DHA Supplements During Pregnancy

Written by Dr. Steve Chaney on . Posted in DHA and Pregnancy

Author: Dr. Stephen Chaney

 

dha supplementation saves moneyA recent study has estimated that taking DHA supplements during pregnancy, specifically in the last two trimesters, could save the US healthcare system close to $6 billion/year (Shireman et al, Prostaglandins, Leukotrienes and Essential Fatty Acids, 111: 8-10, 2016) .

Another study has come to similar conclusion in Australia (Ahmed et al, Prostaglandins, Leukotrienes and Essential Fatty Acids, 102-103: 5-11, 2015) .

When you have two well done studies by different investigators in different countries that come to the same conclusion, it is time to take the studies seriously and start to ask some important questions. For example:

  • Are these studies true?
  • Should we change our public health recommendations during pregnancy?
  • Is this just a public health issue, or does it affect you personally?

The Value of DHA Supplements During Pregnancy

dha supplements during pregnancyThe US study was called “Kansas University DHA Outcomes Study” (KUDOS). It studied health outcomes for 197 pregnant moms who gave birth to a single baby at the Kansas University Hospital between 2006 and 2010. The moms came from the Kansas City metropolitan area and consisted of 42% moms who self-identified as Black and 58% as other races.

The women were randomly assigned to consume 3 capsules per day containing either 600 mg DHA or a placebo containing corn and soybean oil during their second and third trimesters (starting around 14.5 weeks after gestation). Multiple pregnancy outcomes were assessed, but the main focus was on early preterm birth (infants born before 34 week’s gestation). That’s because a recent meta-analysis has reported that omega-3 fatty acid supplementation during pregnancy reduces early preterm births by 58% (Kar et al, European Journal of Obstetrics & Gynecology and Reproductive Biology 198: 40-46, 2016) .

The results of the KUDOS study were:

  • Taking DHA supplements during pregnancy, specifically in the last two trimesters, reduced early preterm birth from 4.8% to 0.6%.
  • DHA supplementation reduced average hospital costs per infant born in the Kansas Medical Center by $1678. This was primarily because of a significant reduction in the average length of time spent in the neonatal intensive care unit because of the reduction in early preterm births.
  • When the cost of supplementation was taken into account, there was a 10-fold return in hospital cost savings for every dollar spent on supplementation.
  • When the authors extrapolated this analysis to the 4 million live births in the US each year, they estimated a potential savings of $6.6 billion.
  • This corresponds to a net savings of $5.94 billion to the US health care system if you take into account the cost of providing all pregnant women in the US with 600 mg of DHA/day during the last two trimesters of pregnancy.

The authors of the KUDOS study concluded “…a public health policy to increase DHA intake during pregnancy could result in significant cost savings to the health care system in our country”.

Are These Studies True?

truthTruth in science is always elusive. It requires many years of research and multiple clinical studies. However, two well done studies in two different countries have concluded that taking DHA supplements during pregnancy significantly reduces health care costs. In addition, a recent meta-analysis of 6 published clinical studies (Kar et al, European Journal of Obstetrics & Gynecology and Reproductive Biology 198: 40-46, 2016) has concluded that omega-3 fatty acid supplementation during pregnancy reduces early preterm births by 58%.

These are all small studies, but their results are remarkably consistent. If you were to generalize the conclusions of all these studies into a statement saying “Omega-3 fatty acid supplementation during pregnancy significantly reduces health care costs”, there is a good probability that statement would be true. However:

  • The exact cost savings is uncertain.
  • The source of omega-3s (DHA, EPA, or a mixture of the two) is uncertain.
  • The amount of omega-3 fatty acids needed to reduce early preterm births is uncertain.

Let’s look at each of these in turn:

Cost Savings of Using DHA Supplements During Pregnancy

  • On the minus side, 42% of the women in the KUDOS study were Black, while the national average is 16%. That is significant because the rate of early preterm births is twice as high for black women as it is for White and Asian women. If the results of the KUDOD study were extrapolated to the percentage of Black women in the US population, the cost savings to the US health care system would only be around $4 billion – still a pretty substantial number!
  • On the plus side, the initial hospital costs associated with early preterm birth are just the tip of the iceberg. There are also considerable long-term expenses for special education services associated with disabling conditions common with premature infants.  A recent study (Mangham et al, Pediatrics 123: e312-e327, 2009) calculated the costs of preterm birth in the UK from birth to 18 years of age and came up with an estimate of $4.567 billion in US dollars. If we assume that omega-3 supplementation results in a 58% decrease in early preterm birth (Kar et al, European Journal of Obstetrics & Gynecology and Reproductive Biology 198: 40-46, 2016) and extrapolate that cost savings to the US population, the total cost savings would be $13.2 billion. Now we’re talking real money!

Source of Omega-3s:

  • DHA has been the focus of the two most recent studies on cost savings because of the role of DHA in nerve, brain and visual development, but EPA is also likely to be important in neonatal development. In addition, the efficiency of conversion of EPA to DHA is very high.
  • In fact, when we look at the individual studies included in the meta-analysis described above (Kar et al, European Journal of Obstetrics & Gynecology and Reproductive Biology 198: 40-46, 2016), DHA, EPA, and EPA+DHA supplementation all gave comparable reductions in early preterm births.

Amount of Omega-3s:

  • While the 600 mg/day used in the KUDOS study is probably a good starting point, the individual studies in the meta-analysis used a wide range of dose. All of them seemed to have at least some efficacy in reducing early preterm births. Obviously, more studies are needed to determine the optimal dose.

What Does This Mean For You?

All this talk about reducing health care costs may seem esoteric. You may be wondering “What does this have to do with me?”

  • Don’t be lulled to complacency by the estimated cost savings of $1678/birth mentioned above. That is the average costs of all births. Early preterm births represent only 4.78% of all the births in the study. If you give birth to a baby earlier than 34 weeks of gestation, there is a high probability your infant will end up in the neonatal intensive care unit and your health care costs will be orders of magnitude more than $1678. How that affects your wallet will depend on your insurance plan.
  • Early preterm birth is associated with increased risk of global and selective cognitive defects. These can range from relatively mild impairment of IQ, memory, executive function, non-verbal skills, and motor skills to much more serious conditions like cerebral palsy, mental retardation, and disorders of psychological development. The possibility of avoiding those kinds of defects in your child is priceless.

 

The Bottom Line

  • Recent studies in the US and Australia have shown that taking 600 mg of DHA supplements during pregnancy during the last two trimesters  significantly reduces early preterm births (infants born before 34 weeks gestation) resulting in an estimated savings to the US health care system of around $6 billion/year.
  • Other studies suggest that supplementation with EPA and EPA+DHA mixtures give similar results.
  • Discussions of cost savings to the US healthcare system sound somewhat esoteric. However, if you are pregnant or considering becoming pregnant, there are real benefits to you associated with reducing the risk of early preterm birth. That is because:
  • The costs associated with early preterm births are substantial. How much they affect your wallet will depend on your health insurance policy.
  • Early preterm births are associated with a variety of global and selective cognitive defects (for details, read the article above). The possibility of avoiding those kinds of defects in your child is priceless.

 

These statements have not been evaluated by the Food and Drug Administration. This information is not intended to diagnose, treat, cure or prevent any disease.

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High Protein Diets and Weight Loss

Posted October 16, 2018 by Dr. Steve Chaney

Do High Protein Diets Reduce Fat And Preserve Muscle?

Author: Dr. Stephen Chaney

Healthy Diet food group, proteins, include meat (chicken or turkAre high protein diets your secret to healthy weight loss? There are lots of diets out there – high fat, low fat, Paleolithic, blood type, exotic juices, magic pills and potions. But recently, high protein diets are getting a lot of press. The word is that they preserve muscle mass and preferentially decrease fat mass.

If high protein diets actually did that, it would be huge because:

  • It’s the fat – not the pounds – that causes most of the health problems.
  • Muscle burns more calories than fat, so preserving muscle mass helps keep your metabolic rate high without dangerous herbs or stimulants – and keeping your metabolic rate high helps prevent both the plateau and yo-yo (weight regain) characteristic of so many diets.
  • When you lose fat and retain muscle you are reshaping your body – and that’s why most people are dieting to begin with.

So let’s look more carefully at the recent study that has been generating all the headlines (Pasiakos et al, The FASEB Journal, 27: 3837-3847, 2013).

The Study Design:

This was a randomized control study with 39 young (21), healthy and fit men and women who were only borderline overweight (BMI = 25). These volunteers were put on a 21 day weight loss program in which calories were reduced by 30% and exercise was increased by 10%. They were divided into 3 groups:

  • One group was assigned a diet containing the RDA for protein (about 14% of calories in this study design).
  • The second group’s diet contained 2X the RDA for protein (28% of calories)
  • The third group’s diet contained 3X the RDA for protein (42% of calories)

In the RDA protein group carbohydrate was 56% of calories, and fat was 30% of calories. In the other two groups the carbohydrate and fat content of the diets was decreased proportionally.

Feet_On_ScaleWhat Did The Study Show?

  • Weight loss (7 pounds in 21 days) was the same on all 3 diets.
  • The high protein (28% and 42%) diets caused almost 2X more fat loss (5 pounds versus 2.8 pounds) than the diet supplying the RDA amount of protein.
  • The high protein (28% and 42%) diets caused 2X less muscle loss (2.1 pounds versus 4.2 pounds) than the diet supplying the RDA amount of protein.
  • In case you didn’t notice, there was no difference in overall results between the 28% (2X the RDA) and 42% (3X the RDA) diets.

Pros And Cons Of The Study:

  • The con is fairly obvious. The participants in this study were all young, healthy and were not seriously overweight. If this were the only study of this type one might seriously question whether the results were applicable to middle aged, overweight coach potatoes. However, there have been several other studies with older, more overweight volunteers that have come to the same conclusion – namely that high protein diets preserve muscle mass and enhance fat loss.
  • The value of this study is that it defines for the first time the upper limit for how much protein is required to preserve muscle mass in a weight loss regimen. 28% of calories is sufficient, and there appear to be no benefit from increasing protein further. I would add the caveat that there are studies suggesting that protein requirements for preserving muscle mass may be greater in adults 50 and older.

The Bottom Line:

1)    Forget the high fat diets, low fat diets, pills and potions. High protein diets (~2X the RDA or 28% of calories) do appear to be the safest, most effective way to preserve muscle mass and enhance fat loss in a weight loss regimen.

2)     That’s not a lot of protein, by the way. The average American consumes almost 2X the RDA for protein on a daily basis. However, it is significantly more protein than the average American consumes when they are trying to lose weight. Salads and carrot sticks are great diet foods, but they don’t contain much protein.

3)     Higher protein intake does not appear to offer any additional benefit – at least in young adults.

4)     Not all high protein diets are created equal. What some people call high protein diets are laden with saturated fats or devoid of carbohydrate. The diet in this study, which is what I recommend, had 43% healthy carbohydrates and 30% healthy fats.

5)    These diets were designed to give 7 pounds of weight loss in 21 days – which is what the experts recommend. There are diets out there promising faster weight loss but they severely restrict calories and/or rely heavily on stimulants, they do not preserve muscle mass, and they often are not safe. In addition they are usually temporary.  I do not recommend them.

6)    This level of protein intake is safe for almost everyone. The major exception would be people with kidney disease, who should always check with their doctor before increasing protein intake. The only other caveat is that protein metabolism creates a lot of nitrogenous waste, so you should drink plenty of water to flush that waste out of your system. But, water is always a good idea.

7)     The high protein diets minimized, but did not completely prevent, muscle loss. Other studies suggest that adding the amino acid leucine to a high protein diet can give 100% retention of muscle mass in a weight loss regimen – but that’s another story for another day.

These statements have not been evaluated by the Food and Drug Administration. This information is not intended to diagnose, treat, cure or prevent any disease.

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