The effect of prenatal docosahexaenoic acid supplementation on infant outcomes in African American women living in low-income environments: A randomized, controlled trial

Abstract Importance African American women living in urban, low-income environments are at high risk for poor nutrition during pregnancy and birth complications. Objective To test the effectiveness of prenatal docosahexaenoic acid (DHA) supplementation on birth outcomes and infant development in a sample of African American women with Medicaid insurance and living in the city of Pittsburgh. Design The Nutrition and Pregnancy Study (NAPS) is a double-blind, randomized controlled trial of prenatal DHA supplementation conducted between 2012 and 2014. Setting Participants were recruited from obstetric clinics at the University of Pittsburgh Medical Center. Participants Sixty-four pregnant, African American women were enrolled at 16–21 weeks of gestation and randomized to either 450 mg/day of DHA (22:6n-3)(n = 43) or a soybean placebo (n = 21). Four women (6.3%) withdrew from the study: two participants from each study arm; complete data were obtained for 49 infants (76.5%) at the 3-month assessment. Interventions Supplementation with DHA or placebo continued from the beginning of enrollment through delivery. Main outcome and measures Data on birth outcomes were collected from medical records. At approximately 3 months post-partum, mothers brought their infants to the laboratory where the Bayley Scales of Infant Development (BSID-III) were administered and cortisol response to the Face-to-Face Still-Face (FFSF) paradigm was assessed. Results Infants of mothers who received DHA supplementation had higher birth weight (3.174 g versus 2.890 g) than infants of mothers receiving placebo ( F [2.40] = 6.09, p  = 0.018, eta  = 0.36), and were more likely to have a 1-min Apgar score greater than 8 ( OR  = 5.99 [95% CI  = 1.25–28.75], p  = 0.025). Infants of mothers who received DHA compared with infants of mothers receiving placebo had lower levels of cortisol in response to the FFSF paradigm ( F [1.32] = 5.36, p  = 0.018, eta  = 0.36). None of the scores on the BSID-III differed as a function of active supplement versus placebo. Conclusions Infants of women living in urban, low-income environments who received DHA supplementation had more optimal birth outcomes and more modulated cortisol response to a stressor. DHA supplementation may be effective in attenuating the negative effects of prenatal stress on offspring development.