PREGNANCY

The Cost of Early Life Nutrition

By: Lucy Jones RD

November 16, 2016

When we think about long chain omega-3 oils, such as those found in oily fish, many of us associate them with our brain and heart health. One aspect few of us have considered is their potential to play a role in health during early life.

Premature births, where babies are born early, is the single most important factor in determining whether a baby survives and also thrives (long term neurodevelopment)[1].

Preterm birth is defined as being born before 37 weeks of pregnancy and recent data from 2013 showed preterm birth accounted for 11.4 percent of the nearly 4 million births in the US[2]. Premature births continue to be the one of the leading causes of infant deaths worldwide[3]. Babies born very early often need prolonged intensive care for prematurity related illness, and long-term support for neurodevelopmental problems3.

Each baby born before 34 weeks of gestation costs around £60,000 to the UK National Health Service (NHS)[4], and $150,000 to the U.S. healthcare system[4].

There is great need for effective, easily available, safe and acceptable measures and interventions to prevent premature births, especially before 34 weeks of pregnancy to help save lives and reduce the cost burden on our health systems.

Long-chain omega-3 polyunsaturated fatty acids, in particular docosahexaenoic acid (DHA), are essential for infant development and there is growing evidence that shows they support the health of mothers during pregnancy[5]. More than 30 years ago, scientists first observed that Faroe Islanders, who consumed more omega-3 rich seafood than Danes, had longer pregnancies and babies with higher birth weights[6].

More recently, a number of randomized controlled trials (the gold standard in research trials) from the UK, the U.S. and Australia have all investigated this link and now large scale reviews of these (meta-analyses) have assessed whether omega-3 supplements could reduce the major health costs associated with early life.

One of these trials undertaken in Kansas, U.S., assessed whether 600mg per day of DHA could help improve birth outcomes. They gave 350 women either DHA or placebo capsules from week 20 of their pregnancy until they gave birth. The DHA supplement group had longer pregnancies and greater birth weights, lengths and head circumferences[7]. The DHA group also had fewer premature births and shorter hospital stays for those born early. They concluded that a supplement of 600 mg DHA per day in the last half of gestation resulted in an increase in pregnancy length in addition to greater baby size, helping to reduce premature births and babies being born with very low birth weights[6].

Another research group took these findings and assessed whether hospital costs differed between the groups. They calculated that the hospital cost saving of DHA supplementation amounted to $1,678 per baby and even after adjusting for the costs of the supplements in the DHA group, the saving per mom and baby was $1,484[8]. If this was applied to the nearly 4 million U.S. deliveries per year, it suggests that universal supplementation with 600 mg per day of DHA during the last two trimesters of pregnancy could save the U.S. health care system up to $6 billion[8].

These findings are not unique to the States with findings being echoed in Australia. An analysis of hospital costs from the DHA to Optimize Mother and Infant Outcome (DOMInO) trial determined DHA supplements could decrease individual hospital costs by AUD 92 with potential savings to the public hospital system of between AUD 15 and 51 million per year[9].

A recent systematic review and meta-analysis of six such studies, including the results from 4,193 women has concluded that omega-3 fatty acids are indeed effective in preventing premature births[10]. They included studies with a wide range of doses from 133mg right up to 3000mg and found that this simple, easily available intervention reduced early premature births (before 34 weeks) by an incredible 58 percent[10].

Pregnancies were almost two weeks longer on average. Considering that delaying premature births by just one week could potentially save £260 million a year in the UK alone[11], this is an incredible finding.

Making pregnant women and those considering pregnancy in the future aware of these findings and the potential benefits of supplementation could help to increase infant survival in addition to creating huge cost savings for public health systems.

References

1.      RCOG. Tocolysis for women in preterm labour Royal College of Obstetricians and Gynaecologists – Greentop guideline no 1b. London; 2011.

2.      Hamilton BE, Martin JA, Osterman MJ, Curtin SC, Matthews TJ (2015). Births: Final Data for 2014, National vital statistics reports: from the Centers for Disease Control and Prevention, National Center for Health Statistics, National Vital Statistics System, vol 64 pp 1-64.

3.      Kar S,Wong M, Rogozinska E,Thangaratinam S (2016) Effects of omega-3 fatty acids in prevention of early preterm delivery: a systematic review and meta-analysis of randomized studies. European Journal of Obstetrics & Gynecology and Reproductive Biology. Vol 198. pp 40–46

4.      Mangham L (2009). The cost of Preterm Birth throughout childhood in England and Wales. Pediatrics. Vol 123(2):e312-27

5.      Ahmed S, Makrides M, Sim N, McPhee A, Quinlivan J, Gibson R, Umberger W (2015) Analysis of hospital cost outcome of DHA-rich fish-oil supplementation in pregnancy: Evidence from a randomized controlled trial. Prostaglandins Leukotrienes and Essential Fatty Acids. Volume 102-103. Page 5-11

6.      Olsen SF, Joensen HD (1985). High liveborn birth weight in the Faroes: a comparison between birth weights in the Faroes and in Denmark. Journal of Epidemiology and community health. Vol 39:27–32.

7.      Shireman T.I, Kerling E.H, Gajewski B.J, Colombo J. and Carlson S.E (2016). Docosahexaenoic acid supplementation (DHA) and the return on investment for pregnancy outcomes, Prostaglandins Leukotrienes and Essential Fatty Acids, http://dx.doi.org/10.1016/j.plefa.2016.05.008

8.      Ahmed S, Makrides M, Sim N, McPhee A, Quinlivan J, Gibson R, Umberger W (2015) Analysis of hospital cost outcome of DHA-rich fish-oil supplementation in pregnancy: Evidence from a randomized controlled trial. Prostaglandins Leukotrienes and Essential Fatty Acids. Volume 102-103. Page 5-11

9.      Kar S,Wong M, Rogozinska E,Thangaratinam S (2016) Effects of omega-3 fatty acids in prevention of early preterm delivery: a systematic review and meta-analysis of randomized studies. European Journal of Obstetrics & Gynecology and Reproductive Biology. Vol 198. pp 40–46

10.   Mangham L (2009). The cost of Preterm Birth throughout childhood in England and Wales. Pediatrics. Vol 123(2):e312-27

Recent Posts