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Effect of n-3 long chain polyunsaturated fatty acid supplementation in pregnancy on infants' allergies in first year of life: randomised controlled trial

By D. Palmer, T. Sullivan, M. Gold, S. Prescott, R. Heddle, R. Gibson and M. Makrides

Abstract

Objective: To determine whether dietary n-3 long chain polyunsaturated fatty acid (LCPUFA) supplementation of pregnant women with a fetus at high risk of allergic disease reduces immunoglobulin E associated eczema or food allergy at 1 year of age. Design: Follow-up of infants at high hereditary risk of allergic disease in the Docosahexaenoic Acid to Optimise Mother Infant Outcome (DOMInO) randomised controlled trial. Setting: Adelaide, South Australia. Participants: 706 infants at high hereditary risk of developing allergic disease whose mothers were participating in the DOMInO trial. Interventions: The intervention group (n=368) was randomly allocated to receive fish oil capsules (providing 900 mg of n-3 LCPUFA daily) from 21 weeks’ gestation until birth; the control group (n=338) received matched vegetable oil capsules without n-3 LCPUFA. Main outcome measure: Immunoglobulin E associated allergic disease (eczema or food allergy with sensitisation) at 1 year of age. Results: No differences were seen in the overall percentage of infants with immunoglobulin E associated allergic disease between the n-3 LCPUFA and control groups (32/368 (9%) v 43/338 (13%); unadjusted relative risk 0.68, 95% confidence interval 0.43 to 1.05, P=0.08; adjusted relative risk 0.70, 0.45 to 1.09, P=0.12), although the percentage of infants diagnosed as having atopic eczema (that is, eczema with associated sensitisation) was lower in the n-3 LCPUFA group (26/368 (7%) v 39/338 (12%); unadjusted relative risk 0.61, 0.38 to 0.98, P=0.04; adjusted relative risk 0.64, 0.40 to 1.02, P=0.06). Fewer infants were sensitised to egg in the n-3 LCPUFA group (34/368 (9%) v 52/338 (15%); unadjusted relative risk 0.61, 0.40 to 0.91, P=0.02; adjusted relative risk 0.62, 0.41 to 0.93, P=0.02), but no difference between groups in immunoglobulin E associated food allergy was seen. Conclusion: n-3 LCPUFA supplementation in pregnancy did not reduce the overall incidence of immunoglobulin E associated allergies in the first year of life, although atopic eczema and egg sensitisation were lower. Longer term follow-up is needed to determine if supplementation has an effect on respiratory allergic diseases and aeroallergen sensitisation in childhood.D J Palmer, T Sullivan, M S Gold, S L Prescott, R Heddle, R A Gibson, M Makride

Topics: Fetal Blood; Humans; Dermatitis, Atopic; Hypersensitivity, Immediate; Food Hypersensitivity; Fatty Acids, Omega-3; Fish Oils; Immunoglobulin E; Treatment Outcome; Regression Analysis; Confounding Factors (Epidemiology); Breast Feeding; Pregnancy; Infant Formula; Dietary Supplements; Eggs; Infant; Australia; Female; Male; Maternal Nutritional Physiological Phenomena; Intention to Treat Analysis
Publisher: British Med Journal Publ Group
Year: 2012
DOI identifier: 10.1136/bmj.e184
OAI identifier: oai:digital.library.adelaide.edu.au:2440/70081
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