Background

Prenatal omega-3 fatty acid supplementation, particularly docosahexaenoic acid and eicosapentaenoic acid, has been associated with greater birthweight in clinical trials; however, its effect on fetal growth throughout gestation is unknown.

Objective

This study aimed to examine the association between first-trimester docosahexaenoic acid and eicosapentaenoic acid supplementation and growth trajectories of estimated fetal weight and specific fetal biometrics measured longitudinally from the second trimester of pregnancy to delivery.

Study Design

In a multisite, prospective cohort of racially diverse, low-risk pregnant women, we used secondary data analysis to examine fetal growth trajectories in relation to self-reported (yes or no) first-trimester docosahexaenoic acid and eicosapentaenoic acid supplementation. Fetal ultrasonographic measurements, including abdominal circumference, biparietal diameter, femur length, head circumference, and humerus length, were measured at enrollment (8–13 weeks) and up to 5 follow-up visits. Estimated fetal weight and head circumference–to–abdominal circumference ratio (a measure of growth symmetry) were calculated. Fetal growth trajectories were modeled for each measure using a linear mixed model with cubic splines. If significant differences in fetal growth trajectories between groups were observed (global P<.05), weekly comparisons were performed to determine when in gestation these differences emerged. Analyses were adjusted for maternal sociodemographics, parity, infant sex, total energy consumption, and diet quality score. All analyses were repeated using dietary docosahexaenoic acid and eicosapentaenoic acid intake, dichotomized at the recommended cutoff for pregnant and lactating women (≥0.25 vs <0.25 g/d), among women who did not report supplement intake in the first trimester of pregnancy were repeated.

Results

Among 1535 women, 143 (9%) reported docosahexaenoic acid and eicosapentaenoic acid supplementation in the first trimester of pregnancy. Overall, first-trimester docosahexaenoic acid and eicosapentaenoic acid supplementation was associated with statistically significant differences (P-value <.05) in fetal growth trajectories during pregnancy. Specifically, estimated fetal weight was larger among women with docosahexaenoic acid and eicosapentaenoic acid supplementation than among those without supplementation (global P=.028) with significant weekly differences in median estimated fetal weight most apparent between 38 to 41 weeks of gestation (median estimated fetal weight difference at 40 weeks of gestation, 114 g). Differences in fetal growth trajectories for abdominal circumference (P=.003), head circumference (P=.003), and head circumference–to–abdominal circumference ratio (P=.0004) were also identified by supplementation status. In weekly comparisons, docosahexaenoic acid and eicosapentaenoic acid supplement use was associated with larger median abdominal circumference (changed from 2 to 9 mm) in midpregnancy onward (19 to 41 weeks), larger median head circumference between 30 to 33 weeks of gestation, and smaller median head circumference–to–abdominal circumference ratio in the second and third trimesters of pregnancy. There was no specific weekly difference in fetal femur length or humerus length by docosahexaenoic acid and eicosapentaenoic acid supplementation. First-trimester dietary sources of docosahexaenoic acid and eicosapentaenoic acid among women with no first-trimester docosahexaenoic acid and eicosapentaenoic acid supplementation (n=1392) were associated with differences in fetal biparietal diameter (P=.043), but not other metrics of fetal growth. At the recommended dietary docosahexaenoic acid and eicosapentaenoic acid levels compared with below-recommended levels, biparietal diameter was larger between 38 to 41 weeks of gestation.

Conclusion

In this racially diverse pregnancy cohort, first-trimester docosahexaenoic acid and eicosapentaenoic acid supplementation was associated with significant increases in fetal growth, specifically greater estimated fetal abdominal circumference in the second and third trimesters of pregnancy.

中文翻译：

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妊娠早期补充 omega-3 脂肪酸与胎儿生长轨迹之间的关联

 背景

临床试验显示，产前补充 omega-3 脂肪酸，特别是二十二碳六烯酸和二十碳五烯酸，与出生体重增加有关；然而，它对整个妊娠期胎儿生长的影响尚不清楚。

 客观的

本研究旨在探讨妊娠早期补充二十二碳六烯酸和二十碳五烯酸与估计胎儿体重的生长轨迹和从妊娠中期到分娩纵向测量的特定胎儿生物特征之间的关系。

 学习规划

在多地点、前瞻性的种族多样化、低风险孕妇队列中，我们使用二次数据分析来检查与自我报告（是或否）孕早期二十二碳六烯酸和二十碳五烯酸补充剂相关的胎儿生长轨迹。胎儿超声测量，包括腹围、双顶径、股骨长度、头围和肱骨长度，在入组时（8-13周）和最多5次随访中进行测量。计算估计的胎儿体重和头围与腹围之比（生长对称性的衡量标准）。使用具有三次样条的线性混合模型对每个测量的胎儿生长轨迹进行建模。如果观察到各组之间胎儿生长轨迹存在显着差异（总体P <.05），则每周进行比较以确定妊娠何时出现这些差异。根据母亲的社会人口统计学、胎次、婴儿性别、总能量消耗和饮食质量评分对分析进行了调整。所有分析均使用膳食二十二碳六烯酸和二十碳五烯酸摄入量重复进行，并按孕妇和哺乳期妇女的建议截止值（≥0.25 与 <0.25 g/d）进行二分，对在怀孕前三个月未报告补充剂摄入量的女性进行了重复分析。

 结果

在 1535 名女性中，有 143 名 (9%) 报告在怀孕前三个月补充了二十二碳六烯酸和二十碳五烯酸。总体而言，妊娠早期补充二十二碳六烯酸和二十碳五烯酸与怀孕期间胎儿生长轨迹的统计学显着差异（ P值 <.05）相关。具体而言，补充二十二碳六烯酸和二十碳五烯酸的女性的估计胎儿体重比未补充的女性更大（总体P = 0.028），估计胎儿体重中位数每周差异显着，在妊娠 38 至 41 周期间最明显（中位估计胎儿体重）妊娠 40 周时的体重差异，114 克）。胎儿生长轨迹的腹围 ( P = .003)、头围 ( P = .003) 和头围与腹围之比 ( P = .0004) 的差异也通过补充状态来确定。在每周比较中，二十二碳六烯酸和二十碳五烯酸补充剂的使用与怀孕中期（19至41周）的中位腹围较大（从2毫米变为9毫米）、妊娠30至33周期间的中位头围较大以及较小的中位头围相关。妊娠中期和晚期的中位头围与腹围之比。补充二十二碳六烯酸和二十碳五烯酸对胎儿股骨长度或肱骨长度没有明显的每周差异。 在孕早期未补充二十二碳六烯酸和二十碳五烯酸的女性 (n=1392) 中，孕早期膳食来源的二十二碳六烯酸和二十碳五烯酸与胎儿双顶径的差异相关 ( P =.043)，但与胎儿的其他指标无关生长。与低于推荐水平相比，在推荐膳食二十二碳六烯酸和二十碳五烯酸水平下，妊娠 38 至 41 周期间双顶径更大。

 结论

在这个种族多样化的妊娠队列中，妊娠早期补充二十二碳六烯酸和二十碳五烯酸与胎儿生长的显着增加相关，特别是在妊娠中期和晚期估计胎儿腹围更大。