An analysis of omega-3 fatty acid status in a population of pregnant women with obesity, at higher risk of preterm birth


An updated Cochrane Review showed that maternal supplementation with omega-3 fatty acids reduced preterm birth, offering a potential strategy for prevention. We hypothesised that pregnant women with obesity, at higher risk of preterm birth, would have low omega-3 fatty acid levels and may benefit from supplementation. Our study measured the omega-3 fatty acid levels of 142 participants from the Healthy Mums and Babies study, Counties Manukau, Auckland, New Zealand. Counties Manukau is a multi-ethnic community with high rates of socio-economic deprivation, obesity, and preterm birth. Red blood cell omega-3 fatty acid levels were measured from samples collected between 120 and 176 weeks’ gestation. Contrary to our hypothesis, participants in our study had similar or higher levels of omega-3 fatty acids to those reported in pregnant populations in Australia, Norway, China, and Germany. Our findings emphasise the importance of testing omega-3 fatty acid status before supplementing groups at risk of preterm birth.

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  1. 1.

    World Health Organisation. Preterm birth. 2018. Accessed 5 Nov 2019.

  2. 2.

    Ministry of Health. Report on maternity 2017. Wellington: Ministry of Health; 2019.

  3. 3.

    Perinatal and Maternal Mortality Review Committee. Twelfth annual report of the perinatal and maternal mortality review committee: reporting mortality 2016. Wellington: Health Quality & Safety Commission; 2018.

  4. 4.

    Ncube CN, Enquobahrie DA, Albert SM, Herrick AL, Burke JG. Association of neighborhood context with offspring risk of preterm birth and low birthweight: a systematic review and meta-analysis of population-based studies. Soc Sci Med. 2016;153:156–64.

    Article  Google Scholar 

  5. 5.

    Cnattingius S, Villamor E, Johansson S, Bonamy AK, Persson M, Wikström AK, et al. Maternal obesity and risk of preterm delivery. JAMA. 2013;309:2362–70.

    CAS  Article  Google Scholar 

  6. 6.

    Middleton P, Gomersall JC, Gould JF, Shepherd E, Olsen SF, Makrides M. Omega‐3 fatty acid addition during pregnancy. Cochrane Database of Systematic Reviews. 2018;11:CD003402.

  7. 7.

    Olsen SF, So̸rensen JD, Secher NJ, Hedegaard M, Henriksen TB, Hansen HS, et al. Randomised controlled trial of effect of fish-oil supplementation on pregnancy duration. The Lancet. 1992.;339:1003–7.

  8. 8.

    Olsen SF, Østerdal ML, Salvig JD, Weber T, Tabor A, Secher NJ. Duration of pregnancy in relation to fish oil supplementation and habitual fish intake: a randomised clinical trial with fish oil. Eur J Clin Nutr. 2007;61:976.

    CAS  Article  Google Scholar 

  9. 9.

    Jackson KH, Polreis JM, Tintle NL, Kris-Etherton PM, Harris WS. Association of reported fish intake and supplementation status with the omega-3 index. Prostaglandins, Leukotrienes Essent Fat Acids. 2019;142:4–10.

    CAS  Article  Google Scholar 

  10. 10.

    Okesene-Gafa KA, Li M, McKinlay CJ, Taylor RS, Rush EC, Wall CR, et al. Effect of antenatal dietary interventions in maternal obesity on pregnancy weight-gain and birthweight: healthy mums and babies (HUMBA) randomized trial. Am J Obstet Gynecol. 2019;221:152.e1–152.e13.

    Article  Google Scholar 

  11. 11.

    Sam CH, Skeaff S, Skidmore PM. A comprehensive FFQ developed for use in New Zealand adults: reliability and validity for nutrient intakes. Public Health Nutr. 2014;17:287–96.

  12. 12.

    Lepage G, Roy CC. Direct transesterification of all classes of lipids in a one-step reaction. J Lipid Res. 1986;27:114–20.

  13. 13.

    Kramer JK, Hernandez M, Cruz‐Hernandez C, Kraft J, Dugan ME. Combining results of two GC separations partly achieves determination of all cis and trans 16: 1, 18: 1, 18: 2 and 18: 3 except CLA isomers of milk fat as demonstrated using Ag‐ion SPE fractionation. Lipids. 2008;43:259–73.

    CAS  Article  Google Scholar 

  14. 14.

    Benjamini Y, Hochberg Y. Controlling the false discovery rate: a practical and powerful approach to multiple testing. J Royal Stat Soc. 1995;57:289–300.

  15. 15.

    Eickstaedt M, Beck KL, Conlon CA. New Zealand women have suboptimal intakes of long chain omega-3 polyunsaturated fatty acids during pregnancy—a cross sectional study. Ethnicity. 2017;31:35.

    Google Scholar 

  16. 16.

    Eickstaedt M. Dietary intakes and food sources of omega-6 and omega-3 polyunsaturated fatty acids in pregnant women living in New Zealand [Master of Science thesis on the internet]. 2015. Accessed 8 Nov 2019.

  17. 17.

    Simmonds LA, Sullivan TR, Skubisz M, Middleton PF, Best KP, Yelland LN, et al. Omega‐3 fatty acid supplementation in pregnancy–baseline omega‐3 status and early preterm birth: exploratory analysis of a randomised controlled trial. BJOG. 2020.

  18. 18.

    Parker G, McClure G, Hegarty BD, Smith IG. The validity of a food frequency questionnaire as a measure of PUFA status in pregnancy. BMC pregnancy and childbirth. 2015;15:60.

  19. 19.

    Gellert S, Schuchardt JP, Hahn A. Higher omega-3 index and DHA status in pregnant women compared to lactating women–Results from a German nation-wide cross-sectional study. Prostaglandins, Leukotrienes Essent Fat Acids. 2016;109:22–8.

    CAS  Article  Google Scholar 

  20. 20.

    Markhus MW, Skotheim S, Graff IE, Frøyland L, Braarud HC, Stormark KM, et al. Low omega-3 index in pregnancy is a possible biological risk factor for postpartum depression. PloS ONE. 2013;8:e67617.

    CAS  Article  Google Scholar 

  21. 21.

    Li Y, Li HT, Trasande L, Ge H, Yu LX, Xu GS, et al. DHA in pregnant and lactating women from coastland, lakeland, and inland areas of China: results of a DHA Evaluation in Women (DEW) Study. nutrients 2015;7:8723–32.

    CAS  Article  Google Scholar 

  22. 22.

    Saito S, Kawabata T, Tatsuta N, Kimura F, Miyazawa T, Mizuno S, et al. Determinants of polyunsaturated fatty acid concentrations in erythrocytes of pregnant Japanese women from a birth cohort study: Study protocol and baseline findings of an adjunct study of the Japan environment & children’s study. Environmental health and preventive medicine. 2017;22:22.

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We would like to acknowledge the support and expertise of Dr Erica Zarate and Saras Green at the Metabolomics Mass Spectrometry Centre, University of Auckland for the RBC analysis and Raphael Bang at BioDEMI for his data processing expertise. We would also like to extend our thanks to the HUMBA participants and wider research team involved in the HUMBA trial, including the research midwives who were involved in the specimen collection and dietary data collection.


The HUMBA trial received financial and in-kind support from the following funding sources: financial support from Cure Kids (Child Health Research Charity); Lottery Health Research Grants; Faculty Research Development Fund, University of Auckland; Counties Manukau Health, South Auckland; Two Mercia Barnes Trust Grants (administered by the New Zealand Committee of the Royal Australian and New Zealand College of Obstetricians and Gynaecologists); Nurture Foundation; and the Heart Foundation of New Zealand. In-kind support: Christian Hansen (Chr. Hansen A/S, Horsholm, Denmark) provided the probiotic/placebo capsules free of charge. The red blood cell omega-3 fatty acid analysis was funded by CW’s and LM’s University of Auckland research funds, and a grant to MBJ from the University of Auckland “Healthy People Healthy Communities” seed fund. The funding sources had no involvement in the trial design; collection, analysis, and interpretation of the data; in the writing of the report; and the decision to submit the article for publication.

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LM and CW conceived the study idea and sourced funding to complete the study. JdS performed the analysis, interpretation of the data, and wrote the manuscript. MBJ provided statistical support in the study design and analysis of the data and sourced additional funding. LM, CW, KO, CM, and RT were involved in the HUMBA study conception, recruitment, and completion. All authors reviewed the manuscript, provided feedback, and approved the final version.

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Correspondence to Jamie V. de Seymour.

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de Seymour, J., Jones, M.B., Okesene-Gafa, K.A.M. et al. An analysis of omega-3 fatty acid status in a population of pregnant women with obesity, at higher risk of preterm birth. Eur J Clin Nutr (2020).

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