Docosahexaenoic acid (DHA) intake estimated from a 7-question survey identifies pregnancies most likely to benefit from high-dose DHA supplementation

D. N. Christifano; S. A. Crawford; G. Lee; A. R. Brown; J. T. Camargo; E. H. Kerling; B. J. Gajewski; C. J. Valentine; K. M. Gustafson; E. A. DeFranco; S. E. Carlson

doi:10.1016/j.clnesp.2022.12.004

Docosahexaenoic acid (DHA) intake estimated from a 7-question survey identifies pregnancies most likely to benefit from high-dose DHA supplementation

D. N. Christifano
, S. A. Crawford
, G. Lee
, A. R. Brown
, J. T. Camargo
, E. H. Kerling
, B. J. Gajewski
, C. J. Valentine
, K. M. Gustafson
, E. A. DeFranco
, S. E. Carlson

Obstetrics and Gynecology

Research output: Contribution to journal › Article › peer-review

11 Scopus citations

Abstract

Background: Two randomized trials found women with low blood docosahexaenoic acid (DHA; an omega 3 fatty acid) had fewer early preterm births (<34 weeks gestation) if they were assigned to high dose DHA supplementation, however, there is currently no capacity for clinicians who care for pregnancies to obtain a blood assessment of DHA. Determining a way to identify women with low DHA intake whose risk could be lowered by high dose DHA supplementation is desired. Objective: To determine if assessing DHA intake can identify pregnancies that benefit from high dose DHA supplementation. Study design: This secondary analysis used birth data from 1310 pregnant women who completed a 7-question food frequency questionnaire (DHA-FFQ) at 16.8 ± 2.5 weeks gestation that is validated to assess DHA status. They were then randomly assigned to a standard (200 mg/day) or high dose (800 or 1000 mg/day) DHA supplement for the remainder of pregnancy. Bayesian logistic regressions were fitted for early preterm birth and preterm birth as a function of DHA intake and assigned DHA dose. Results: Participants who consumed less than 150 mg/day DHA prior to 20 weeks’ gestation (n = 810/1310, 58.1%) had a lower Bayesian posterior probability (pp) of early preterm birth if they were assigned to high dose DHA supplementation (1.4% vs 3.9%, pp = 0.99). The effect on preterm birth (<37 weeks) was also significant (11.3% vs 14.8%, pp = 0.97). Conclusion: The DHA-FFQ can identify pregnancies that will benefit most from high dose DHA supplementation and reduce the risk of preterm birth. The DHA-FFQ is low burden to providers and patients and could be easily implemented in obstetrical practice.

Original language	English
Pages (from-to)	93-99
Number of pages	7
Journal	Clinical Nutrition ESPEN
Volume	53
DOIs	https://doi.org/10.1016/j.clnesp.2022.12.004
State	Published - Feb 2023

Bibliographical note

Publisher Copyright:
© 2022 The Author(s)

Funding

This work was supported by grants from The Eunice Kennedy Shriver National Institute of Health Child Health and Human Development ( NICHD ) (R01HD083292, R01HD086001) and the National Institutes of Health Office of Dietary Supplements (R01HD083292-03S1). The NICHD had no role in study design, data collection, data analysis, data interpretation, or writing of this article. Life's DHA™-S oil, DSM Nutritional Products LLC, Switzerland donated the investigational capsules for both trials but had no role in study design, data collection, data analysis, data interpretation, or writing of this article. A DHA Food Frequency Questionnaire (DHA-FFQ) with only 7 questions about food and supplement intake is a valid indicator of blood DHA [8] and can be reliably completed by women at their first prenatal visit [9]. Collecting DHA intake would be a lower burden to patients and providers than a blood measure of DHA. In this study, we asked if DHA intake at baseline alone could identify pregnancies for which high dose DHA supplementation lowered risk of EPTB and PTB. We used the results from two randomized clinical trials of DHA supplementation during pregnancy in which participants completed the DHA-FFQ before randomization to 200 mg/day or high dose DHA, i.e., 800 [10] or 1000 [4] mg/day. Both trials were funded by the Eunice Kennedy Shriver National Institute of Health and Human Development and conducted in the US between 2016 and 2021 (ClinicalTrials.gov: NCT02626299 and NCT02709239) [4,10].DHA intake was estimated using a validated DHA questionnaire (DHA-FFQ) [8] that can be reliably completed without assistance [9] and that could easily be administered in a clinical setting. The DHA-FFQ predicted participants whose risk of EPTB and PTB was reduced by consuming a DHA supplement of 800 or 1000 mg/day compared to 200 mg/day. Participants who started the study with an average daily DHA intake of <150 mg had a 64% lower rate of EPTB and a 24% lower rate of PTB if they were assigned to 800 or 1000 mg/day compared to 200 mg/day DHA. Therefore, our study supports providing pregnant women with low intake with between 800 and 1000 mg/day of DHA during pregnancy. In contrast, participants who were consuming ≥150 mg/day at baseline do not appear to need a high dose of DHA to reduce EPTB. In contrast to EPTB, there is convincing evidence that high dose DHA reduces PTB rates among all women, even those with higher DHA intake at baseline (pp = 0.77). This raises the question of whether universal supplementation with a high dose of DHA might be appropriate for all [18]. The major disadvantage of this approach may be the cost of the supplement. However, it is also important to consider other possible benefits of a higher dose of DHA, such as observed for the women who participated in PANDA and ADORE [19,20], and to carefully evaluate the safety data from randomized clinical trials that provided high dose DHA during pregnancy in attempting to answer this question.This work was supported by grants from The Eunice Kennedy Shriver National Institute of Health Child Health and Human Development (NICHD) (R01HD083292, R01HD086001) and the National Institutes of Health Office of Dietary Supplements (R01HD083292-03S1). The NICHD had no role in study design, data collection, data analysis, data interpretation, or writing of this article. Life's DHA™-S oil, DSM Nutritional Products LLC, Switzerland donated the investigational capsules for both trials but had no role in study design, data collection, data analysis, data interpretation, or writing of this article.

Funders	Funder number
EPTB	19,20
National Institutes of Health Office of Dietary Supplements	R01HD083292-03S1
Eunice Kennedy Shriver National Institute of Child Health and Human Development	R01HD086001, NCT02626299, NCT02709239, R01HD083292, 4,10
DSM Nutritional Products, Inc

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

SDG 3 Good Health and Well-being

Keywords

Diet
Docosahexaenoic acid
Pregnancy
Prenatal supplements
Preterm birth

ASJC Scopus subject areas

Endocrinology, Diabetes and Metabolism
Nutrition and Dietetics

Access to Document

10.1016/j.clnesp.2022.12.004

Cite this

Christifano, D. N., Crawford, S. A., Lee, G., Brown, A. R., Camargo, J. T., Kerling, E. H., Gajewski, B. J., Valentine, C. J., Gustafson, K. M., DeFranco, E. A., & Carlson, S. E. (2023). Docosahexaenoic acid (DHA) intake estimated from a 7-question survey identifies pregnancies most likely to benefit from high-dose DHA supplementation. Clinical Nutrition ESPEN, 53, 93-99. https://doi.org/10.1016/j.clnesp.2022.12.004

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abstract = "Background: Two randomized trials found women with low blood docosahexaenoic acid (DHA; an omega 3 fatty acid) had fewer early preterm births (<34 weeks gestation) if they were assigned to high dose DHA supplementation, however, there is currently no capacity for clinicians who care for pregnancies to obtain a blood assessment of DHA. Determining a way to identify women with low DHA intake whose risk could be lowered by high dose DHA supplementation is desired. Objective: To determine if assessing DHA intake can identify pregnancies that benefit from high dose DHA supplementation. Study design: This secondary analysis used birth data from 1310 pregnant women who completed a 7-question food frequency questionnaire (DHA-FFQ) at 16.8 ± 2.5 weeks gestation that is validated to assess DHA status. They were then randomly assigned to a standard (200 mg/day) or high dose (800 or 1000 mg/day) DHA supplement for the remainder of pregnancy. Bayesian logistic regressions were fitted for early preterm birth and preterm birth as a function of DHA intake and assigned DHA dose. Results: Participants who consumed less than 150 mg/day DHA prior to 20 weeks{\textquoteright} gestation (n = 810/1310, 58.1\%) had a lower Bayesian posterior probability (pp) of early preterm birth if they were assigned to high dose DHA supplementation (1.4\% vs 3.9\%, pp = 0.99). The effect on preterm birth (<37 weeks) was also significant (11.3\% vs 14.8\%, pp = 0.97). Conclusion: The DHA-FFQ can identify pregnancies that will benefit most from high dose DHA supplementation and reduce the risk of preterm birth. The DHA-FFQ is low burden to providers and patients and could be easily implemented in obstetrical practice.",

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note = "Publisher Copyright: {\textcopyright} 2022 The Author(s)",

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doi = "10.1016/j.clnesp.2022.12.004",

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Christifano, DN, Crawford, SA, Lee, G, Brown, AR, Camargo, JT, Kerling, EH, Gajewski, BJ, Valentine, CJ, Gustafson, KM, DeFranco, EA & Carlson, SE 2023, 'Docosahexaenoic acid (DHA) intake estimated from a 7-question survey identifies pregnancies most likely to benefit from high-dose DHA supplementation', Clinical Nutrition ESPEN, vol. 53, pp. 93-99. https://doi.org/10.1016/j.clnesp.2022.12.004

TY - JOUR

T1 - Docosahexaenoic acid (DHA) intake estimated from a 7-question survey identifies pregnancies most likely to benefit from high-dose DHA supplementation

AU - Christifano, D. N.

AU - Crawford, S. A.

AU - Lee, G.

AU - Brown, A. R.

AU - Camargo, J. T.

AU - Kerling, E. H.

AU - Gajewski, B. J.

AU - Valentine, C. J.

AU - Gustafson, K. M.

AU - DeFranco, E. A.

AU - Carlson, S. E.

PY - 2023/2

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N2 - Background: Two randomized trials found women with low blood docosahexaenoic acid (DHA; an omega 3 fatty acid) had fewer early preterm births (<34 weeks gestation) if they were assigned to high dose DHA supplementation, however, there is currently no capacity for clinicians who care for pregnancies to obtain a blood assessment of DHA. Determining a way to identify women with low DHA intake whose risk could be lowered by high dose DHA supplementation is desired. Objective: To determine if assessing DHA intake can identify pregnancies that benefit from high dose DHA supplementation. Study design: This secondary analysis used birth data from 1310 pregnant women who completed a 7-question food frequency questionnaire (DHA-FFQ) at 16.8 ± 2.5 weeks gestation that is validated to assess DHA status. They were then randomly assigned to a standard (200 mg/day) or high dose (800 or 1000 mg/day) DHA supplement for the remainder of pregnancy. Bayesian logistic regressions were fitted for early preterm birth and preterm birth as a function of DHA intake and assigned DHA dose. Results: Participants who consumed less than 150 mg/day DHA prior to 20 weeks’ gestation (n = 810/1310, 58.1%) had a lower Bayesian posterior probability (pp) of early preterm birth if they were assigned to high dose DHA supplementation (1.4% vs 3.9%, pp = 0.99). The effect on preterm birth (<37 weeks) was also significant (11.3% vs 14.8%, pp = 0.97). Conclusion: The DHA-FFQ can identify pregnancies that will benefit most from high dose DHA supplementation and reduce the risk of preterm birth. The DHA-FFQ is low burden to providers and patients and could be easily implemented in obstetrical practice.

AB - Background: Two randomized trials found women with low blood docosahexaenoic acid (DHA; an omega 3 fatty acid) had fewer early preterm births (<34 weeks gestation) if they were assigned to high dose DHA supplementation, however, there is currently no capacity for clinicians who care for pregnancies to obtain a blood assessment of DHA. Determining a way to identify women with low DHA intake whose risk could be lowered by high dose DHA supplementation is desired. Objective: To determine if assessing DHA intake can identify pregnancies that benefit from high dose DHA supplementation. Study design: This secondary analysis used birth data from 1310 pregnant women who completed a 7-question food frequency questionnaire (DHA-FFQ) at 16.8 ± 2.5 weeks gestation that is validated to assess DHA status. They were then randomly assigned to a standard (200 mg/day) or high dose (800 or 1000 mg/day) DHA supplement for the remainder of pregnancy. Bayesian logistic regressions were fitted for early preterm birth and preterm birth as a function of DHA intake and assigned DHA dose. Results: Participants who consumed less than 150 mg/day DHA prior to 20 weeks’ gestation (n = 810/1310, 58.1%) had a lower Bayesian posterior probability (pp) of early preterm birth if they were assigned to high dose DHA supplementation (1.4% vs 3.9%, pp = 0.99). The effect on preterm birth (<37 weeks) was also significant (11.3% vs 14.8%, pp = 0.97). Conclusion: The DHA-FFQ can identify pregnancies that will benefit most from high dose DHA supplementation and reduce the risk of preterm birth. The DHA-FFQ is low burden to providers and patients and could be easily implemented in obstetrical practice.

KW - Diet

KW - Docosahexaenoic acid

KW - Pregnancy

KW - Prenatal supplements

KW - Preterm birth

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Docosahexaenoic acid (DHA) intake estimated from a 7-question survey identifies pregnancies most likely to benefit from high-dose DHA supplementation

Abstract

Bibliographical note

Funding

UN SDGs

Keywords

ASJC Scopus subject areas

Access to Document

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