by Anne Eglash MD, IBCLC, FABM
Should mothers who are providing breastmilk for their premature infants take DHA (docosahexanoic acid) supplements?
DHA is an essential fatty acid that our bodies are unable to manufacture to sufficient levels on our own. Our diet is our main source of DHA, with the best food resources being fish and seafood. Because DHA is crucial to the development of neural tissue in infants, such as the brain and the retina, pregnant and nursing women are encouraged to have an adequate amount of DHA in their diets. According to the Food and Drug Administration, pregnant and breastfeeding mothers are advised to eat 2-3 meals of fish each week to supply an adequate amount of DHA to their infants.
The author of a 2017 review of DHA and premature infant development suggests that premature infants require more DHA than term infants, because premature infants need nutritional balances similar to those found in-utero. Fetuses are exposed to more DHA through placental transfer from the mother, as compared to premature infants of the same gestation who mainly receive DHA through breastmilk. The DHA concentration in formula is similar to the average amount in breastmilk.
Research outcomes for premature infants receiving high amounts of DHA as compared to the standard amounts in breastmilk or formula have shown which of the following (choose 1 or more):
- A. Improved visual function by the corrected age of 4 months.
- B. The rate of severe mental retardation, an IQ < 70, was reduced by 50%
- C. Premature infants exposed to maternal diets high in fish oil are more likely to be allergic to fish.
- D. Decreased hay fever during infancy.
See the Answer
Should Women Providing Milk to Their Preterm Infants Take Docosahexaenoic Acid Supplements?
Berthold Koletzko, MD, PhD
Key Points
- Human milk globally has a mean DHA content of 0.3% of fatty acids, with large variation along with different maternal DHA intakes from fish and seafood.
- Breastfeeding usually meets DHA needs of term infants (100 mg/d) but not the much higher requirements of very low birthweight infants (VLBWI).
- To match intrauterine DHA accretion, VLBWI require a human milk DHA content of about 1% that is achievable by maternal supplementation with 3 g/d tuna oil.
- A high milk DHA supply to VLBWI may enhance early visual and cognitive development and reduce adverse events include severe developmental delay, bronchopulmonary dysplasia, necrotizing enterocolitis and allergies.
Milk Mob Comment
Anne Eglash MD, IBCLC, FABM
The essential fatty acids in mother’s diet play a role in the fatty acid make up in her breastmilk. We know that women who live near the coasts, especially the West coast, have more DHA in their breastmilk as compared to women who live in the Midwest because of the differences in fish and seafood intake. Please see a past Clinical Question of the Week regarding the safety of eating fish in order to provide DHA in breastmilk.
Breastfeeding mothers with preterm infants are encouraged to take extra DHA to boost the DHA in her breastmilk, beyond the recommended 2-3 servings of fish or seafood a week.
The author of this review suggests that mothers providing breastmilk to their very low or extremely low birthweight infants can achieve the desired higher level of DHA by taking 3 grams of tuna oil daily.