Suplementación prenatal con omega 3 y su efecto en complicaciones durante el embarazo
DOI:
https://doi.org/10.37527/2022.72.2.007Palavras-chave:
Omega 3, Suplementación, Embarazo, Parto PrematuroResumo
Durante los últimos años se ha incentivado la suplementación con omega 3 durante el embarazo principalmente debido a la evidencia que mostraría beneficios en el desarrollo neuronal y visual del hijo en gestación, y a la prevención de patologías obstétricas asociadas a un aumento de la morbi-mortalidad perinatal. Los ácidos grasos poliinsaturados (PUFAs) omega 3, específicamente el ácido eicosapentaenoico (EPA) y el ácido docosahexaenoico (DHA), poseen propiedades antiinflamatorias, vasodilatadoras, además de propiedades anti-agregantes, las cuales han estimulado el uso de PUFAs en la prevención de enfermedades cardiovasculares. En esta revisión detallamos los efectos de la suplementación con omega 3 en diferentes aspectos del embarazo tales como la prevención del parto prematuro, preeclampsia, depresión post-parto y mejora del metabolismo durante la diabetes gestacional. Si bien existen diversos ensayos clínicos randomizados que estudian la suplementación con omega 3 durante la gestación, la evidencia sigue siendo no concluyente, debido a la variabilidad de las dosis y tiempo de administración. Ciertamente, un mayor número de estudios de calidad son necesarios para determinar el real impacto de la suplementación con omega 3 durante la gestación en la prevención de patologías obstétricas
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Godhamgaonkar AA, Wadhwani NS, Joshi SR. Exploring the role of LC-PUFA metabolism in pregnancy complications. Prostaglandins, Leukot Essent Fat Acids 2020;163:102203. https://doi.org/10.1016/j.plefa.2020.102203
Calder PC. Omega-3 polyunsaturated fatty acids and inflammatory processes: nutrition or pharmacology? Br J Clin Pharmacol 2013;75(3):645–662. http://doi.wiley.com/10.1111/j.1365-2125.2012.04374.x
Cholewski M, Tomczykowa M, Tomczyk M. A Comprehensive Review of Chemistry, Sources and Bioavailability of Omega-3 Fatty Acids. Nutrients 2018;10(11):1662. http://www.mdpi.com/2072-6643/10/11/1662
SACN. Advice on fish consumption: benefits & risks 2004. London, UK; 2004.
Mozurkewich EL, Berman DR, Vahratian A. et al. Effect of prenatal EPA and DHA on maternal and umbilical cord blood cytokines. BMC Pregnancy Childbirth. 2018;18(1):261. http://doi.org/10.1186/s12884-018-1899-6
Mulder KA, King DJ, Innis SM. Omega-3 fatty acid deficiency in infants before birth identified using a randomized trial of maternal DHA supplementation in pregnancy. PLoS One. 2014;9(1):e83764. http://doi.org/10.1371/journal.pone.0083764
Ostadrahimi A, Salehi-pourmehr H, Mohammad-Alizadeh-Charandabi S, Heidarabady S, Farshbaf-Khalili A. The effect of perinatal fish oil supplementation on neurodevelopment and growth of infants: a randomized controlled trial. Eur J Nutr 2017;57(7):2387–2397. http://doi.org/10.1007/s00394-017-1512-1.
Lalooha F. Evaluation of the effect of omega-3 supplements in the prevention of preeclampsia among high risk women. African J Pharm Pharmacol. 2012;6(35):2580–2583. https://doi.org/10.5897/AJPP11.836
Wadhwani N, Patil V, Pisal H et al. Altered maternal proportions of long chain polyunsaturated fatty acids and their transport leads to disturbed fetal stores in preeclampsia. Prostaglandins, Leukot Essent Fat Acids 2014;91(1–2):21–30. http://dx.doi.org/10.1016/j.plefa.2014.05.006
Li F, Pei L, Huang G, Ye H. Influence of omega-3 fatty acid and vitamin co-supplementation on metabolic status in gestational diabetes: A meta-analysis of randomized controlled studies. Eur J Obstet Gynecol Reprod Biol 2020;247:191–197. https://doi.org/10.1016/j.ejogrb.2020.02.024
Jiang L, Gao C, Yan P, Chen P, Jiang C, Xu Y, et al. Omega-3 fatty acids plus vitamin for women with gestational diabetes or prediabetes: a meta-analysis of randomized controlled studies. J Matern Neonatal Med 2020; 35(16):3135-3142. https://doi.org/10.1080/14767058.2020.1814239
Zhong N, Wang J. The efficacy of omega-3 fatty acid for gestational diabetes: a meta-analysis of randomized controlled trials. Gynecol Endocrinol 2019;35(1):4–9. https://doi.org/10.1080/09513590.2018.1480716
Kar S, Wong M, Rogozinska E, Thangaratinam S. Effects of omega-3 fatty acids in prevention of early preterm delivery: a systematic review and meta-analysis of randomized studies. Eur J Obstet Gynecol Reprod Biol 2016;198:40–46. http://dx.doi.org/10.1016/j.ejogrb.2015.11.033
Olsen SF, Halldorsson TI, Thorne-Lyman AL et al. Plasma Concentrations of Long Chain N-3 Fatty Acids in Early and Mid-Pregnancy and Risk of Early Preterm Birth. EBioMedicine 2018;35:325–333. https://doi.org/10.1016/j.ebiom.2018.07.009
Harris MA, Reece MS, McGregor JA et al. The Effect of Omega-3 Docosahexaenoic Acid Supplementation on Gestational Length: Randomized Trial of Supplementation Compared to Nutrition Education for Increasing n-3 Intake from Foods. Biomed Res Int 2015;2015:123078 https://doi.org/10.1155/2015/123078
Institute of Medicine. Dietary Reference Intakes for Energy, Carbohydrate, Fiber, Fat, Fatty acids, Cholesterol, Protein, and Amino Acids. The National Academies Press. Washington, DC; 2005.
Food and Agriculture Organization FAO. Fats and fatty acids in human nutrition. Proceedings of the Joint FAO/WHO Expert Consultation. Vol. 55, FAO Food and Nutrition Paper 91. Rome, Italy; 2008.
Smuts CM, Borod E, Peeples JM, Carlson SE. High-DHA eggs: Feasibility as a means to enhance circulating DHA in mother and infant. Lipids. 2003;38(4):407–414. https://doi.org/10.1007/s11745-003-1076-y
Smuts CM, Huang M, Mundy D, Plasse T, Major S, Carlson SE. A randomized trial of docosahexaenoic acid supplementation during the third trimester of pregnancy. Obstet Gynecol. 2003;101(3):469–479. https://doi.org/10.1016/s0029-7844(02)02585-1
Courville AB, Harel O, Lammi-Keefe CJ. Consumption of a DHA-containing functional food during pregnancy is associated with lower infant ponderal index and cord plasma insulin concentration. Br J Nutr. 2011;106(2):208–212. https://doi.org/10.1017/s0007114511000961
Judge MP, Cong X, Harel O, Courville AB, Lammi-Keefe CJ. Maternal consumption of a DHA-containing functional food benefits infant sleep patterning: An early neurodevelopmental measure. Early Hum Dev 2012;88(7):531–537. http://dx.doi.org/10.1016/j.earlhumdev.2011.12.016
Judge MP, Harel O, Lammi-Keefe CJ. A docosahexaenoic acid-functional food during pregnancy benefits infant visual acuity at four but not six months of age. Lipids. 2007;42(2):117–122. http//doi.org/10.1007/s11745-006-3007-3.
Makrides M, Best K, Yelland L et al. A Randomized Trial of Prenatal n−3 Fatty Acid Supplementation and Preterm Delivery. N Engl J Med 2019;381(11):1035–1045. https://doi.org/10.1056/NEJMoa1816832
Ishihara T, Yoshida M, Arita M. Omega-3 fatty acid-derived mediators that control inflammation and tissue homeostasis. Int Immunol. 2019;31(9):559–567. https://doi.org/10.1093/intimm/dxz001
Norwitz ER, Robinson JN, Challis JRG. The Control of Labor. N Engl J Med 1999; 341:660-666. https://doi.org/10.1056/NEJM199908263410906.
Peiris HN, Romero R, Vaswani K et al. Preterm labor is characterized by a high abundance of amniotic fluid prostaglandins in patients with intra-amniotic infection or sterile intra-amniotic inflammation. J Matern Neonatal Med 2021;34(24):4009-4024. https://doi.org/10.1080/14767058.2019.1702953
Qiu C, Sanchez SE, Larrabure G, David R, Bralley JA, Williams MA. Erythrocyte omega-3 and omega-6 polyunsaturated fatty acids and preeclampsia risk in Peruvian women. Arch Gynecol Obstet. 2006;274(2):97–103. https://doi.org/10.1007/s00404-006-0140-4
Yamashita A, Kawana K, Tomio K, Taguchi A, Isobe Y, Iwamoto R, et al. Increased tissue levels of omega-3 polyunsaturated fatty acids prevents pathological preterm birth. Sci Rep. 2013;3:1–7.
Makrides M, Gibson RA, McPhee AJ, Yelland L, Quinlivan J, Ryan P, et al. Effect of DHA Supplementation During Pregnancy on Maternal Depression and Neurodevelopment of Young Children. JAMA 2010;304(15):1675-1683 https://doi.org/10.1001/jama.2010.1507
Olsen SF, Halldorsson TI, Li M, Strøm M, Mao Y, Che Y, et al. Examining the Effect of Fish Oil Supplementation in Chinese Pregnant Women on Gestation Duration and Risk of Preterm Delivery. J Nutr. 2019;149(11):1942–1951. https://doi.org/10.1093/jn/nxz153
Serra R, Peñailillo R, Monteiro LJ, et al. Supplementation of Omega 3 during Pregnancy and the Risk of Preterm Birth: A Systematic Review and Meta-Analysis. Nutrients 2021;13(5):1704. https://www.mdpi.com/2072-6643/13/5/1704
Mol BWJ, Roberts CT, Thangaratinam S, Magee LA, de Groot CJM, Hofmeyr GJ. Pre-eclampsia. Lancet 2016;387(10022):999–1011. https://doi.org/10.1016/s0140-6736(15)00070-7
Duttaroy AK, Basak S. Maternal dietary fatty acids and their roles in human placental development. Prostaglandins, Leukot Essent Fat Acids 2020;155:102080. https://doi.org/10.1016/j.plefa.2020.102080
Hsu M-C, Tung C-Y, Chen H-E. Omega-3 polyunsaturated fatty acid supplementation in prevention and treatment of maternal depression: Putative mechanism and recommendation. J Affect Disord 2018;238:47–61. https://doi.org/10.1016/j.jad.2018.05.018
Nishi D, Su KP, Usuda K, Chang JPC, Hamazaki K, Ishima T, et al. Plasma estradiol levels and antidepressant effects of omega-3 fatty acids in pregnant women. Brain Behav Immun [Internet]. 2020;85:29–34. https://doi.org/10.1016/j.bbi.2019.02.014
Markhus MW, Skotheim S, Graff IE et al. Low omega-3 index in pregnancy is a possible biological risk factor for postpartum depression. PLoS One. 2013;8(7). e67617. https://doi.org/10.1371/journal.pone.0067617
Kaviani M, Saniee L, Azima S, Sharif F, Sayadi M. The Effect of Omega-3 Fatty Acid Supplementation on Maternal Depression during Pregnancy: A Double Blind Randomized Controlled Clinical Trial. Int J Community Based Nurs Midwifery 2014;2(3):142–7. PMC4201198
Wolters M, von der Haar A, Baalmann AK, Wellbrock M, Heise TL, Rach S. Effects of n‐3 polyunsaturated fatty acid supplementation in the prevention and treatment of depressive disorders— a systematic review and meta‐analysis. Nutrients. 2021;13(4):1070. https://doi.org/10.3390/nu13041070
Suradom C, Suttajit S, Oon-arom A, Maneeton B, Srisurapanont M. Omega-3 polyunsaturated fatty acid (n-3 PUFA) supplementation for prevention and treatment of perinatal depression: a systematic review and meta-analysis of randomized-controlled trials. Nord J Psychiatry 2021;75(4):239–246. https://doi.org/10.1080/08039488.2020.1843710
Samimi M, Jamilian M, Asemi Z, Esmaillzadeh A. Effects of omega-3 fatty acid supplementation on insulin metabolism and lipid profiles in gestational diabetes: Randomized, double-blind, placebo-controlled trial. Clin Nutr 2015;34(3):388–393. http://dx.doi.org/10.1016/j.clnu.2014.06.005
Jamilian M, Hashemi Dizaji S, Bahmani F et al. A Randomized Controlled Clinical Trial Investigating the Effects of Omega-3 Fatty Acids and Vitamin E Co-Supplementation on Biomarkers of Oxidative Stress, Inflammation and Pregnancy Outcomes in Gestational Diabetes. Can J Diabetes 2017;41(2):143–149. https://doi.org/10.1016/j.jcjd.2016.09.004
Razavi M, Jamilian M, Samimi M. et al. The effects of Vitamin D and omega-3 fatty acids co-supplementation on biomarkers of inflammation, oxidative stress and pregnancy outcomes in patients with gestational diabetes. Nutr Metab. 2017;14:80 https://doi.org/10.1186/s12986-017-0236-9
Dilli D, Doğan NN, İpek MŞ. et al. Maternal fish oil supplementation in women with gestational diabetes and cord blood DNA methylation at insulin like growth factor-1 (IGF-1) gene. Clin Nutr ESPEN 2018;23:73–78. https://doi.org/10.1016/j.clnesp.2017.12.006
Pellonperä O, Mokkala K, Houttu N. et al. Efficacy of fish oil and/or probiotic intervention on the incidence of gestational diabetes mellitus in an at-risk group of overweight and obese women: A randomized, placebo-controlled, double-blind clinical trial. Diabetes Care. 2019;42(6):1009–1017
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Direitos de Autor (c) 2022 Reyna Peñailillo, Alejandra Plaza, Claudio Díaz, Matías Lagos, Antonia Barros, Sebastián E. Illanes
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