Saturday, 25 April 2020

DHA supplementation in pregancy

DHA supplementation in pregnancy  could  decrease   the incidence   of deep placental  disorders . DHA supplementation in pregnancy  could  decrease   the incidence   of deep placental  disorders. The  failure    of a normal   placentation  may cause   uteroplacental  ischemia responsible  for several   complications   including  preeclampsia   fetal growth  restriction preterm   labor PROM. Researchers have noticed an early first trimester    supplementation   was associated with    a significantly  better outcome that  the effects of DHA supplementation  on the placentation disorders Other research have shown that DHA supplementation     after 20 weeks low  level   of placental   apoptosis  and subsequently   with a   decreased  incidence   of placental   failure. Additionally , it has been shown that routine DHA supplementation  prevents  Preeclampsia     and Pregnancy   Induced  Hypertension by diminishing  multifactorial     placental  dysfunction   combining excessive  oxidative    stress and endothelial    dysfunction. Vascular   endothelial    growth factor is an angiogenic factor  that is involved  in preeclampsia low    serum level of VEGF deficit   could lead  to endothelium cell   dysfunction   with a possible reduced   transfer   of fatty  acids. an early first trimester    supplementation   was associated with    a significantly  better outcome. Preeclampsia    was associated with a reduced    maternal level  of   plasmatic    total   omega-3   fatty acids and    with a higher level  of oxidative  stress   activity.Not only prevention of PIH but too much body weight gain and prevalence of GDM can be minimized with regular intake of DHA.


What is the fault is Indian   diets? Ans:-- The ideal ratio of omega 3 to omega 6     should be 1: 1  to 1;2.5. But  in Indian diets  it is usually  around 1:17  to 1:20  . Such    low levels   become a concern   especially  during  peak spurts of   neurodevelopment   such as  the first  1000 days.  Indian   diets are largely deficient in  DHA are quite low.  Indians do consume    sources of   the precursor, alpha    linolenic  acid   like mustard oils , soybean oil. Flax seeds walnuts.  Excess   omega 6 fats in Indian diets inhibit the endogenous  synthesis  of DHA from ALNA. Hence   negligible DHA rich products  coupled  with   an excess   of omega 6  sources   result  in low plasma   DHA and a sub optimal   omega -3  to omega 6   ratio among    Indian   populations.

DHA & Foetal and  Neonatal development:-- DHA and Neurodevelopment :- Higher  omega 3   long chain   poly unsaturated  fatty acid  levels    such as docosahexaenoic  acid have been  correlated   with enhanced   infant  neurodevelopment. DHA is a vital structural component of human   brain   and retina. 
DHA an important component  of neural lipids   accumulating   in neural  tissue  during  development   . Inadequate DHA in   gestation   may compromise infant  development   . The n-3 fatty acid DHA increases in the  brain  grey matter as well as   retina   phospholipids  during early  development    with a well known   higher proportion of DHA in the brain   and retina  PL than   other organs. The infant brain  is only about 25% of the adult  brain weight   at term gestation being about 370   g and increasing to about 70 %  of adult brain   weight by 12 months synapses,  that    are rich   in DHA  increase   with remarkable     rates of formation of 4000  synapses / second during   the first 2 years  with   structural   reorganization   and pruning of synapses leading    to maximum  synaptic density from   about  6-7  years..DHA   intake    and status of children    up to about   10 years    are related to child neural    function including verbal  learning     ability language  reading  spelling non verbal intelligence and memory. The first 1000 days   is the period   from conception   through to a child’s second birthday commonly, is  a crucial   window to improve  maternal child health   and nutrition   indicators   and optimize   human capital.  . A mother’s   nutrition during  this critical phase   impacts    both prenatal   and postnatal growth   and the offspring   development . Higher  omega 3   long chain   poly unsaturated  fatty acid  levels    such as docosahexaenoic  acid have been  correlated   with enhanced   infant  neurodevelopment.


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Lc-PUFA  & prevalence of  Preeclampsia
It has been shown that Patients   with preeclampsia   showed a reduced   concentration   of Lc- PUFA   and consequently has a deficiency   of antiinflammatory factors  such as  lipoxin and prostaglandins. Omega 3 fatty  acids & preeclampsia . A prospective study comparing   preeclampsia women and healthy controls   showed also that preeclampsia    was associated with a reduced    maternal level  of   plasmatic    total   omega-3   fatty acids and    with a higher level  of oxidative  stress   activity.
A study   measured  serum  fatty acid concentrations in 140  normotensive and   54  PE women    from the 16th week   of gestation till delivery. It was    found lower  levels   of DHA in maternal   plasma , cord   plasma  and placenta  in the group   with PE .Further    it was   suggested that supplementation    of omega 3 fatty acids  during the   16-20th  week   of gestation   could improve  fatty acid status  in infants   born to   mothers  with PE.
Maternal   and placental   DHA level  was   inversely correlated   with   the seric   concentration  of an antagonist  of VEGF and placental   growth factor, the soluble like tyrosine   kinase   receptor. It   was recommended that an   abnormal  LCPUFA  metabolism    in the membrane   with low DHA  concentration    was responsible for an increased  release  of  sFIT-1 in the maternal   circulation.
DHA and Obesity
During pregnancy obesity is a concern   for the obstetrician  because    of the associated    maternal   and  fetal   morbidity. A review   studied the role  of n-3       LC- PUFAs   in pregnant    obese women    with   metabolic   syndrome . The  authors observed that prevention of  preterm  delivery     and improvement    of fetal  and   neonatal   outcome  .Further   they concluded that a supplementation with PUFAs is recommended  although  the optimal   dose and treatment   strategy  should be  determined.
DHA  and Gestational  Diabetes
Gestational   diabetes  mellitus      a common pregnancy    complication   with  an increasing   prevalence    between 3 and  10 %    GDM is associated  with short  as well  as long   term  maternal  and  fetal    morbidity

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