When to stop taking fish oil during pregnancy

Pregnant women are being advised to consume omega-3 fatty acids in order to ensure proper development of the fetal neurological system. Even after birth, fish oil supplementation can improve the early development of a newborn’s brain, visual system, and motor function in women who breastfeed. These fish oils, most notably the fatty aciddocosahexaenoic acid (DHA)is part of a group of omega-3s known as polyunsaturated fatty acids (PUFAs). The human brain is full of PUFAs that modulate inflammation and provide integrity to the neuronal network. By supplying a developing brain with plenty of PUFAs, a mother can support their child’s proper development. Along with benefits to the child, a pregnant mother that consumes fish oils can prevent pre-term labor, reduce the risk of pre-ecclampsia, and may even help in the prevention of post-pardum depression (PPD).

Another breakthrough in fish oil research shows that fish oil supplementation during pregnancy decreases the risk of a newborn developing eczema. In a study of 700 pregnant women, those who took fish oil supplements versus a placebo had a decreased incidence of infant eczema by three times. When DHA and eicosapentaenoic acid (EPA) enter the cell membrane, they suppress inflammation that could potentially lead to various allergies and skin reactions that develop in early childhood. This study is ongoing as it plans to follow the children until age six to determine the extent of the lasting benefits.

If you want to start taking fish oils, the FDA recommends not exceeding the maximum dosage of 3000 mg of fish oil per day. The American Pregnancy Association recommends that pregnant and lactating women consume 500-1000 mg of fish oil per day ensuring that at least 300 mg are DHA. Although most capsules of fish oil supplements are 1000 mg, this does not indicate the amounts of actual fish oil (EPA and DHA) in each capsule, which is usually between 200-500 mg. Instead of taking a supplement, one can simply eat raw fish. The most EPA and DHA dense fish is salmon. Additionally, pregnant mothers should make sure they are getting their fish oils from a natural source free of heavy metals (mercury, BPA). To avoid heavy metal toxicity, avoid consuming fish that are high in the food chain (shark, swordfish), or be sure to purchase supplements from a reputable source with natural ingredients.

If you want to boost your baby’s growth, European researchers believe it might be a good idea to take fish oil supplements while you’re in the later stages of pregnancy.

A new study from Denmark’s University of Copenhagen, published in the BMJ today, shows that taking a fish oil supplement during pregnancy is linked to an increase in lean mass, bone mass and fat mass by the time a child is aged six.

The study demonstrates that taking fish oil supplements from the 24th week of pregnancy right up until a week after birth may be beneficial for a child's healthy growth in early life.

Previous studies suggest that taking a fish oil supplement while you’re pregnant could increase your child’s BMI in the first six years of their life.

However, this research demonstrates that the increase in BMI might not increase their risk of obesity or overweight.

The study reveals the driver of the rise in BMI is not more body fat but instead, more bone, lean and fat mass.

"Fish oil supplementation from the 24th week of pregnancy led to a higher BMI in the offspring from zero to six years of age but not an increased risk of obesity at age six," the study paper reads.

“The body composition at age six years in children given fish oil supplementation was characterised by a proportional increase in lean, bone, and fat mass, suggesting a general growth stimulating effect."

Melanie McGrice, Accredited Practising Dietitian and spokesperson for the Dietitians Association of Australia supports the study's findings.

“This study confirms what we know about the benefits of omega 3 during pregnancy,” McGrice tells SBS.

“Omega 3 is a critical nutrient during pregnancy.

“I believe that it’s better for women to consume low mercury, omega 3-rich fish during pregnancy, but if they can’t tolerate fish, fish oil supplements should definitely be considered.”

The trial involved 736 pregnant women from the Copenhagen Prospective Studies on Asthma in Childhood study who were randomised to receive n-3 long-chain polyunsaturated fatty acids (LCPUFAs) (fish oil) or olive oil (control) daily from week 24 of pregnancy until one week after birth.

Height, weight, head and waist measurements and body composition were assessed 11 times from birth to age six.

Body composition was also scanned when the children were aged 3.5 and six.

"Fish oil supplementation from the 24th week of pregnancy led to a higher BMI in the offspring from zero to six years of age but not an increased risk of obesity at age six."

The scans confirmed that the higher BMI was not the result of a higher fat percentage, but reflected a proportional increase in lean mass, bone mass, and fat mass.

This suggested that the fish oil supplementation had a general growth stimulating effect.

At age six, scans showed children whose mothers had taken fish oil supplements while pregnant had a 395g higher total mass, 280.7g higher lean mass, 10.3g higher bone mineral content and 116.3g higher fat mass compared with children of mothers who took the control oil.

A study published in 2008 says that omega 3 fatty acids are essential for fetal neurodevelopment and may be important for the timing of gestation and birth weight as well.

But most pregnant women do not get enough omega 3 fatty acids. The study reasons this is because the major dietary source, seafood, is restricted to two servings a week of low mercury fish.

"For pregnant women to obtain adequate omega 3 fatty acids, a variety of sources should be consumed: vegetable oils, two low-mercury fish servings a week, and supplements (fish oil or algae-based docosahexaenoic acid)," the study reads.

Fishy recipes

Yes and no. There are two types of fish oil supplement. One is safe to take in pregnancy, and one isn’t:

Supplements made from the body of fish, often called omega-3 supplements, are safe to take in pregnancy.
Supplements made from the liver of fish, such as cod liver oil, aren’t safe to take in pregnancy.

Both types of fish oil supplements contain beneficial long-chain omega-3 fatty acids, which help your baby's brain and eyes develop. In the long-term, they may also help to protect you against heart disease. But liver-derived supplements, such as cod liver oil, also contain high levels of the retinol form of vitamin A. You shouldn’t take supplements containing retinol when you’re pregnant, because large amounts of retinol can harm your baby.

There’s no official recommendation that pregnant women should take a fish oil supplement. Some research suggests that babies born to women taking omega-3 long-chain fatty acids weigh a little more and are less likely to be born early, but more research is needed to be sure.

If you eat some oily fish every week, you probably won't need to take a supplement. Eating fish is recommended as part of a healthy, balanced diet. Oily fish will provide you with plenty of omega-3 fatty acids, as well as other vitamins, minerals, and protein that you wouldn't get from taking just a supplement.

Some research has shown that in countries where pregnant women tend to eat more fish, fewer develop pre-eclampsia, or have a baby who is premature, or has a low birth weight.

Fish especially rich in omega-3 fatty acids include tinned or fresh salmon, tuna, trout, herring, silver warehou, anchovies, mackerel and sardines.

Crab and prawns contain reasonable amounts of omega-3 fats. And white fish, such as blue-eye trevalla and ling, contain some omega-3, but in lower amounts.

But limit how much you eat of shark (flake), swordfish (broadbill), marlin, orange roughy (deep-sea perch) and catfish during pregnancy, as these fish can contain high levels of mercury.

You can also get some omega-3 from other foods, such as nuts and seeds, vegetable oils, soy and soy products, and green leafy vegetables.

If you don't want to eat fish oil, but would like to take a supplement containing long-chain omega-3 (EPA and DHA), you can buy supplements derived from algae. Fish get their omega-3 from algae.

If you're unsure about which supplement to take, ask a pharmacist for advice.

Find out more about eating seafood and fish during pregnancy.

Reviewed for BabyCenter Australia by Naras Lapsys, dietitian and nutritionist.

Don’t forget to download our free app for a day-by-day guide to your pregnancy. My Pregnancy & Baby Today gives you all the expert advice you need, right at your fingertips.

A fish oil supplement should not be considered an alternative to the consumption of fish or omega-3 rich food. For more information on omega-3 in food, click here. As with all supplements, omega-3 intake should be assessed and monitored by a healthcare professional, considering all the impacts this may have on the pregnant woman’s health.

In recent years, particular interest has been taken on omega-3 and its possible beneficial impact in reducing the risk of certain health conditions during pregnancy, such as premature delivery *, problems with the child’s neurological development, low birth weight, preeclampsia, gestational diabetes or postpartum depression. Following a review of the different studies on the subject, it is to remember that:

There is a real benefit on the neurological development of the fetus when consuming omega-3 in the form of fish during pregnancy. To learn more about what types of fish to choose during pregnancy, click here.
Positive effects have not been demonstrated for the conditions mentioned above (*) when taking an omega-3 supplement.
In the case of a high-risk pregnancy, taking an omega-3 supplement would have little positive effect on the birth weight and the risk of prematurity, but further studies are necessary.
In most pregnancies, there are no benefits to taking an omega-3 supplement, but there is no inconvenience or risks for the pregnant woman or the child.

The consumption of fish seems to be the most beneficial health wise. Although more research is needed to fully understand the mechanism, it could be that it is the combination of omega-3 with other nutrients in fish that is most favorable.

At the Montreal Diet Dispensary, taking a fish oil supplement may be recommended as part of a treatment plan established and monitored by a nutritionist, and in some situations:

Low omega-3 intake: low consumption of fish, seafood and plant sources (walnuts, flaxseed, etc.).
High risk of preterm birth or severe restriction of intrauterine growth: history of preterm delivery, signs of early labor, important stress.
The presence of certain risk factors may also justify the relevance of taking an omega-3 supplement; this is to be determined by a healthcare professional. To learn more about risk factors during pregnancy, click here (article coming soon).

For women with low-risk pregnancies, there is no interest in taking an omega-3 supplement. The recommendation is to consume 200-350 g of cooked fish per week to meet the needs during pregnancy. To learn on which fish to consume during pregnancy, click here.

Although fish oil supplements are relatively safe during pregnancy, they are not recommended for pregnant women who present with bleeding or who take anticoagulants (a blood thinner) such as Coumadin or Heparin. Cod liver oil is also not recommended for all pregnant women due to its high vitamin A content. For more information on the effects of vitamin A on the fetus, click here. For information on how to choose an omega-3 supplement, click here. In all cases, before choosing a supplement, consult a pharmacist and/or a healthcare professional.

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Ressources

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Gouvernement du Canada. (2014). Consommation d’acides gras oméga 3 et de poisson pendant la grossesse : Utiliser les suppléments d’huiles de poisson.

In collaboration with the Dispensary workers