Should prenatal patients take omega-3 (fatty acids) or DHEA (dehydroepiandrosterone) supplements?

Omega-3 Supplementation During Pregnancy: Recommendations and Considerations

Pregnant women should take omega-3 fatty acid supplements, particularly those containing DHA and EPA, as they can reduce the risk of preterm birth and support fetal neurological development, while DHEA supplementation is not recommended during pregnancy due to lack of evidence and potential risks. 1, 2, 3

Benefits of Omega-3 Supplementation During Pregnancy

Reduction of Preterm Birth Risk

• Omega-3 supplementation can reduce the risk of preterm birth, particularly when started before 20 weeks gestation 2, 3
• Most effective dosage: 600-1000 mg/day of combined DHA+EPA for women with low omega-3 status 3
• Supplementation should continue until approximately 37 weeks gestation 3

Fetal Development Benefits

• Supports neurological development of the fetus and infant 1
• Improves language, memory, attention, and hand coordination in offspring 1
• Enhances visual acuity development 1
• Affects sleep patterns positively 1

Recommended Dosage Protocol

1. For all women of childbearing age:

   • Baseline intake of 250 mg/day of DHA+EPA from diet or supplements 3

2. During pregnancy:

   • Additional 100-200 mg/day of DHA for all pregnant women 1, 3
   • For women with low omega-3 status: 600-1000 mg/day of DHA+EPA 3
   • FDA-approved prenatal supplements typically include DHA 4

3. Timing:

   • Begin supplementation preferably before 20 weeks gestation 2, 3
   • Continue through pregnancy and during breastfeeding 1

Identifying Women Who Need Higher Doses

• Women with low fish consumption 5
• Those with low measured blood levels of omega-3 fatty acids 6, 3
• Assessment can be done through dietary questionnaires or blood testing 3

Safety Considerations and Monitoring

Potential Side Effects

• Gastrointestinal: dysgeusia, eructation, nausea 7, 8
• Dermatological: skin eruption, itchiness, exanthema, eczema 7, 8
• Biochemical: potential increases in LDL-C, fasting blood sugar 7, 8
• Hematological: potential effects on clotting in patients taking anticoagulants 7, 8

Quality of Supplements

• Choose high-quality omega-3 products with antioxidants (vitamin E) added 7, 8
• Store supplements in airtight dark containers and refrigerate after opening 7, 8
• Consider prescription omega-3 products when quality is a concern 7

Mercury and Environmental Contaminants

• Fish oil supplements are generally free of methylmercury 7
• Alternative sources for those avoiding fish: purified fish oil supplements, algal oil supplements, DHA-enriched eggs 5

DHEA (Dehydroepiandrosterone)

• There is no evidence supporting DHEA supplementation during pregnancy
• DHEA is not mentioned in any of the pregnancy guidelines or recommendations
• DHEA should be avoided during pregnancy due to potential hormonal effects and lack of safety data

Practical Implementation

• Assess omega-3 intake through dietary questionnaires focusing on fish consumption
• For women with adequate omega-3 intake through diet (2+ servings of fatty fish weekly), maintain current intake 7
• For women with low fish consumption, recommend supplements containing both DHA and EPA 5
• Monitor for side effects, particularly in women taking higher doses
• Ensure supplements are from reputable sources with quality control measures

By following these evidence-based recommendations, healthcare providers can help optimize maternal and fetal outcomes through appropriate omega-3 supplementation during pregnancy.