Supplementation with long chain polyunsaturated fatty acids (LCPUFA) to breastfeeding mothers for improving child growth and development
Abstract
Background
Long chain polyunsaturated fatty acids (LCPUFA), especially docosahexaenoic acid (DHA), are the most abundant fatty acids in the brain and are necessary for growth and maturation of the brain and retina. LCPUFA are named “essential” because they cannot be synthesised efficiently by the human body and come from maternal diet. It remains controversial whether LCPUFA supplementation to breastfeeding mothers is beneficial for the development of their infants.
Objectives
To assess the effectiveness and safety of supplementation with LCPUFA in breastfeeding mothers in the cognitive and physical development of their infants as well as safety for the mother and infant.
Search methods
We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (November 2009), CENTRAL (2009, Issue 2), PubMed (1966 to July 2009), EMBASE (1974 to June 2009), CINAHL (1984 to June 2009), LILACS (1982 to June 2009), Google Scholar (June 2009) and reference lists of published narrative and systematic reviews.
Selection criteria
Randomised controlled trials or cluster‐randomised controlled trials evaluating the effects of LCPUFA supplementation on breastfeeding mothers and their infants.
Data collection and analysis
Two review authors independently assessed eligibility and trial quality and performed data extraction.
Main results
We included six randomised controlled trials involving 1280 women. We found no significant difference in children's neurodevelopment: language development (standardised mean difference (SMD) ‐0.14, 95% confidence interval (CI) ‐0.49 to 0.20; two trials, 349 participants); intelligence or problem‐solving ability (two trials, 817 participants; SMD ‐0.22, 95% CI ‐0.23 to 0.66); psychomotor development (SMD 0.34, 95% CI ‐0.11 to 0.78; two trials, 279 participants); motor development (SMD 0.08, 95% CI ‐0.13 to 0.29; two trials, 349 participants); in child attention there was a significant difference (SMD 0.50, 95% CI 0.24 to 0.77; one study). For child visual acuity there was no significant difference (SMD ‐0.06, 95% CI ‐0.26 to 0.14; three trials, 401 participants). For growth, there were significant differences in length (MD ‐0.75 cm, 95% CI ‐1.38 to ‐0.12; two trials, 834 participants) and head circumference (MD 0.69 cm, 95% CI 0.35 to 1.02; one trial, 244 participants). One study reported a significant difference in infant allergy (risk ratio (RR) 0.12, 95% CI 0.02 to 0.95). We found no significant difference in one trial evaluating postpartum depression (SMD 0.15, 95% CI ‐0.11 to 0.41).
Authors' conclusions
Based on the limited evidence that we found, LCPUFA supplementation did not appear to improve children's neurodevelopment or visual acuity. In two studies, LCPUFA supplementation was associated with increased head circumference. Currently, there is insufficient evidence to support or refute the practice of giving LCPUFA supplementation to breastfeeding mothers in order to improve infant growth and development.
PICOs
Plain language summary
Long chain polyunsaturated fatty acid supplements for mothers who breast feed
Long chain polyunsaturated fatty acids (LCPUFA) are abundant in the brain and are necessary for growth and maturation of a young infant’s brain and the retina of the eye. These particular fatty acids include docosahexaenoic acid (DHA) and are said to be ‘essential’ because the human body is not efficient in producing them. This means that infants who are breastfeeding obtain the fatty acids from their mothers’ diet, mainly from fish oil and ocean fish.
This review of six randomised clinical trials showed that supplementing a mother’s diet with LCPUFA during the pregnancy and the first four months after birth did not improve the child’s neurodevelopment in terms of problem solving ability or intelligence, psychomotor or motor development. In language development at 12 to 24 months and at five years in child attention, weak evidence was found (one study) favouring the supplementation. The age of the children at the last neurodevelopment assessment was seven years. A total of 1280 women from high‐income countries were included in the six included trials but our individual analyses were based on fewer numbers of trials and women. The children’s visual acuity was not clearly different at 12 months of age compared with children of the control groups of mothers who received supplements of olive, soybean or corn oils. More evidence is needed.
