome 12 Birthweight (g).
See this image and copyright information in PMC

Update of

Comment in

References

References to studies included in this review

Ali 2017 {published data only}
    1. Ali MK. The effect of omega 3 on pregnancy complicated by asymmetrical intrauterine growth restriction. clinicaltrials.gov/ct2/show/NCT02696577 (first received 28 February 2016).
    1. Ali MK, Amin ME, Amin AF, Abd El, Aal DE. Evaluation of the effectiveness of low‐dose aspirin and omega 3 in treatment of asymmetrically intrauterine growth restriction: a randomized clinical trial. European Journal of Obstetrics, Gynecology, and Reproductive Biology 2017;210:231‐5. [NCT02696577] - PubMed
Bergmann 2007 {published data only}
    1. Bergmann RL, Bergmann KE, Haschke‐Becher E, Richter R, Dudenhausen JW, Barclay D, et al. Does maternal docosahexaenoic acid supplementation during pregnancy and lactation lower BMI in late infancy?. Journal of Perinatal Medicine 2007;35(4):295‐300. - PubMed
    1. Bergmann RL, Bergmann KE, Richter R, Haschke‐Becher E, Henrich W, Dudenhausen JW. Does docosahexaenoic acid (DHA) status in pregnancy have any impact on postnatal growth? Six‐year follow‐up of a prospective randomized double‐blind monocenter study on low‐dose DHA supplements. Journal of Perinatal Medicine 2012;40:677‐84. - PubMed
    1. Bergmann RL, Haschke‐Becher E, Klassen‐Wigger P, Bergmann KE, Richter R, Dudenhausen JW, et al. Supplementation with 200 mg/day docosahexaenoic acid from mid‐pregnancy through lactation improves the docosahexaenoic acid status of mothers with a habitually low fish intake and of their infants. Annals of Nutrition & Metabolism 2008;52(2):157‐66. - PMC - PubMed
    1. Bergmann RL, Haschke‐Becher, Bergmann KE, Dudenhausen JW, Haschke F. Low dose docosahexaenoic acid supplementation improves the DHA status of pregnant women. Pediatric Academic Societies Annual Meeting; 2006 April 29‐May 2; San Francisco (CA). 2006.
    1. Bergmann RL, Richter R, Bergmann KE, Dudenhausen JW, Haschke F. 21 months old infants are leaner if their mothers received low dose DHA supplements during pregnancy and lactation. European Journal of Pediatrics 2006;165(Suppl 1):114.
Bisgaard 2016 {published data only}
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Boris 2004 {published data only}
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Bosaeus 2015 {published data only}
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Bulstra‐Ramakers 1994 {published data only}
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Carlson 2013 {published data only}
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    1. Carlson SE. DHA supplementation and pregnancy outcome. clinicaltrials.gov/ct2/show/NCT00266825 (first received 19 December 2005).
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    1. Carlson SE, Gajewski BJ, Alhayek S, Colombo J, Kerling EH, Gustafson KM. Dose‐response relationship between docosahexaenoic acid (DHA) intake and lower rates of early preterm birth, low birth weight and very low birth weight. Prostaglandins, Leukotrienes and Essential Fatty Acids 2018;138:1‐5. - PMC - PubMed
    1. Colombo J, Gustafson KM, Gajewski BJ, Shaddy DJ, Kerling EH, Thodosoff JM, et al. Prenatal DHA supplementation and infant attention. Pediatric Research 2016;80(5):656‐62. [DOI: 10.1038/pr.2016.134] - DOI - PMC - PubMed
Chase 2015 {published data only}
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D'Almedia 1992 {published data only}
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de Groot 2004 {published data only}
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    1. Groot RH, Hornstra G, Jolles J. Exploratory study into the relation between plasma phospholipid fatty acid status and cognitive performance. Prostaglandins Leukotrienes and Essential Fatty Acids 2004;76(3):165‐72. - PubMed
    1. Groot RH, Hornstra G, Houwelingen AC, Roumen F. Effect of alpha‐linolenic acid supplementation during pregnancy on maternal and neonatal polyunsaturated fatty acid status and pregnancy outcome. American Journal of Clinical Nutrition 2004;79:251‐60. - PubMed
Dilli 2018 {published data only}
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    1. Dilli D, Dogan NN, Ipek MS, Cavus Y, Ceylaner S, Dogan H, et al. MaFOS‐GDM trial: maternal fish oil supplementation in women with gestational diabetes and cord blood DNA methylation at insulin like growth factor‐1 (IGF‐1) gene. Clinical Nutrition ESPEN 2018;23:73‐8. - PubMed
Dunstan 2008 {published data only}
    1. Amarasekera M, Noakes P, Strickland D, Saffery R, Martino DJ, Prescott SL. Epigenome‐wide analysis of neonatal CD4+ T‐cell methylation sites potentially affected by maternal fish oil supplementation. Epigenetics 2014;9(12):1570‐6. - PMC - PubMed
    1. Barden AE, Dunstan JA, Beilin LJ, Prescott SL, Mori TA. n ‐ 3 fatty acid supplementation during pregnancy in women with allergic disease: effects on blood pressure, and maternal and fetal lipids. Clinical Science 2006;111(4):289‐94. - PubMed
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    1. Denburg JA, Hatfield HM, Cyr MM, Hayes L, Holt PG, Semhi R, et al. Fish oil supplementation in pregnancy modifies neonatal progenitors at birth in infants at risk of atopy. Pediatric Research 2005;57(2):276‐81. - PubMed
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England 1989 {published data only}
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Freeman 2008 {published data only}
    1. Freeman MP, Davis M, Sinha P, Wisner KL, Hibbeln JR, Gelenberg AJ. Omega‐3 fatty acids and supportive psychotherapy for perinatal depression: a randomized placebo‐controlled study. Journal of Affective Disorders 2008;110:142‐8. - PMC - PubMed
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Furuhjelm 2009 {published data only}
    1. Duchen K. Omega‐3 fatty acid supplementation in pregnancy and during lactation: a randomized, double‐blind, placebo controlled trial. clinicaltrials.gov/show/NCT00892684 (first received 4 May 2009).
    1. Duchen KM. Combined dietary supplementation with Lactobacillus reuteri and omega‐3 PUFA during pregnancy and postnatally in relation to development of IgE‐associated disease during infancy. clinicaltrials.gov/show/NCT01542970 (first received 2 March 2012).
    1. Furuhjelm C, Jenmalm MC, Falth‐Magnusson K, DuchIn K. Th1 and Th2 chemokines, vaccine‐induced immunity, and allergic disease in infants after maternal ‐3 fatty acid supplementation during pregnancy and lactation. Pediatric Research 2011;69(3):259‐64. - PubMed
    1. Furuhjelm C, Warstedt K, Fageras M, Falth‐Magnusson K, Larsson J, Fredriksson M, et al. Allergic disease in infants up to 2 years of age in relation to plasma omega‐3 fatty acids and maternal fish oil supplementation in pregnancy and lactation. Pediatric Allergy and Immunology 2011;22(5):505‐14. - PubMed
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Giorlandino 2013 {published data only}
    1. Giorlandino C, Giannarelli D. Effect of vaginally administered DHA fatty acids on pregnancy outcome in high risk pregnancies for preterm delivery: a double blinded randomised controlled trial. Journal of Prenatal Medicine 2013;7(3):42‐5. - PMC - PubMed
    1. Giorlandino C, ISRCTN39268609. Effect of vaginally administered docosahexaenoic acid (DHA) fatty acids on pregnancy outcome: a randomised controlled trial. isrctn.com/ISRCTN39268609 (first received 27 May 2009). [ISRCTN39268609]
Gustafson 2013 {published data only}
    1. Carlson SE, Gajewski BJ, Alhayek S, Colombo J, Kerling EH, Gustafson KM. Dose‐response relationship between docosahexaenoic acid (DHA) intake and lower rates of early preterm birth, low birth weight and very low birth weight. Prostaglandins, Leukotrienes and Essential Fatty Acids 2018;138:1‐5. - PMC - PubMed
    1. Gustafson K, NCT01007110. The effects of docosahexaenoic acid (DHA) on fetal cardiac outcomes. clinicaltrials.gov/show/NCT01007110 (first received 3 November 2009).
    1. Gustafson KM, Carlson SE, Colombo J, Yeh HW, Shaddy DJ, Li S, et al. Effects of docosahexaenoic acid supplementation during pregnancy on fetal heart rate and variability: a randomized clinical trial. Prostaglandins Leukotrienes, and Essential Fatty Acids 2013;88(5):331‐8. - PMC - PubMed
Haghiac 2015 {published data only}
    1. Berggren EK, Groh‐Wargo S, Presley L, Hauguel‐de Mouzon S, Catalano PM. Maternal fat, but not lean, mass is increased among overweight/obese women with excess gestational weight gain. American Journal of Obstetrics and Gynecology 2016;214:745.e1‐5. - PMC - PubMed
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    1. Calabuig‐Navarro V, Puchowicz M, Glazebrook P, Haghiac M, Minium J, Catalano P, et al. Effect of omega‐3 supplementation on placental lipid metabolism in overweight and obese women. American Journal of Clinical Nutrition 2016;103:1064‐72. - PMC - PubMed
    1. Calabuig‐Navarro V, Puchowicz M, Haghiac M, Catalano P, De‐Mouzon SH, O'Tierney‐Ginn P. Reduced fatty acid esterification and accumulation in placentas of omega‐3 supplemented women. Diabetes 2015;64:A95.
    1. Catalano P, Haghiac M, Smith S, Dettlebach S, Gunzler D, Groh‐Wargo S, et al. Omega‐3 poly‐unsaturated fatty acid supplementation in overweight and obese women: a pilot RCT to improve inflammation, insulin sensitivity and decrease fetal adiposity. American Journal of Obstetrics and Gynecology 2014;210(1 Suppl):S43.
Harper 2010 {published data only}
    1. Bustos ML, Caritis SN, Jablonski KA, Reddy UM, Sorokin Y, Manuck T, et al. The association among cytochrome P450 3A, progesterone receptor polymorphisms, plasma 17‐alpha hydroxyprogesterone caproate concentrations, and spontaneous preterm birth. American Journal of Obstetrics and Gynecology 2017;271(3):369.e1‐369.e9. [DOI: 10.1016/j.ajog.2017.05.019] - DOI - PMC - PubMed
    1. Caritis S. Pharmacodynamic impact of 17‐hydroxyprogesterone caproate (17‐OHPC) in singleton gestation. Reproductive Sciences 2012;19(3 Suppl):126A.
    1. Caritis SN, Venkataramanan R, Thom E, Harper M, Klebanoff MA, Sorokin Y, et al. Relationship between 17‐alpha hydroxyprogesterone caproate concentration and spontaneous preterm birth. American Journal of Obstetrics and Gynecology 2014;210(2):128.e1‐6. - PMC - PubMed
    1. Harper M. Low maternal omega‐3 levels prior to 22 weeks' gestation are associated with preterm delivery and low fish intake. American Journal of Obstetrics and Gynecology 2009;201(6 Suppl 1):S172‐3.
    1. Harper M. Omega‐3 fatty acids and cytokine production. American Journal of Obstetrics and Gynecology 2011;204(1 Suppl):S202.
Harris 2015 {published data only}
    1. Harris MA. DHA supplementation and pregnancy outcome. clinicaltrials.gov/ct2/show/record/NCT02219399 (first received 18 August 2014).
    1. Harris MA, Reece MS, McGregor JA, Wilson JW, Burke SM, Wheeler M, et al. The effect of omega‐3 docosahexaenoic acid supplementation on gestational length: randomized trial of supplementation compared to nutrition education for Increasing n‐3 intake from foods. BioMed Research International 2015;2015:Article ID: 123078. [CENTRAL: 3195090; DOI: 10.1155/2015/123078] - DOI - PMC - PubMed
Hauner 2012 {published data only}
    1. Amann‐Gassner U, NCT00362089. The impact of the nutritional fatty acids during pregnancy and lactation for early human adipose tissue development. clinicaltrials.gov/ct2/show/NCT00362089 (first received 3 February 2014).
    1. Brei C, Brunner S, Pusch K, Much D, Stecher L, Amann‐Gassner U, et al. Long‐chain polyunsaturated fatty acids during pregnancy/lactation and children's body composition: 5‐year follow‐up data (INFAT‐study). Annals of Nutrition and Metabolism 2015;67(Suppl 1):413.
    1. Brei C, Much D, Heimberg E, Schulte V, Brunner S, Stecher L, et al. Sonographic assessment of abdominal fat distribution during the first year of infancy. Pediatric Research 2015;78(3):342‐50. [DOI: 10.1038/pr.2015.108] - DOI - PubMed
    1. Brei C, Stecher L, Brunner S, Ensenauer R, Heinen F, Wagner PD, et al. Impact of the n‐6:n‐3 long‐chain PUFA ratio during pregnancy and lactation on offspring neurodevelopment: 5‐year follow‐up of a randomized controlled trial. European Journal of Clinical Nutrition 2017; Vol. 71, issue 9:1114‐20. [DOI: 10.1038/ejcn.2017.79] - DOI - PubMed
    1. Brei C, Stecher L, Much D, Karla MT, Amann‐Gass U, Shen J, et al. Reduction of the n‐6:n‐3 long‐chain PUFA ratio during pregnancy and childbirth on offspring body composition: follow‐up results from a randomized controlled trial up to 5 y of age. American Journal of Clinical Nutrition 2016; Vol. 103, issue 6:1472‐81. [DOI: ] - PubMed
Helland 2001 {published data only}
    1. Haugen G, Helland I. Influence of preeclampsia or maternal intake of omega‐3 fatty acids on the vasoactive effect of prostaglandin F‐two‐alpha in human umbilical arteries. Gynecologic & Obstetric Investigation 2001;52:75‐81. - PubMed
    1. Helland IB, Saugstad OD, Saarem K, Houwelingen AC, Nylander G, Drevon CA. Supplementation of n‐3 fatty acids during pregnancy and lactation reduces maternal plasma lipid levels and provides DHA to the infants. Journal of Maternal‐Fetal & Neonatal Medicine 2006;19(7):397‐406. - PubMed
    1. Helland IB, Saugstad OD, Smith L, Saarem K, Solvoll K, Ganes T, et al. Similar effects on infants of n‐3 and n‐6 fatty acid supplementation to pregnant and lactating women. Pediatrics 2001;108:1‐7. - PubMed
    1. Helland IB, Smith L, Blomen B, Saarem K, Saugstad OD, Drevon CA. Effect of supplementing pregnant and lactating mothers with n‐3 very‐long‐chain fatty acids on children's IQ and body mass index at 7 years of age. Pediatrics 2008;122(2):e472‐9. - PubMed
    1. Helland IB, Smith L, Saarem K, Saugstad OD, Drevon CA. Maternal supplementation with very‐long‐chain n‐3 fatty acids during pregnancy and lactation augments children's IQ at 4 years of age. Pediatrics 2003;111:e39‐44. - PubMed
Horvaticek 2017 {published data only}
    1. Djelmis J, ISRCTN15203878. The impact of EPA and DHA supplementation on C‐peptide preservation in type 1 diabetic pregnant women. isrctn.com/ISRCTN15203878 (first received 8 September 2016). [ISRCTN15203878]
    1. Horvaticek M, Djelmis J, Ivanisevic M, Oreskovic S, Herman M. Effect of eicosapentaenoic acid and docosahexaenoic acid supplementation on C‐peptide preservation in pregnant women with type‐1 diabetes: randomized placebo controlled clinical trial. European Journal of Clinical Nutrition 2017; Vol. 71, issue 8:968‐72. - PubMed
Hurtado 2015 {published data only}
    1. Campos‐Martinez A, Serrano L, Medina M, Ochoa J, Pena‐Caballero M. Levels of docosahexaenoic acid in pregnant women and their children after taking a fish oil enriched diet. Journal of Maternal‐Fetal and Neonatal Medicine 2012;25(S2):92.
    1. Diaz‐Castro J, Moreno‐Fernandez J, Hijano S, Kajarabille N, Pulido‐Moran M, Latunde‐Dada GO, et al. DHA supplementation: a nutritional strategy to improve prenatal Fe homeostasis and prevent birth outcomes related with Fe‐deficiency. Journal of Functional Foods 2015;19:385‐93.
    1. Hurtado JA, Iznaola C, Pena M, Ruiz J, Pena‐Quintana L, Kajarabille N, et al. Effects of maternal omega‐3 supplementation on fatty acids and on visual and cognitive development. Journal of Pediatric Gastroenterology and Nutrition 2015;61:472‐80. - PubMed
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Ismail 2016 {published data only}
    1. Ismail AA, NCT01990690. Role of antioxidants in unexplained oligohydramnios, a randomized trial. clinicaltrials.gov/ct2/show/NCT01990690 (first received 21 November 2013). [NCT01990690]
    1. Ismail AA, Ramadan MF, Ali MK, Abbas AM, Saman AM, Makarem MH. A randomized controlled study of the efficacy of 4 weeks of supplementation with ω‐3 polyunsaturated fatty acids in cases of unexplained oligohydramnios. Journal of Perinatology 2016;36(11):944‐7. - PubMed
Jamilian 2016 {published data only}
    1. Asemi Z, IRCT201406305623N20. Effect of omega‐3 supplementation on inflammatory factors, biomarkers of oxidative stress and pregnancy outcomes in gestational diabetes. en.search.irct.ir/view/18933 (first received 16 July 2014).
    1. Jamilian M, Samimi M, Kolahdooz F, Khalaji F, Razavi M, Asemi Z. Omega‐3 fatty acid supplementation affects pregnancy outcomes in gestational diabetes: a randomized, double‐blind, placebo‐controlled trial. Journal of Maternal‐Fetal & Neonatal Medicine 2016;29(4):669‐75. - PubMed
Jamilian 2017 {published data only}
    1. Jamilian M, Samimi M, Afshar Ebrahimi F, Hashemi T, Taghizadeh M, Sanami M, et al. The effects of vitamin D and omega‐3 fatty acid co‐supplementation on glycemic control and lipid concentrations in patients with gestational diabetes. Journal of Clinical Lipidology 2017;11(2):459‐68. - PubMed
Judge 2007 {published data only}
    1. Courville AB, Harel O, Lammi‐Keefe CJ. Consumption of a DHA‐containing functional food during pregnancy is associated with lower infant ponderal index and cord plasma insulin concentration. British Journal of Nutrition 2011;106(2):208‐12. - PubMed
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    1. Durham H, Wood JT, Williams JS, Geaghan JP, Makriyannis A, Lammi‐Keefe CJ. How do plasma endocannabinoids and inflammatory markers respond to docosahexaenoic acid (DHA) supplementation in pregnancy?. FASEB Journal 2011;25:777.4.
    1. Judge MP. Impact of maternal docosahexaenoic acid (DHA) supplementation in the form of a functional food during pregnancy on infant neurodevelopment: A comparison of vision, memory, temperament and problem‐solving abilities. Proquest Dissertations Publishing, 2006.
    1. Judge MP, Cong X, Harel O, Courville AB, Lammi‐Keefe CJ. Maternal consumption of a DHA‐containing functional food benefits infant sleep patterning: An early neurodevelopmental measure. Early Human Development 2012;88(7):531‐7. - PubMed
Judge 2014 {published data only}
    1. Judge MP, Beck C, Durham H, Lammi‐Keefe C, McKelvey MM. Specific symptoms of postpartum depression (PPD) are decreased in mothers supplemented with docosahexaenoic acid (DHA, 22:6n‐3) during pregnancy. Nursing Research 2013;62(2):E21.
    1. Judge MP, Beck CT, Durham H, McKelvey MM, Lammi‐Keefe CJ. Maternal docosahexaenoic acid (DHA, 22:6n‐3) consumption during pregnancy decreases postpartum depression (PPD) symptomatology. FASEB Journal 2011;25:349.7.
    1. Judge MP, Beck CT, Durham H, McKelvey MM, Lammi‐Keefe CJ. Pilot trial evaluating maternal docosahexanoic acid consumption during pregnancy: decreased postpartum depressive symptomatology. International Journal of Nursing Sciences 2014;1:339‐45.
Kaviani 2014 {published data only}
    1. Azima S. The effect of omega‐3 fatty acid capsules on anxiety and quality of life gravida during pregnancy depression that refer to health clinic in Shiraz, Iran. en.search.irct.ir/view/11938 (first received 3 January 2013).
    1. Kaviani M, Saniee L, Azima S, Sharif F, Sayadi M. The effect of omega‐3 fatty acid supplementation on maternal depression during pregnancy: a double blind randomized controlled clinical trial. International Journal of Community Based Nursing and Midwifery 2014;2(3):142‐7. - PMC - PubMed
Keenan 2014 {published data only}
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Khalili 2016 {published data only}
    1. Faraji I, Ostadrahimi A, Farshbaf‐Khalili A, Aslani H. The impact of supplementation with fish oil on lipid profile of pregnant mothers: a randomized controlled trial. Crescent Journal of Medical and Biological Sciences 2016;3(3):100‐6.
    1. Farshbaf‐Khalili A, IRCT2013100914957N1. The effect of fish‐oil supplementation on pregnancy outcomes in mother and infant: a randomized controlled trial. en.search.irct.ir/view/15365 (first received 14 February 2014).
    1. Farshbaf‐Khalili A, Mohammad‐Alizadeh S, Mohammadi F, Ostadrahimi A. Fish‐oil supplementation and maternal mental health: a triple‐blind, randomized controlled trial. Iranian Red Crescent Medical Journal 2017;19(1):e36237. [IRCT2013100914957N1]
    1. Khalili AF, Mohamad‐Alizadeh S, Darabi M, Hematzadeh S, Mehdizadeh A, Shaaker M, et al. The effect of fish oil supplementation on serum phospholipid fatty acids profile during pregnancy: a double blind randomized controlled trial. Women & Health 2017;57(2):137‐53. [DOI: 10.1080/03630242.2016.1159269] - DOI - PubMed
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Knudsen 2006 {published data only}
    1. Knudsen VK, Hansen HS, Osterdal ML, Mikkelsen TB, Mu H, Olsen SF. Fish oil in various doses or flax oil in pregnancy and timing of spontaneous delivery: a randomised controlled trial. BJOG: an international journal of obstetrics and gynaecology 2006;113(5):536‐43. - PubMed
Krauss‐Etschmann 2007 {published data only}
    1. Broekaert I, Campoy C, Iznaola C, Hoffman B, Mueller‐Felber W, Koletzko BV. Visual evoked potentials in infants after dietary supply of docosahexaenoic acid and 5‐methyl‐tetrahydrofolate during pregnancy. Journal of Pediatric Gastroenterology and Nutrition 2004;39(Suppl 1):S33.
    1. Campoy C, Escolano‐Margarit MV, Ramos R, Parrilla‐Roure M, Csabi G, Beyer J, et al. Effects of prenatal fish‐oil and 5‐methyltetrahydrofolate supplementation on cognitive development of children at 6.5 y of age. American Journal of Clinical Nutrition 2011;94(6 Suppl):1880S‐8S. - PubMed
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    1. Catena A, Martinez‐Zaldivar C, Diaz‐Piedra C, Torres‐Espinola FJ, Brandi P, Perez‐Garcia M, et al. On the relationship between head circumference, brain size, prenatal long‐chain PUFA/5‐methyltetrahydrofolate supplementation and cognitive abilities during childhood. British Journal of Nutrition 2017 [Epub ahead of print]:1‐9. - PubMed
    1. Catena A, Muñoz‐Machicao JA, Torres‐Espínola FJ, Martínez‐Zaldívar C, Diaz‐Piedra C, Gil A, et al. Folate and long‐chain polyunsaturated fatty acid supplementation during pregnancy has long‐term effects on the attention system of 8.5‐y‐old offspring: a randomized controlled trial. American Journal of Clinical Nutrition 2016;103(1):115‐27. - PubMed
Krummel 2016 {published data only}
    1. Escaname EN, Foster BA, Larsen B, Siddiqui SK, Menchaca J, Hale D, et al. Randomized controlled trial of DHA supplementation in pregnancy: results from long term follow up of offspring. Pediatric Academic Societies Annual Meeting; 2016 April 30‐May 3; Baltimore (MD). 2016:3365.8.
    1. Foster BA, Escaname E, Powell TL, Larsen B, Siddiqui SK, Menchaca J, et al. Randomized controlled trial of DHA supplementation during pregnancy: child adiposity outcomes. Nutrients 2017;9(6):E566. [DOI: 10.3390/nu9060566] - DOI - PMC - PubMed
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Laivuori 1993 {published data only}
    1. Laivuori H, Hovatta O, Viinikka L, Ylikorkala O. Dietary supplementation with primrose oil or fish oil does not change urinary excretion of prostacyclin and thromboxane metabolites in pre‐eclamptic women. Prostaglandins Leukotrienes and Essential Fatty Acids 1993;49:691‐4. - PubMed
Makrides 2010 {published data only}
    1. Ahmed S, Makrides M, Sim N, McPhee A, Quinlivan J, Gibson R, et al. Analysis of hospital cost outcome of DHA‐rich fish‐oil supplementation in pregnancy: evidence from a randomized controlled trial. Prostaglandins, Leukotrienes, and Essential Fatty Acids 2015;102‐103:5‐11. - PubMed
    1. Best K, ACTRN12615000498594. Six year follow up of a randomised controlled trial to compare maternal omega‐3 long chain poly‐unsaturated fatty acids (n‐3 LCPUFA) supplementation versus vegetable oil in pregnancy, on allergic disease outcomes in the school age child. anzctr.org.au/Trial/Registration/TrialReview.aspx?id=367939 (first received 24 April 2015). [ACTRN12615000498594]
    1. Best K, Sullivan T, Gold M, Kennedy D, Martin J, Palmer D, et al. Six‐year follow up of children at high hereditary risk of allergy, born to mothers supplemented with docosahexaenoic acid (DHA) in the DOMInO trial. Journal of Paediatrics and Child Health 2015;51(Suppl 1):58.
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Malcolm 2003 {published data only}
    1. Malcolm CA, Hamilton R, McCulloch DL, Montgomery C, Weaver LT. Scotopic electroretinogram in term infants born of mothers supplemented with docosahexaenoic acid during pregnancy. Investigative Ophthalmology & Visual Science 2003;44:3685‐91. - PubMed
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Mardones 2008 {published data only}
    1. Mardones F, Urrutia MT, Villarroel L, Rioseco A, Castillo O, Rozowski J, et al. Effects of a dairy product fortified with multiple micronutrients and omega‐3 fatty acids on birth weight and gestation duration in pregnant Chilean women. Public Health Nutrition 2008;11(1):30‐40. - PubMed
Martin‐Alvarez 2012 {published data only}
    1. Martin Alvarez E, Pena‐Caballero M, Hurtado‐Suazo JA, Kajarabille N, Lara‐Villoslada F, Ochoa JJ. Variability in adipokines profile of newborns and their mothers after DHA supplementation in pregnancy [PS‐053]. Archives Disease in Childhood 2014;99(Suppl 2):A131.
    1. Martin E, Pena M, Kajarabille N, Hurtado JA, Lara‐Villoslada F, Ochoa JJ. Effect of DHA supplementation during pregnancy and lactation on several adipokines in pregnant women and their neonates. Journal of Maternal‐Fetal & Neonatal Medicine 2014;27(Suppl 1):85.
    1. Martin‐Alvarez E, Guerrero‐Montenegro B, Romero‐Paniagua MT, Lara‐Villoslada F, Hurtado‐Suazo JA. Maternal docosahexaenoic acid supplementation during pregnancy and lactation can modulate oxidative stress in the term newborn. Journal of Maternal‐Fetal and Neonatal Medicine 2012;25(S2):40.
Miller 2016 {published data only}
    1. Harris M, Miller S, Baker S, McGirr K, Davalos D. The omega smart baby project; effect of maternal DHA on infant development. FASEB Journal 2014;28(1 Suppl):[abstract no: 269.1].
    1. Miller SM, Harris MA, Baker SS, Davalos DB, Clark AM, McGirr KA. Intake of total omega‐3 docosahexaenoic acid associated with increased gestational length and improved cognitive performance at 1 year of age. Journal of Nutritional Health & Food Engineering 2016;5(3):00176.
Min 2014 {published data only}
    1. Min Y, Djahanbakhch O, Hutchinson J, Bhullar AS, Raveendran M, Hallot A, et al. Effect of docosahexaenoic acid‐enriched fish oil supplementation in pregnant women with type 2 diabetes on membrane fatty acids and fetal body composition ‐ double‐blinded randomized placebo‐controlled trial. Diabetic Medicine 2014;31:1331‐40. - PubMed
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Min 2014 [diabetic women] {published data only}
    1. Min Y, Djahanbakhch O, Hutchinson J, Bhullar AS, Raveendran M, Hallot A, et al. Effect of docosahexaenoic acid‐enriched fish oil supplementation in pregnant women with type 2 diabetes on membrane fatty acids and fetal body composition ‐ double‐blinded randomized placebo‐controlled trial. Diabetic Medicine 2014;31:1331‐40. - PubMed
    1. Min Y, ISRCTN68997518. Dietary omega‐3 and omega‐6 fatty acids supplementation in pregnant women with diabetes: a randomised, double‐blind, placebo‐controlled trial. isrctn.com/ISRCTN68997518 (first received 30 July 2010).
Min 2016 {published data only}
    1. Min Y, Djahanbakhch O, Hutchinson J, Eram S, Bhullar AS, Namugere I, et al. Efficacy of docosahexaenoic acid‐enriched formula to enhance maternal and fetal blood docosahexaenoic acid levels: randomized double‐blinded placebo‐controlled trial of pregnant women with gestational diabetes mellitus. Clinical Nutrition 2016;35:608‐14. - PubMed
Mozurkewich 2013 {published data only}
    1. Berman D, Clinton C, Limb R, Somers EC, Romero V, Mozurkewich E. Prenatal omega‐3 supplementation and eczema risk among offspring at age 36 months. Insights Allergy Asthma Bronchitis 2016; Vol. 2, issue 1:1. [DOI: 10.21767/2471-304X.100014] - DOI - PMC - PubMed
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    1. Jain JA, Tyner JE, Holbrook BD, Williams JA, Mozurkewich EL. Is vitamin D associated with insulin sensitivity in maternal or umbilical cord blood?. Reproductive Sciences 2015;22(Suppl 1):251A.
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Mulder 2014 {published data only}
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Noakes 2012 {published data only}
    1. Anonymous. Salmon in pregnancy study (SiPS). clinicaltrials.gov/ct2/show/NCT00801502 (first received 3 December 2008).
    1. Garcia‐Rodriguez C, Helmersson‐Karlqvis J, Mesa M, Miles E, Noakes P, Vlachava M, et al. Increased intake of salmon decreases F2‐isoprostanes in pregnant women. Annals of Nutrition and Metabolism 2011;58(Suppl 3):122‐3.
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Ogundipe 2016 {published data only}
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Oken 2013 {published data only}
    1. Oken E, Guthrie LB, Bloomingdale A, Gillman MW, Olsen SF, Amarasiriwardena CJ, et al. Assessment of dietary fish consumption in pregnancy: comparing one‐, four‐ and thirty‐six‐item questionnaires. Public Health Nutrition 2014;17:1949‐59. - PMC - PubMed
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Olsen 1992 {published data only}
    1. Dalby Sorensen J, Olsen SF, Pedersen AK, Boris J, Secher NJ, FitzGerald GA. Effect of fish oil supplementation in the third trimester of pregnancy on prostacyclin and thromboxane production. American Journal of Obstetrics and Gynecology 1993;168:915‐22. - PubMed
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Olsen 2000 {published data only}
    1. Hansen S, Maslova E, Strom M, Secher NJ, Olsen SF. Does mode of delivery modify the association between intake of fish oil during pregnancy and the risk of child asthma? Results from a randomized controlled trial with twin pregnancies. Acta Obstetricia et Gynecologica Scandinavica 2013;92:17.
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Olsen 2000 [twins] {published data only}
    1. Hansen S, Maslova E, Strom M, Secher NJ, Olsen SF. Does mode of delivery modify the association between intake of fish oil during pregnancy and the risk of child asthma? Results from a randomized controlled trial with twin pregnancies. Acta Obstetricia et Gynecologica Scandinavica 2013;92:17.
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Onwude 1995 {published data only}
    1. Onwude J, Hjartar H, Tuffnell D, Thornton JG, Lilford RJ. Fish oil in high risk pregnancy: a randomised, double blind, placebo‐controlled trial. Proceedings of 26th British Congress of Obstetrics and Gynaecology; 1992 July 7‐10; Manchester (UK). 1992:430.
    1. Onwude JL, Lilford RJ, Hjartardottir H, Staines A, Tuffnell D. A randomised double blind placebo controlled trial of fish oil in high risk pregnancy. British Journal of Obstetrics and Gynaecology 1995;102:95‐100. - PubMed
Otto 2000 {published data only}
    1. Otto SJ, Houwelingen AC, Hornstra G. The effect of supplementation with docosahexaenoic and arachidonic acid derived from single cell oils on plasma and erythrocyte fatty acids of pregnant women in the second trimester. Prostaglandins Leukotrienes, and Essential Fatty Acids 2000;63:323‐8. - PubMed
Pietrantoni 2014 {published data only}
    1. Pietrantoni E, Chierico F, Rigon G, Vernocchi P, Salvatori G, Manco M, et al. Docosahexaenoic acid supplementation during pregnancy: a potential tool to prevent membrane rupture and preterm labor. International Journal of Molecular Sciences 2014;15:8024‐36. - PMC - PubMed
Ramakrishnan 2010 {published data only}
    1. Barraza‐Villarreal A, Escamilla‐Nunez MC, Hernandez‐Cadena L, Navarro‐Olivos E, Texcalac‐Sangrador JL, Shackleton C, et al. Volatile organic compounds air concentrations and respiratory function in Mexican preschoolers from mothers whose participated in a randomized clinical trial during pregnancy. American Journal of Respiratory Critical Care 2012;185:A6887.
    1. Escamilla‐Nunez MC, Barraza‐Villarreal A, Hernandez‐Cadena L, Navarro‐Olivos E, Sly PD, Romieu I. Omega‐3 fatty acid supplementation during pregnancy and respiratory symptoms in children. Chest 2014;146(2):373‐82. - PMC - PubMed
    1. Gonzalez‐Casanova I, Rzehak P, Hao W, Aryeh S, Barraza‐Villarreal A, Garcia‐Feregrino R, et al. Fatty acid desaturase single nucleotide polymorphisms modify the effect of prenatal supplementation with docosahexaenoic acid on birth weight. FASEB Journal 2015;29(1 Suppl):403.3.
    1. Gonzalez‐Casanova I, Rzehak P, Stein AD, Garcia Feregrino R, Rivera Dommarco JA, Barraza‐Villareal A, et al. Maternal single nucleotide polymorphisms in the fatty acid desaturase 1 and 2 coding regions modify the impact of prenatal supplementation with DHA on birth weight. American Journal of Clinical Nutrition 2016;103(4):1171‐8. - PMC - PubMed
    1. Gonzalez‐Casanova I, Stein A, Hao W, Feregrino R, Romieu I, Barraza‐Villarreal A, et al. Height and BMI at five years of age following prenatal supplementation with docosahexaenoic acid in Mexico. FASEB Journal 2014;28(1 Suppl 1):256.8.
Ranjkesh 2011 {published data only}
    1. Lalooha F, Ghaleh TD, Pakniiat H, Ranjkesh F, Gholshahi T, Mashrabi O. Evaluation of the effect of omega‐3 supplements in the prevention of preeclampsia among high risk women. African Journal of Pharmacy and Pharmacology 2012;6(35):2580‐3. [DOI: 10.5897/AJPP11.836] - DOI
    1. Ranjkesh F. The effect of omega3 supplementation in preeclampsia in pregnant women at risk in Qazvin [IRCT138706061113N1]. en.irct.ir/trial/145 (first received 27 March 2010).
    1. Ranjkesh F, Laluha F, Pakniat H, Kazemi H, Golshahi T, Esmaili S. Effect of omeg‐3 supplementation on preeclampsia in high risk pregnant women. Journal of Qazvin University of Medical Sciences 2011;15(2):28‐33.
Razavi 2017 {published data only}
    1. Razavi M. Clinical trial of the effect of combined omega‐3 fatty acids and vitamin D supplementation compared with the placebo on metabolic profiles and pregnancy outcomes in patients with gestational diabetes. en.search.irct.ir/view/35656 (first received 9 February 2017). [IRCT201701305623N106]
    1. Razavi M, Jamilian M, Samimi M, Afshar Ebrahimi F, Taghizadeh M, Bekhradi R, et al. The effects of vitamin D and omega‐3 fatty acids co‐supplementation on biomarkers of inflammation, oxidative stress and pregnancy outcomes in patients with gestational diabetes. Nutrition & Metabolism 2017;14:80. [DOI: 10.1186/s12986-017-0236-9] - DOI - PMC - PubMed
Razavi 2017 [vit D] {published data only}
    1. Razavi M. Clinical trial of the effect of combined omega‐3 fatty acids and vitamin D supplementation compared with the placebo on metabolic profiles and pregnancy outcomes in patients with gestational diabetes. en.search.irct.ir/view/35656 (first received 9 February 2017). [IRCT201701305623N106]
    1. Razavi M, Jamilian M, Samimi M, Afshar Ebrahimi F, Taghizadeh M, Bekhradi R, et al. The effects of vitamin D and omega‐3 fatty acids co‐supplementation on biomarkers of inflammation, oxidative stress and pregnancy outcomes in patients with gestational diabetes. Nutrition & Metabolism 2017;14:80. [DOI: 10.1186/s12986-017-0236-9] - DOI - PMC - PubMed
Rees 2008 {published data only}
    1. Rees AM, Austin MP, Parker GB. Omega‐3 fatty acids as a treatment for perinatal depression: randomized double‐blind placebo‐controlled trial. Australian and New Zealand Journal of Psychiatry 2008;42:199‐205. - PubMed
Ribeiro 2012 {published data only}
    1. Ribeiro P, Carvalho FD, Abreu Ade A, Sant'anna Mde T, Lima RJ, Carvalho Pde O. Effect of fish oil supplementation in pregnancy on the fatty acid composition of erythrocyte phospholipids and breast milk lipids. International Journal of Food Sciences & Nutrition 2012;63(1):36‐40. - PubMed
Rivas‐Echeverria 2000 {published data only}
    1. Rivas‐Echeverria CA, Echeverria Y, Molina L, Novoa D. Synergic use of aspirin, fish oil and vitamins C and E for the prevention of preeclampsia. Hypertension in Pregnancy 2000;19:30.
Samimi 2015 {published data only}
    1. Samimi M, Jamilian M, Asemi Z, Esmaillzadeh A. Effects of omega‐3 fatty acid supplementation on insulin metabolism and lipid profiles in gestational diabetes: randomized, double‐blind, placebo‐controlled trial. American Journal of Clinical Nutrition 2015;34:388‐93. - PubMed
Sanjurjo 2004 {published data only}
    1. Sanjurjo P, Ruiz‐Sanz JI, Jimeno P, Aldamiz‐Echevarria L, Aquino L, Matorras R, et al. Supplementation with docosahexaenoic acid in the last trimester of pregnancy: maternal‐fetal biochemical findings. Journal of Perinatal Medicine 2004;32(2):132‐6. - PubMed
Smuts 2003a {published data only}
    1. Colombo J, Kannass KN, Shaddy DJ, Kundurthi S, Maikranz JM, Anderson CJ, et al. Maternal DHA and the development of attention in infancy and toddlerhood. Child Development 2004;75(4):1254‐67. - PubMed
    1. Smuts CM, Huang M, Mundy D, Plasse T, Major S, Carlson SE. A randomized trial of docosahexaenoic acid supplementation during the third trimester of pregnancy. Obstetrics & Gynecology 2003;101:469‐79. - PubMed
Smuts 2003b {published data only}
    1. Borod E, Atkinson R, Barclay WR, Carlson SE. Effects of third trimester consumption of eggs high in docosahexaenoic acid on docosahexaenoic acid status and pregnancy. Lipids 1999;34 Suppl:S231. - PubMed
    1. Smuts CM, Borod E, Peeples JM, Carlson SE. High‐DHA eggs: feasibility as a means to enhance circulating DHA in mother and infant. Lipids 2003;38(4):407‐14. - PubMed
Su 2008 {published data only}
    1. Su K‐P, Huang S‐Y, Chiu T‐H, Huang K‐C, Huang C‐L, Chang H‐C, et al. Omega‐3 fatty acids for major depressive disorder during pregnancy: results from a randomized, double‐blind, placebo‐controlled trial. Journal of Clinical Psychiatry 2008;69(4):644‐51. - PubMed
Taghizadeh 2016 {published data only}
    1. Asemi Z, IRCT201507035623N47. Clinical trial of the effect of combined omega‐3 and vitamin E supplementation on pregnancy outcomes in gestational diabetes. en.search.irct.ir/view/24407 (first received 19 July 2015).
    1. Jamilian M, Hashemi Dizaji S, Bahmani F, Taghizadeh M, Memarzadeh MR, Karamali M, et al. A randomized controlled clinical trial investigating the effects of omega‐3 fatty acids and vitamin E co‐supplementation on biomarkers of oxidative stress, inflammation and pregnancy outcomes in gestational diabetes. Canadian Journal of Diabetes 2017;41(2):143‐9. [DOI: 10.1016/j.jcjd.2016.09.004] - DOI - PubMed
    1. Taghizadeh M, Jamilian M, Mazloomi M, Sanami M, Asemi Z. A randomised‐controlled clinical trial investigating the effect of omega‐3 fatty acids and vitamin E co‐supplementation on markers of insulin metabolism and lipid profiles in gestational diabetes. Journal of Clinical Lipidology 2016;10:386‐93. - PubMed
Tofail 2006 {published data only}
    1. Tofail F, Hamadani JD, Ahmed AZ, Mehrin F, Hakim M, Huda SN. The mental development and behavior of low‐birth‐weight Bangladeshi infants from an urban low‐income community. European Journal of Clinical Nutrition 2012;66(2):237‐43. - PubMed
    1. Tofail F, Kabir I, Hamadani JD, Chowdhury F, Yesmin S, Mehreen F, et al. Supplementation of fish‐oil and soy‐oil during pregnancy and psychomotor development of infants. Journal of Health, Population & Nutrition 2006;24(1):48‐56. - PubMed
Valenzuela 2015 {published data only}
    1. Valenzuela R, Bascunan K, Chamorro R, Barrera C, Sandoval J, Puigrredon C, et al. Modification of docosahexaenoic acid composition of milk from nursing women who received alpha linolenic acid from chia oil during gestation and nursing. Nutrients 2015;7(8):6405‐24. - PMC - PubMed
Van Goor 2009 {published data only}
    1. Doornbos B, Goor SA, Dijck‐Brouwer DA, Schaafsma A, Kork J, Muskiet FA. Supplementation of a low dose of DHA or DHA+AA does not prevent peripartum depressive symptoms in a small population based sample. Progress in Neuro‐Psychopharmacology & Biological Psychiatry 2009;33(1):49‐52. - PubMed
    1. Goor SA, Dijck‐Brouwer DA, Erwich JJ, Schaafsma A, Mijna Hadders‐Algra M. The influence of supplemental docosahexaenoic and arachidonic acids during pregnancy and lactation on neurodevelopment at eighteen months. Prostaglandins Leukotrienes and Essential Fatty Acids 2011;84(5‐6):139‐46. - PubMed
    1. Goor SA, Dijck‐Brouwer DA, Hadders‐Algra M, Doornbos B, Erwich JJ, Schaafsma A, et al. Human milk arachidonic acid and docosahexaenoic acid contents increase following supplementation during pregnancy and lactation. Prostaglandins Leukotrienes, and Essential Fatty Acids 2009;80(1):65‐9. - PubMed
    1. Goor SA, Muskiet FA. The effect of a high DHA‐fish oil and arachidonic acid (AA) supplementation during pregnancy and lactation on LCP status of mother and child and on the neurological development of the baby. trialregister.nl/trialreg/admin/rctview.asp?TC=366 (first received 19 December 2005.
    1. Goor SA, Schaafsma A, Erwich JJ, Dijck‐Brouwer DA, Muskiet FA. Mildly abnormal general movement quality in infants is associated with higher Mead acid and lower arachidonic acid and shows a U‐shaped relation with the DHA/AAratio. Prostaglandins Leukotrienes and Essential Fatty Acids 2010;82:15‐20. - PubMed
Van Winden 2017 {published data only}
    1. Winden KR, Montoro M, Silverstein E, Ovalle B, Shulman I, Ouzounian JG. The use of omega‐3 fatty acids to improve insulin sensitivity in pregnancy: a pilot study of safety and tolerability. Obstetrics and Gynecology 2017;129:174S.
Vaz 2017 {published data only}
    1. Vaz JD, Farias DR, Adegboye AR, Nardi AE, Kac G. Omega‐3 supplementation from pregnancy to postpartum to prevent depressive symptoms: a randomized placebo controlled trial. BMC Pregnancy and Childbirth 2017;17(1):180. [DOI: 10.1186/s12884-017-1365-x] - DOI - PMC - PubMed

References to studies excluded from this review

Escobar 2008 {published data only}
    1. Escobar G, NCT00691418. DHA administration and length of gestation: a feasibility study. clinicaltrials.gov/show/NCT00691418 (first received 5 June 2008). [NCT00691418]
Fievet 1985 {published data only}
    1. Fievet P, Tribout B, Castier B, Dieval J, Capiod JC, Delobel J, et al. Effects of evening primrose oil (EPO) on platelet functions during pregnancy in patients with high risk of toxemia. Kidney International 1985;28:234.
Gholami 2017 {published data only}
    1. Gholami SN, IRCT2015072123269N1. Clinical trial to evaluate the effect of fish oil supplementation on pregnancy outcomes in pregnant women. http://en.search.irct.ir/view/24693 (first received 11 June 2017). [IRCT2015072123269N1]
Herrera 1993 {published data only}
    1. Herrera JA. Nutritional factors and rest reduce pregnancy‐induced hypertension and pre‐eclampsia in positive roll‐over test primigravidas. International Journal of Gynecology & Obstetrics 1993;41:31‐5. - PubMed
Herrera 1998 {published data only}
    1. Herrera JA, Arevalo‐Herrera M, Herrera S. Prevention of preeclampsia by linoleic acid and calcium supplementation: a randomized controlled trial. Obstetrics & Gynecology 1998;91:585‐90. - PubMed
Herrera 2004 {published data only}
    1. Herrera JA, Shahabuddin AK, Ersheng G, Wei Y, Garcia RG, Lopez‐Jaramillo P. Calcium plus linoleic acid therapy for pregnancy‐induced hypertension. International Journal of Gynecology & Obstetrics 2005;91(3):221‐7. - PubMed
    1. Herrera JA, Shahabuddin AK, Faisal M, Ersheng G, Wei Y, Lixia D, et al. Effects of supplementation with oral calcium and linoleic acid in primigravidas at high risk [Efectos de la supplementacion oral con calcio y acido linoleico conjugado en primigravidas de alto riesgo]. Colombia Medica 2004;35(1):31‐7.
Lauritzen 2004 {published data only}
    1. Asserhoj M, Nehammer S, Matthiessen J, Michaelsen KF, Lauritzen L. Maternal fish oil supplementation during lactation may adversely affect long‐term blood pressure, energy intake, and physical activity of 7‐year‐old boys. Journal of Nutrition 2009;139(2):298‐304. - PubMed
    1. Cheatham CL, Nerhammer AS, Asserhoj M, Michaelsen KF, Lauritzen L. Fish oil supplementation during lactation: effects on cognition and behavior at 7 years of age. Lipids 2011;46(7):637‐45. - PubMed
    1. Cheatham CL, Nerhammer S, Asserhoj M, Michaelsen KF, Lauritzen L. Fish oil supplementation during lactation: effects on cognition and behavior at 7 years of age. FASEB Journal 2011;25(Suppl):766.9. - PubMed
    1. Larnkjaer A, Christensen JH, Michaelsen KF, Lauritzen L. Maternal fish oil supplementation during lactation does not affect blood pressure, pulse wave velocity, or heart rate variability in 2.5‐y‐old children. Journal of Nutrition 2006;136(6):1539‐44. - PubMed
    1. Lauritzen L, Halkjaer LB, Mikkelsen TB, Olsen SF, Michaelsen KF, Loland L, et al. Fatty acid composition of human milk in atopic Danish mothers. American Journal of Clinical Nutrition 2006;84(1):190‐6. - PubMed
Marangell 2004 {published data only}
    1. Marangell LB, Martinez JM, Zboyan HA, Chong H, Puryear LJ. Omega‐3 fatty acids for the prevention of postpartum depression: negative data from a preliminary, open‐label pilot study. Depression and Anxiety 2004;19:20‐3. - PubMed
Morrison 1984 {published data only}
    1. Morrison RA, O'Brien PMS, Micklewright A. The effect of dietary supplementation with linoleic acid on the development of pregnancy induced hypertension. 4th World Congress of the International Society for the Study of Hypertension in Pregnancy; 1984 June 18‐21; Amsterdam (The Netherlands). 1984:48.
Morrison 1986 {published data only}
    1. Morrison RA, O'Brien PMS. The effect of dietary supplementation with prostaglandin precursors in pregnancy induced hypertension (PIH). 5th International Congress of the International Society for the Study of Hypertension in Pregnancy; 1986 July 7‐10; Nottingham (UK). 1986.
Nishi 2016 {published data only}
    1. Nishi D, Su KP, Usada, K, Chiang YJ, Guu TW, Haamazaki K, et al. Omega‐3 fatty acid supplementation for expectant mothers with depressive symptoms in Japan and Taiwan: An open‐label trial. Psychiatry and Clinical Neurosciences 2016;70:253‐5. - PubMed
Starling 1990 {published data only}
    1. Starling M, Gunn T, Stewart F. The control of gestational proteinuric hypertension (GPH) with dietary marine lipids. Australian and New Zealand Journal of Medicine 1990;20:357.
Valentine 2013 {published data only}
    1. Valentine CJ, Morrow G, Pennell M, Morrow AL, Hodge A, Haban‐Bartz A, et al. Randomized controlled trial of docosahexaenoic acid supplementation in midwestern U.S. human milk donors. Breastfeeding Medicine 2013;8(1):86‐91. [DOI: 10.1089/bfm.2011.0126] - DOI - PMC - PubMed
Velzing‐Aarts 2001 {published data only}
    1. Velzing‐Aarts FV, Klis FR, Dijs FP, Beusekom CM, Landman H, Capello JJ, et al. Effect of three low‐dose fish oil supplements, administered during pregnancy, on neonatal long‐chain polyunsaturated fatty acid status at birth. Prostaglandins, Leukotrienes, and Essential Fatty Acids 2001;65(1):51‐7. [PUBMED: 11487309] - PubMed
Yelland 2016 {published data only}
    1. Yelland LN, Gajewski BJ, Colombo J, Gibson RA, Makrides M, Carlson SE. Predicting the effect of maternal docosahexaenoic acid (DHA) supplementation to reduce early preterm birth in Australia and the United States using results of within country randomized controlled trials. Prostaglandins, Leukotrienes, and Essential Fatty Acids 2016;112:44‐9. - PMC - PubMed

References to studies awaiting assessment

Farahani 2010 {published data only}
    1. Farahani MD. A clinical trial on effect of omega‐3 fatty acids on pregnancy outcome. en.search.irct.ir/view/2314 (first received 3 June 2010). [IRCT138811173291N1]
Gopalan 2004 {published data only}
    1. Gopalan S, Patnaik R, Ganesh K. Feasible strategies to combat low birth weight and intra‐uterine growth retardation. Journal of Pediatric Gastroenterology and Nutrition 2004;39(Suppl 1):S37.
Jamilian 2018 {published data only}
    1. Jamilian M, Samimi M, Mirhosseini N, Afshar Ebrahimi F, Aghadavod E, Taghizadeh M, et al. A randomized double‐blinded, placebo‐controlled trial investigating the effect of fish oil supplementation on gene expression related to insulin action, blood lipids, and inflammation in gestational diabetes mellitus‐fish oil supplementation and gestational diabetes. Nutrients 2018;10(2):E163. - PMC - PubMed
Kadiwala 2015 {published data only}
    1. Kadiwala SM, Ramirez V, Miller E, Matula K, Sifford S, Hakala K, et al. Impact of maternal docosahexaenoic acid supplementation on toddler growth and body composition. Journal of Investigative Medicine 2015;63(2):474.
Laitinen 2013 {published data only}
    1. Laitinen K. Nutrition and pregnancy intervention study. clinicaltrials.gov/ct2/show/NCT01922791 (first received 12 August 2013). [NCT01922791]
    1. Mokkala K, Pussinen P, Houttu N, Koivuniemi E, Vahlberg T, Laitinen K. The impact of probiotics and n‐3 long‐chain polyunsaturated fatty acids on intestinal permeability in pregnancy: a randomised clinical trial. Beneficial Microbes 2018;9(2):199‐208. - PubMed
Lazzarin 2009 {published data only}
    1. Lazzarin N, Vaquero E, Exacoustos C, Bertonotti E, Romanini ME, Arduini D. Low‐dose aspirin and omega‐3 fatty acids improve uterine artery blood flow velocity in women with recurrent miscarriage due to impaired uterine perfusion. Fertility and Sterility 2009;92(1):296‐300. - PubMed
Parisi 2013 {published data only}
    1. Parisi F, Brunetti M, Berti C, Capriata IV, Mazzococo MI, Cetin M. Effects of DHS supplementation during pregnancy on fetal body composition. Reproductive Sciences 2013;20(3 Suppl):244A.
Pavlovich 1999 {published data only}
    1. Pavlovich SV, Burlev VA, Vikhliaeva EM. The effect of n‐3 polyunsaturated fatty acids on the lipid spectrum indices in the 2nd‐3rd pregnancy trimesters [Vliianie n‐3 polinenasyshchennykh zhirnykh kislot na pokazateli lipidnogo spektra vo II‐III trimestrakh beremennosti.]. Eksperimentalnaia i Klinicheskaia Farmakologiia 1999;62(6):35‐8. - PubMed
Sajina‐Stritar 1994 {published data only}
    1. Sajina‐Stritar B. Prevention of gestational hypertension and its complications with ASA and N‐3 fatty acids (comparative study). 14th European Congress of Perinatal Medicine; 1994; Helsinki (Finland). 1994:182.
Sajina‐Stritar 1998 {published data only}
    1. Sajina‐Stritar B. The effect of acetylsaliclic acid and N‐3 fatty acids in prevention of complications of hypertension diseases in pregnancy. Zdravstveni Vestnik 1998;67:489‐93.
Salvig 2009 {published data only}
    1. Salvig J, Hjort J, Moeller M, Holmskov A, Weber T, Olsen S, et al. Randomised clinical trial of fish oil for prevention of preterm birth in high risk women. International Journal of Gynecology & Obstetrics 2009;107(Suppl 2):S529.
Salzano 2001 {published data only}
    1. Salzano P, Felicetti M, Laboccetta A, Borrelli P, Domenico A, Borrelli A. Prevention of gestational hypertension with calcium, linoleic acid, mono and polyunsaturated fatty acid supplements. Minerva Ginecologica 2001;53(4):235‐8. - PubMed
Stoutjesdijk 2014 {published data only}
    1. Stoutjesdijk E. Fish oil supplemental dose needed to reach 1 g% DHA+EPA in mature milk (ZOOG MUM). trialregister.nl/trialreg/admin/rctview.asp?TC=4959 (first received 19 November 2014). [NTR4959]
    1. Stoutjesdijk E, Schaafsmab A, Dijck‐Brouwera DA, Muskiet FA. Fish oil supplemental dose needed to reach 1 g% DHA+EPA in mature milk. Prostaglandins, Leukotrienes and Essential Fatty Acids 2018;128:53‐61. - PubMed
Vahedi 2018 {published data only}
    1. Vahedi L, Ostadrahimi A, Edalati‐Fard F, Aslani H, Farshbaf‐Khalili A. Is fish oil supplementation effective on maternal serum FBS, oral glucose tolerance test, hemoglobin and hematocrit in low risk pregnant women? A triple‐blind randomized controlled trial. Journal of Complementary & Integrative Medicine 2018 [Epub ahead of print]. - PubMed
Vakilian 2010 {published data only}
    1. Davod‐Abadi M, Vakilian M, Ranjbar A, Seyed‐Zadeh T. The effect of fish oil in oxidative stress indices in healthy pregnant women. Journal of Shahrekord University of Medical Sciences 2010;11(4 Suppl 1):11.
    1. Vakilian K. The effect of fish oil in oxidative stress indices in healthy pregnant women. en.search.irct.ir/view/2974 (first received 29 May 2010). [IRCT138902091557N3]
Valentine 2014 {published data only}
    1. Valentine CJ, NCT02137408. Docosahexaenoic acid supplementation of women with hypertension in pregnancy to improve endothelial health and reduce the risks of preterm delivery. clinicaltrials.gov/show/NCT02137408 (first received 2014). [NCT02137408]
Valenzuela 2017 {published data only}
    1. Valenzuela Baez RW, Barrera C, Bascunan K, Chamorro R, Valenzuela A. Modification of docosahexaenoic acid composition of milk from women who received DHA from a milk formula during the pregnancy and breastfeeding period. Annals of Nutrition and Metabolism 2017;71(Suppl 2):506, Abstract no: 144‐766.

References to ongoing studies

Albert 2017 {published data only}
    1. Albert B. Omega‐3 supplementation during pregnancy to improve metabolic health in children of obese mothers. anzctr.org.au/Trial/Registration/TrialReview.aspx?id=373332 (first received 20 July 2017).
Carlson 2017 ADORE {published data only}
    1. Carlson SE, Gajewski BJ, Valentine CJ, Rogers LK, Weiner CP, DeFranco EA, et al. Assessment of DHA on reducing early preterm birth: the ADORE randomized controlled trial protocol. BMC Pregnancy and Childbirth 2017;17:62. [DOI: 10.1186/s12884-017-1244-5] - DOI - PMC - PubMed
Carvajal 2014 {published data only}
    1. Carvajal J. Docosahexaenoic acid (DHA) supplementation during pregnancy to prevent deep placentation disorders: a randomized clinical trial and a study of the molecular pathways of abnormal placentation prevention. clinicaltrials.gov/show/NCT02336243 (first received 12 January 2015). [NCT02336243]
de Carvalho 2017 {published data only}
    1. Carvalho Sardinha FL. Impact of fish oil or probiotic intake on maternal obesity and molecular biomarkers in the placenta. clinicaltrials.gov/ct2/show/record/NCT03215784 (first received 12 July 2017). [NCT03215784]
Dos Santos 2018 {published data only}
    1. Dos Santos LC. Omega‐3 supplementation during pregnancy to prevent postpartum depressive symptoms and possible effect on breastfeeding, child growth and development. ensaiosclinicos.gov.br/rg/RBR‐6gbzw6/ (first received 16 June 2018).
Dragan 2013 {published data only}
    1. Dragan S, ISRCTN36705743. The impact of EPA and DHA supplementation on the content of lipids in the pregnant women and the fetus. isrctn.com/ISRCTN36705743 (first received 25 October 2016). [ISRCTN36705743]
FOPCHIN {unpublished data only}
    1. NCT02770456. Fish oil supplementation to prevent preterm delivery in China: a randomized controlled trial. clinicaltrials.gov/ct2/show/NCT02770456 (first received 11 May 2016). [NCT02770456]
Garg 2017 {published data only}
    1. Garg M, ACTRN12617000177358. Omega‐3 fish oil for the prevention of gestational diabetes: a double‐blind, randomized controlled proof of concept study. anzctr.org.au/Trial/Registration/TrialReview.aspx?id=371580 (first received 30 January 2017).
Garmendia 2015 {published data only}
    1. Garmendia M, NCT02574767. Diet and physical activity counselling and n3‐long chain (PUFA) supplementation in obese pregnant women (MIGHT). clinicaltrials.gov/ct2/show/NCT02574767 (first received 7 October 2015). [NCT02574767]
    1. Garmendia ML, Corvalan C, Casanello P, Araya M, Flores M, Bravo A, et al. Effectiveness on maternal and offspring metabolic control of a home‐based dietary counseling intervention and DHA supplementation in obese/overweight pregnant women (might study): a randomized controlled trial‐study protocol. Contemporary Clinical Trials 2018;70:35‐40. - PubMed
Ghebremeskel 2014 {published data only}
    1. Ghebremeskel K, ISRCTN03848493. DHA for PREGnant women: is the current recommendation appropriate for women with very low intake and status?. isrctn.com/ISRCTN03848493 (first received 16 May 2014). [ISRCTN03848493]
Hegarty 2012 {published data only}
    1. Hegarty B, ACTRN12612000405819. Long‐chain omega‐3 fatty acids for mood stabilization during pregnancy in women with bipolar disorder ‐ a randomized controlled trial. anzctr.org.au/Trial/Registration/TrialReview.aspx?ACTRN=12612000405819 (first received 2012). [ACTRN12612000405819]
Hendler 2017 {published data only}
    1. Hendler I. The effect of alpha linolenic acid (ALA) supplementation on essential fatty acids profile during pregnancy compared to common supplements and the epigenetic effect on the newborn. clinicaltrials.gov/show/NCT03040856 (first received 2017). [NCT03040856]
Khandelwal 2012 {published data only}
    1. Khandelwal S. Effect of docosa‐hexaenoic acid (DHA) supplementation during pregnancy on newborn outcomes in India ‐ the DHANI randomized controlled trial. clinicaltrials.gov/ct2/show/NCT01580345 (first received 19 February 2012). [NCT01580345]
    1. Khandelwal S, Swamy MK, Patil K, Kondal D, Chaudhry M, Gupta R, et al. The impact of docosahexaenoic acid supplementation during pregnancy and lactation on neurodevelopment of the offspring in India (DHANI): trial protocol. BMC Pediatrics 2018;18(1):261. - PMC - PubMed
Kodkhany 2017 {published data only}
    1. Kodkhany B, NCT03072277. Maternal docosa‐hexaenoic acid (DHA) supplementation and offspring neurodevelopment in India (DHANI‐2). clinicaltrials.gov/show/NCT03072277 (first received 7 March 2017). [NCT03072277]
Li 2013 {published data only}
    1. Li D, NCT01912170. Effect of omega‐3 fatty acids on insulin sensitivity in Chinese gestational diabetic patients. clinicaltrials.gov/ct2/show/NCT01912170 (first received 27 July 2013). [NCT01912170]
Makrides 2013 (ORIP) {published data only}
    1. Makrides M, ACTRN12613001142729. Omega‐3 fats to reduce the incidence of prematurity in healthy women with a singleton or multiple pregnancy less than 20 weeks gestation. anzctr.org.au/ACTRN12613001142729.aspx (first received 27 September 2009). [ACTRN12613001142729]
    1. Zhou J, Best K, Gibson R, McPhee A, Yelland L, Quinlivan J, et al. Study protocol for a randomised controlled trial evaluating the effect of prenatal omega‐3 LCPUFA supplementation to reduce the incidence of preterm birth: the ORIP trial. BMJ Open 2017;7(9):e018360. [doi: 10.1136/bmjopen‐2017‐018360] - PMC - PubMed
Martini 2014 (CORDHA) {published data only}
    1. ISRCTN58396079. A randomised controlled trial for the optimization of the viability of stem cells derived from umbilical cord blood after maternal supplementation with DHA during the second or third trimester of pregnancy. isrctn.com/ISRCTN58396079 (first received 8 October 2013). [ISRCTN58396079] - PMC - PubMed
    1. Martini I, Domenico EG, Scala R, Caruso F, Ferreri C, Ubaldi FM, et al. Optimization of the viability of stem cells derived from umbilical cord blood after maternal supplementation with DHA during the second or third trimester of pregnancy: study protocol for a randomized controlled trial. Trials 2014;15:164. [ISRCTN58396079] - PMC - PubMed
Mbayiwa 2016 {published data only}
    1. Mbayiwa K, NCT02647723. Improving maternal and child health through prenatal fatty acid supplementation: a randomized controlled study in African American women living in low‐income urban environments. clinicaltrials.gov/show/NCT02647723 (first received 6 January 2016). [NCT02647723]
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Zielinsky 2015 {published data only}
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Zimmermann 2018 {published data only}
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