Docosahexaenoic Acid Supplementation in Lactating Women Increases Breast Milk and Erythrocyte Membrane Docosahexaenoic Acid Concentrations and Alters Infant n-6:n-3 Fatty Acid Ratio

Shweta Khandelwal; Dimple Kondal; Ruby Gupta; Monica Chaudhry; Soumam Dutta; Lakshmy Ramakrishnan; Kamal Patil; M K Swamy; Dorairaj Prabhakaran; Nikhil Tandon; Usha Ramakrishnan; Aryeh D Stein

doi:10.1016/j.cdnut.2023.102010

Docosahexaenoic Acid Supplementation in Lactating Women Increases Breast Milk and Erythrocyte Membrane Docosahexaenoic Acid Concentrations and Alters Infant n-6:n-3 Fatty Acid Ratio

Curr Dev Nutr. 2023 Sep 29;7(10):102010. doi: 10.1016/j.cdnut.2023.102010. eCollection 2023 Oct.

Authors

Shweta Khandelwal^{1

2}, Dimple Kondal², Ruby Gupta², Monica Chaudhry¹, Soumam Dutta^{3

4}, Lakshmy Ramakrishnan⁵, Kamal Patil⁶, M K Swamy⁶, Dorairaj Prabhakaran^{1

2}, Nikhil Tandon⁵, Usha Ramakrishnan⁷, Aryeh D Stein⁷

Affiliations

¹ Department of Public Health Nutrition, Public Health Foundation of India, Gurugram, India.
² Department of Biostatistics, Centre for Chronic Disease Control, Gurugram, India.
³ Department of Home Science, University of Calcutta, Kolkata, India.
⁴ Department of Nutrition, ICMR-National Institute of Nutrition, Hyderabad, India.
⁵ Department of Biochemistry, All India Institute of Medical Sciences (AIIMS), New Delhi, India.
⁶ Department of Obstetrics and Gynaecology, KLE's J.N. Medical College Belagavi, Karnataka, India.
⁷ Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, United States.

Abstract

Background: Low concentrations of docosahexaenoic acid (DHA) or high n-6 (ω-6):n-3 ratio in pregnant women is associated with poor fetal growth velocity and suboptimal neurodevelopment. However, there is a lack of data on levels of important n-6 and n-3 fatty acids (FAs) at different time points during pregnancy and lactation from India. Data on how much DHA is transferred during actual supplementation are also scarce.

Objectives: We report the concentrations of n-6 and n-3 FAs in maternal and infant blood and in breast milk following maternal supplementation with DHA or placebo.

Methods: A total of 957 pregnant women (≤20 wk) from Belagavi, Karnataka, were randomly assigned to receive either 400 mg/d of algal DHA or placebo through 6 mo postpartum. Blood samples were collected from the mother at recruitment/baseline, delivery, and 6 mo postpartum and from the infant at birth (cord) and 12 mo (venous). Breast milk samples were collected from a subsample at delivery, 1 mo and 6 mo postpartum. The FA profile was analyzed using gas chromatography.

Results: The concentration of DHA appeared to be higher in erythrocyte and breast milk samples of the DHA-supplemented group at all subsequent time points. The n-6:n-3 ratio was lower among women in the DHA group at delivery [DHA: 4.08 (1.79); placebo: 5.84 (3.57); P < 0.001] and at 6 mo postpartum [DHA: 5.34 (2.64); placebo: 7.69 (2.9); P < 0.001]. Infants of DHA-supplemented mothers also had a lower n-6:n-3 ratio at delivery and 12 mo. The n-6:n-3 ratio of breast milk increased from delivery through 1 to 6 mo but remained lower in the DHA-supplemented group than in the placebo.

Conclusions: Maternal DHA supplementation with 400 mg/d from early pregnancy through 6 mo postpartum significantly increased circulating DHA in breast milk and infant erythrocyte, whereas decreased erythrocyte and breast milk n-6:n-3 ratio. However, maternal supplementation did not get the ratio to the recommended levels.

Keywords: breast milk; docosahexaenoic acid; fatty acid transfer; linoleic acid (LA); long-chain polyunsaturated fatty acid (LC-PUFA); n–3 LC-PUFA supplementation; placenta; pregnancy; α linolenic acid (ALA).