Fish oil supplementation during pregnancy and postpartum in mothers with overweight and obesity to improve body composition and metabolic health during infancy: A double-blind randomized controlled trial

Systematic review of interventions in early pregnancy among pregnant individuals at risk for hyperglycemia

OBJECTIVE

The maternal metabolic environment in early pregnancy can influence fetal growth trajectories. Our objective was to identify interventions initiated in early pregnancy (<20 weeks gestation) in pregnant individuals with risk factors for hyperglycemia and report their impact on primary (neonatal adiposity, small for gestational age, large for gestational age, macrosomia) and secondary outcomes (gestational weight gain, maternal hypertensive disorder, birth injury, NICU admission, preterm delivery, emergency cesarean section).

DATA SOURCES

We searched Cochrane Central database, Medline, Embase, CINAHL databases, and clinicaltrials.gov (September 2024) for clinical trials published between 2009 and 2024. Search terms included the key words "early OR during" OR "first trimester OR second trimester" AND "gestation OR pregnancy" OR "prenatal care" AND "insulin resistance" OR "metabolic health" OR "diabet*" OR "body composition" OR "obes*" OR "weight gain" OR "gestational diabetes" OR "hyperglycemia" OR "metabolic syndrome" AND "clinical trial."

STUDY ELIGIBILITY CRITERIA

Randomized controlled trials (RCTs) and other trials reporting interventions initiated before 20 weeks gestation in participants with singleton pregnancies at risk for hyperglycemia (overweight and/or obesity, history of type 2 diabetes, and/or history of GDM) that reported at least one primary outcome were included. Studies had to be conducted with humans in high income countries as defined by the World Bank, written in English.

STUDY APPRAISAL AND SYNTHESIS METHODS

We used the Downs and Black checklist to evaluate the methodological quality and risk. Data was extracted independently and any questions were resolved through group discussion. Interventions were categorized and synthesized by type.

RESULTS

21,924 records were identified and 70 full-text articles met inclusion criteria. 65 articles were RCTs. Eight intervention categories were identified: diet only, physical activity or exercise only, diet and physical activity or exercise combined, lifestyle counseling, supplements, pharmaceuticals, early GDM screening, and mixed interventions. Only 12 studies reported statistically significant effects on primary neonatal outcomes.

CONCLUSIONS

Interventions initiated in early pregnancy (<20 weeks) among pregnant individuals at risk for hyperglycemia that include one or more of the following strategies can reduce risk of excess neonatal adiposity, macrosomia, large for gestational age and small for gestational age neonates: goal-setting and motivational strategies to improve diet and increase physical activity through individual and group sessions; lifestyle coaching that included behavioral techniques designed to empower participants by fostering autonomy in a supportive environment; structured group exercise classes three times per week; and personalized dietary recommendations. El resumen está disponible en Español al final del artículo.

Impact of omega-3 fatty acids supplementation on lipid levels in pregnant women with previous pregnancy losses: a retrospective longitudinal study

Objective

This research aims to investigate the impact of omega-3 fatty acids supplementation on the lipid levels of pregnant women who have experienced pregnancy losses.

Methods

This retrospective study analyzed data from pregnant women with previous pregnancy losses from two medical centers. Their lipid profiles were measured at least twice during pregnancy. According to the use of omega-3 soft gel capsules, participants were divided into the omega-3 group and the control group. We assessed the relationship between omega-3 fatty acids supplementation and longitudinal lipid levels during pregnancy using generalized estimating equations (GEE). Subsequently, we conducted subgroup analyses to delineate the profile of beneficiaries who received omega-3 fatty acids based on body mass index (BMI), age, menstrual regularity, number of previous pregnancy losses, number of previous live births, and educational level.

Results

The omega-3 group included 105 participants, while the control group comprised 274 participants. Women in the omega-3 group started supplementation between 3.43 and 17.14 weeks of gestation. According to GEE analysis, supplementing omega-3 fatty acids significantly reduced triglyceride (TG) levels during pregnancy (adjusted β = -0.300, 95% CI -0.445 to -0.154, p < 0.001). No associations between omega-3 fatty acids supplementation and total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), or high-density lipoprotein cholesterol (HDL-C) levels were observed. Subgroup analyses revealed that omega-3 fatty acids supplementation was related to a reduction in TG levels among pregnant women with age of ≤35 years, a normal BMI (18.5-24.9 kg/m2), 1-2 previous pregnancy losses, no previous live births, or an educational level above high school.

Conclusion

Supplementation with omega-3 fatty acids may significantly reduce TG levels, yet it does not seem to improve TC, LDL-C, or HDL-C levels in pregnant women with previous pregnancy losses.

Developmentally programmed obesity: Is there a role for anti-inflammatory nutritional strategies?

Pregnancy represents a period of immense maternal physiological adaptation, with progressive increases in lipid storage potential and insulin resistance to support fetal/placental growth. This requires significant change in the adipose tissue. Women living with obesity/overweight are more susceptible to these changes causing complications such as gestational diabetes. This is particularly worrying as up to 60% of European women are living with overweight/obesity at the onset of pregnancy. Furthermore, less than 1% meet all nutrition guidelines. There is now evidence that these deep metabolic changes can result in a predisposition to metabolic disease in both the mother and child in later life. Health and nutrition status during this period therefore represents a window to future health. This period offers a valuable opportunity for intervention to prevent the negative consequences of poor in utero environments and increases the long-term quality of life for mother and offspring. This review will examine a range of in utero factors which determine adipose tissue development, the impact of these factors on later-life obesity and metabolic health and the therapeutic value of dietary anti-inflammatory nutritional interventions during pregnancy and early life. When it comes to early life nutrition, a 'one size fits all' approach is not always appropriate. Understanding the mechanisms of adipose tissue development in response to differing nutritional strategies may be important in the context of complicated or adverse in utero environments and represents a substantial step towards a more personalised nutritional approach for the prevention of obesity, metabolic syndrome and related non-communicable diseases in future generations.

Fish oil supplementation during pregnancy, anthropometrics, and metabolic health at age ten: A randomized clinical trial

BACKGROUND

We previously reported that children of mothers who received fish oil supplementation during pregnancy had higher body mass index [BMI (in kg/m2)] at 6 y of age as well as a concomitant increase in fat-, muscle, and bone mass, but no difference in fat percentage.

OBJECTIVES

Here, we report follow-up at age 10 y including assessment of metabolic health.

METHODS

This is a follow-up analysis of a randomized clinical trial conducted among 736 pregnant females and their offspring participating in the Copenhagen Prospective Studies on Asthma in Childhood mother-child cohort. The intervention was 2.4 g n-3 (ω-3) Long-Chain PolyUnsaturated Fatty Acid (n-3 LCPUFA) or control daily from pregnancy week 24 until 1 wk after birth. Outcomes were anthropometric measurements, body composition from Bioelectrical Impedance Analysis, blood pressure, concentrations of triglycerides, cholesterol, glucose, and C-peptide from fasting blood samples, and a metabolic syndrome score was calculated. Anthropometric measurements and body composition were prespecified secondary endpoints of the n-3 LCPUFA trial, and others were exploratory.

RESULTS

Children in the n-3 LCPUFA group had a higher mean BMI at age 10 year compared to the control group: 17.4 (SD: 2.44) compared with 16.9 (2.28); P = 0.020 and a higher odds ratio of having overweight (odds ratio: 1.53; 95% CI: 1.01, 2.33; P = 0.047). This corresponded to differences in body composition in terms of increased lean mass (0.49 kg; 95% CI: -0.20, 1.14; P = 0.17), fat mass (0.49 kg; 95% CI: -0.03, 1.01; P = 0.06), and fat percent (0.74%; 95% CI: -0.01, 1.49; P = 0.053) compared to the control group. Children in the n-3 LCPUFA group had a higher metabolic syndrome score compared to the control (mean difference: 0.19; 95% CI: -0.02, 0.39; P = 0.053).

CONCLUSIONS

In this randomized clinical trial, children of mothers receiving n-3 LCPUFA supplementation had increased BMI at age 10 y, increased risk of being overweight, and a tendency of increased fat percentage and higher metabolic syndrome score. These findings suggest potential adverse health effects from n-3 LCPUFA supplementation during pregnancy and need to be replicated in future independent studies. This trial was registered at clinicaltrials.gov as NCT00798226.

Human milk polyunsaturated fatty acids are related to neurodevelopmental, anthropometric, and allergic outcomes in early life: a systematic review

Polyunsaturated fatty acids are critically important for newborn nutrition and in the trajectory of growth and developmental processes throughout early life. This systematic review (PROSPERO ID: CRD42023400059) critically analyzes literature pertaining to how omega-3 and omega-6 fatty acids in human milk are related to health outcomes in early life. Literature selected for the review were published between 2005 and 2020 and included assessments in healthy term children between 0 and 5 years of age. The studies reported the relation between human milk fatty acids docosahexaenoic acid (C22:6n-3, DHA), eicosapentaenoic acid (C20:5n-3, EPA), alpha-linolenic acid (C18:3n-3, ALA), arachidonic acid (C20:4n-6, AA), and linoleic acid (C18:2n-6, LA) with three domains of health outcomes: neurodevelopment, body composition, and allergy, skin & eczema. Results from the 21 studies consistently suggested better health outcomes across the three domains for infants consuming milk with higher concentrations of total n-3, DHA, EPA, and ALA. Negative health outcomes across the three domains were associated with higher levels of total n-6, AA, and LA in milk. N-3 and n-6 content of milk were related to neurodevelopmental, body composition, and allergy, skin & eczema outcomes with moderate certainty. Maternal diet impacting milk fatty acid content and fatty acid desaturase genotype modifying physiologic responses to fatty acid intake were prominent gaps identified in the review using the NIH Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies and GRADE approach. This research study can inform baby nutrition product development, and fatty acid intake recommendations or dietary interventions for mothers and children.

Role of Fish Oil in Preventing Paternal Obesity and Improving Offspring Skeletal Muscle Health

This study investigates the effects of fish oil supplementation during the periconceptional period in male mice. Specifically, it examines the impact of fish oil on intergenerational health, as determined by skeletal muscle markers. To mimic paternal obesity, thirty mice were separated into three groups with distinct dietary regimes for 10 weeks: a high-fat diet (HF), a high-fat diet supplemented with fish oil (FO), and a low-fat diet (LF). Then, these mice mated with control female mice. Dams and offspring consumed a chow diet during gestation and lactation, and the offspring continued on a chow diet. To study short-term (8 weeks) and long-term (16 weeks) effects of FO, skeletal muscle was isolated at the time of sacrifice, and gene analyses were performed. Results suggest that offspring born to FO-supplemented sires exhibited a significant, short-term upregulation of genes associated with insulin signaling, fatty acid oxidation, and skeletal muscle growth with significant downregulation of genes involved in fatty acid synthesis at 8 weeks. Prominent differences in the above markers were observed at 8 weeks compared to 16 weeks. These findings suggest the potential benefits of FO supplementation for fathers during the periconceptional period in reducing the health risks of offspring due to paternal obesity.

The Effect of Maternal Exposure to a Diet High in Fats and Cholesterol on the Placental Function and Phenotype of the Offspring in a Rabbit Model: A Summary Review of About 15 Years of Research

The rates of obesity and being overweight are increasing all around the world, especially among women of childbearing age, in part due to overconsumption of lipids. The aim of this summary review was to present the cellular and molecular effects of a hyperlipidic high-cholesterol (H) diet on the maternal and offspring phenotype at the early embryonic, neonatal, weaning and adult stages while considering the effects of sex and to identify the window(s) of vulnerability linked to this exposure in a rabbit model. Before breeding, the H diet induced dyslipidemia and aortic atherosclerosis lesions and increased the number of atretic follicles. In the offspring, the H diet disrupted the embryonic phenotype and induced fetal hypotrophy associated with sex-specific disturbances of the feto-placental unit. In adulthood, the offspring of the H dams were heavier and hyperphagic and had increased blood pressure associated with disturbed gonadal development in both sexes. Vulnerability windows were explored via embryo transfers. The maternal gestational diet was shown to play a key role in the feto-placental phenotype, and preconception programming was unquestionably also observed. These two periods could represent windows of intervention in the context of obesity or being overweight to limit fetal and placental consequences.

Made in the Womb: Maternal Programming of Offspring Cardiovascular Function by an Obesogenic Womb

Obesity incidence has been increasing at an alarming rate, especially in women of reproductive age. It is estimated that 50% of pregnancies occur in overweight or obese women. It has been described that maternal obesity (MO) predisposes the offspring to an increased risk of developing many chronic diseases in an early stage of life, including obesity, type 2 diabetes, and cardiovascular disease (CVD). CVD is the main cause of death worldwide among men and women, and it is manifested in a sex-divergent way. Maternal nutrition and MO during gestation could prompt CVD development in the offspring through adaptations of the offspring's cardiovascular system in the womb, including cardiac epigenetic and persistent metabolic programming of signaling pathways and modulation of mitochondrial metabolic function. Currently, despite diet supplementation, effective therapeutical solutions to prevent the deleterious cardiac offspring function programming by an obesogenic womb are lacking. In this review, we discuss the mechanisms by which an obesogenic intrauterine environment could program the offspring's cardiovascular metabolism in a sex-divergent way, with a special focus on cardiac mitochondrial function, and debate possible strategies to implement during MO pregnancy that could ameliorate, revert, or even prevent deleterious effects of MO on the offspring's cardiovascular system. The impact of maternal physical exercise during an obesogenic pregnancy, nutritional interventions, and supplementation on offspring's cardiac metabolism are discussed, highlighting changes that may be favorable to MO offspring's cardiovascular health, which might result in the attenuation or even prevention of the development of CVD in MO offspring. The objectives of this manuscript are to comprehensively examine the various aspects of MO during pregnancy and explore the underlying mechanisms that contribute to an increased CVD risk in the offspring. We review the current literature on MO and its impact on the offspring's cardiometabolic health. Furthermore, we discuss the potential long-term consequences for the offspring. Understanding the multifaceted effects of MO on the offspring's health is crucial for healthcare providers, researchers, and policymakers to develop effective strategies for prevention and intervention to improve care.