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zoom RSS オメガ3脂肪酸 DHA服用で早産が減少/米国医療事情

<<   作成日時 : 2013/03/16 19:06   >>

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妊娠8〜20週の女性350人を募集し、出産までの間、その半数にDHA1回200mgカプセルを1日3回服用、他の半数には対照群としてプラセボを投与した。
対照群では34週未満の出生が5%(米国の平均と同様)であったが、ω-3群では1%未満だった。
しかし、早産は減少したが、リスクの最も高い早産は減少しなかったという。

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Omega-3 DHA may prevent earliest preemies
http://www.reuters.com/article/2013/03/12/us-omega-3-dha-idUSBRE92B0RB20130312

By Kathryn Doyle
NEW YORK | Tue Mar 12, 2013 12:33pm EDT
(Reuters Health) - For pregnant women, supplements of an omega-3 fatty acid called Docosahexaenoic acid (DHA) may help to reduce the likelihood of giving birth very prematurely, according to a new study.

The results add to evidence that omega-3 fatty acid supplements make pregnancy last a little longer, which means more development time for babies before birth, less hospital time after birth and a better long-term health outlook.

That's important for women in the U.S., who have shorter pregnancies and lower birth weights, on average, than in many other developed countries, lead author Susan Carlson told Reuters Health.

"It didn't reduce all preterm births, but reduced the riskiest preterm births," said Carlson, a nutritionist at the University of Kansas Medical Center in Kansas City.

Carlson and her colleagues recruited 350 women between eight and 20 weeks pregnant and gave half of them a supply of capsules, each containing 200 milligrams of algae-derived DHA, to take three times a day until giving birth. The other half of the women received identical-looking placebo capsules with mainly corn and soy oils.

When Carlson's team looked at the outcomes of the women's pregnancies, they found that overall, participants taking the DHA supplements tended to have slightly larger, heavier babies and to give birth about three days later than the placebo group.

Though there was little difference in the number of preterm births in both groups, the placebo group had considerably more births of very early preemies, according to results published in the American Journal of Clinical Nutrition.

Normally, a full-term pregnancy lasts 39 weeks and babies born more than five weeks early are at the greatest risk for serious health problems and potentially long hospital stays.

Five percent of mothers in the placebo group had their babies at less than 34 weeks - similar to the early preterm birth rate in the U.S. population - compared to less than one percent in the omega-3 group.

The researchers credit DHA with the differences because they measured fatty acid levels in mothers' and babies' blood, and found that only the DHA-supplemented mothers had raised DHA compared to the study's outset, and DHA was the only fatty acid whose level had changed.

DHA is one of the essential fatty acids, important for brain and eye development, that can't be manufactured in the body and must be obtained by eating cold water oceanic fish. It is included in some prenatal vitamins and can be bought as a supplement on its own, costing about $30 for a bottle of 180 capsules, 500 mg each.

Though studies haven't found clear, consistent benefits for fetal brain development, as researchers once hoped, the evidence for prolonging pregnancy is sound.

"This one adds another brick to the foundation," Dr. Emily Oken, of the department of population medicine at Harvard Medical School in Boston, who was not involved in the study, told Reuters Health.

"It seems that one of the very few consistent effects of fish oil and other marine oil supplementation in pregnancy is to increase duration of pregnancy by 2-3 days," according to Maria Makrides, professor of human nutrition at the University of Adelaide in Australia.

A previous study in Mexico that used 400 mg per day did not lead to longer pregnancies. The newest results may indicate that at least 600 mg is necessary for the beneficial effect, Makrides told Reuters Health by email.

Birth before 34 weeks is one of the leading causes of infant death, Oken said, so these results are "definitely reason for enthusiasm."

Women in the U.S. tend to avoid fish during pregnancy because of the mercury, which can impair brain and nervous system development for the baby, so they may be missing out on some important nutrients, like DHA, selenium and protein, Carlson said.

"We shouldn't discount the benefits of eating fish," up to two times per week during pregnancy, Oken said. Just avoid fish high in mercury, like swordfish, tilefish, mackerel and shark.

SOURCE: American Journal of Clinical Nutrition, February 20, 2013.

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DHA supplementation and pregnancy outcomes1,2,3

First published February 20, 2013, doi: 10.3945/?ajcn.112.050021
Am J Clin Nutr April 2013 ajcn.050021

Susan E Carlson, John Colombo, Byron J Gajewski, Kathleen M Gustafson, David Mundy, John Yeast, Michael K Georgieff, Lisa A Markley, Elizabeth H Kerling, and D Jill Shaddy

Abstract

Background: Observational studies associate higher intakes of n?3 (omega-3) long-chain PUFAs (LCPUFAs) during pregnancy with higher gestation duration and birth size. The results of randomized supplementation trials using various n?3 LCPUFA sources and amounts are mixed.

Objective: We tested the hypothesis that 600 mg/d of the n?3 LCPUFA DHA can increase maternal and newborn DHA status, gestation duration, birth weight, and length. Safety was assessed.

Design: This phase III, double-blind, randomized controlled trial was conducted between January 2006 and October 2011. Women (n = 350) consumed capsules (placebo, DHA) from <20 wk of gestation to birth. Blood (enrollment, birth, and cord) was analyzed for red blood cell (RBC) phospholipid DHA. The statistical analysis was intent-to-treat.

Results: Most of the capsules were consumed (76% placebo; 78% DHA); the mean DHA intake for the treated group was 469 mg/d. In comparison with placebo, DHA supplementation resulted in higher maternal and cord RBC-phospholipid-DHA (2.6%; P < 0.001), longer gestation duration (2.9 d; P = 0.041), and greater birth weight (172 g; P = 0.004), length (0.7 cm; P = 0.022), and head circumference (0.5 cm; P = 0.012). In addition, the DHA group had fewer infants born at <34 wk of gestation (P = 0.025) and shorter hospital stays for infants born preterm (40.8 compared with 8.9 d; P = 0.026) than did the placebo group. No safety concerns were identified.

Conclusions: A supplement of 600 mg DHA/d in the last half of gestation resulted in overall greater gestation duration and infant size. A reduction in early preterm and very-low birth weight could be important clinical and public health outcomes of DHA supplementation. This trial was registered at clinicaltrials.gov as NCT00266825.

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