Maternal and Socioeconomic Factors Affecting Polyunsaturated Fatty Acid Intake
This clinical summary emphasizes the role of long-chain polyunsaturated fatty acids (LCPUFA)
intake on phospholipid fatty acid concentration in the erythrocyte membrane in pregnant women.
It also highlights the various maternal and socioeconomic factors influencing the saturated fatty
acid (SFA) and LCPUFA concentrations in the breast milk of low-income maternal cohorts.
Background
Long-chain w-3 polyunsaturated fatty acids (omega-3 LCPUFA) play a crucial role in the growth and
development of the offspring. Docosahexaenoic acid (DHA), an w-3 LCPUFA, is involved in brain
growth and functioning and visual and neural processes. DHA is synthesized in the liver from a-
linolenic acid (ALA); however, only a small amount of ALA is converted into DHA. The partial
conversion frequently results in insufficient LCPUFA, especially during pregnancy and breastfeeding,
when their needs are more significant.
The LCPUFA Intake Gap in Indian Mothers
The recommended daily intake of DHA is 300 mg/day (d) during pregnancy. DHA intake by Indian
women is a meager 3% of the recommended amounts, about 0.011 g/d throughout pregnancy. This
is lower than 10 times the consumption of pregnant women in United Kingdom (0.147 g/d) and the
Denmark (0.182 g/d). 1 Thus, a diet rich in w-3 fatty acids is critical in ensuring adequate
concentrations of LCPUFA in pregnant and lactating women.
1
Read this article, providing a summary of two independent clinical trials emphasizing the importance
of PUFA on pregnancy and the growth and development of the offspring, and the factors influencing
the composition of breast milk.
Study 1:
Objective
To analyze the effect of consuming LCPUFA on their concentrations in the erythrocyte membrane
during pregnancy.
Study design and results
The details of the study design, which assessed the role of PUFA during pregnancy, are provided in
table 1.1.
Table 1.1. Summary of the study design.
1 (Adapted from Dwarkanath et al., 2019)
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Study type
|
Prospective cohort study
|
|
No. of participants, n
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829
|
|
Study group
|
Pregnant women from urban South Indian middle-class population
|
|
Inclusion criteria
|
Women in the
|
|
Exclusion criteria
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Women with:
-
Multiple pregnancies
-
Chronic illnesses – diabetes mellitus, hypertension, heart disease and thyroid disease, hepatitis B surface antigen (HBsAg) positive, HIV or syphilis infection
|
|
Duration of study
|
Four years
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Indain diet has a w-3:w-6 intake ratio of 1:30-70, much higher than 1:5-10 which is the
recommended ratio for optimal health.The dietary graph of pregnant women over the 3 trimesters
revealed increased intake of all w-3 fatty acids, while the w-6 fatty acids remained unchanged.
Saturated and monounsaturated fatty acid intakes also increased, while PUFA intake remained
unchanged. Thus LA or AA intake profile didn’t show a significant variation. When trimester- based
changes were analyzed, a significant increase in macronutrients and ALA (15-20%) intakes was seen
in the 2nd and 3rd trimesters. DHA intakes were similar in the 2nd and 3rd trimester, EPA intakes
showed an increased trend across the trimesters.
1
The effect of various fatty acid intakes on red cell membrane concentrations of w-3 and w-6 fatty
acids is shown in Table 1.2. The quantity of EPA and DHA consumed during pregnancy was positively
linked (p<0.01).
1
Table 1.2: Correlation (r values) between intake of fatty acids and red cell membrane
concentrations across all three trimesters. (Adapted from Dwarkanath et al., 2009)
|
Nutrients
|
I trimester (n=133)
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II trimester (n=130)
|
III trimester (n=123)
|
|
Linoleic acid
|
0.094
|
0.209
|
0.191 (p<0.05)
|
|
α-linolenic acid
|
-0.007
|
0.048
|
-0.140
|
|
Arachidonic acid
|
-0.091
|
-0.106
|
-0.154
|
|
Eicosapentaenoic acid
|
0.431
|
0.331
|
0.370 (p<0.01)
|
|
Docosahexaenoic acid
|
0.402
|
0.322
|
0.413 (p<0.01)
|
The w-3: w-6 parent fatty acid ratio in red cell membranes showed a trend similar to that of the
intake ratio. Comparison of individual fatty acid consumptions and the erythrocyte membrane
concentration of w-3 and w-6 fatty acids (Table 1.2) implied that EPA and DHA intake and
concentration were positively correlated throughout the pregnancy (p 0.01).
1
Conclusion
South Indian diets during normal pregnancies are low in w-3 fatty acids, and the red cell membrane
concentration of DHA did not change throughout the pregnancy duration. Therefore, dietary
methods for improving the consumption of w-3 fatty acids need to be considered in the diets of
young women and especially during pregnancy.
Study 2:
Objective:
To assess the effect of maternal and socioeconomic factors on the SFA and PUFA concentrations in
the breast milk of low-income nursing women.
Study design and results:
The entire design of this study, evaluating the performance of rotavirus and oral poliovirus vaccines
in developing countries (PROVIDE study), is summarized in table 2.1.
2
Table 2.1. A summary of the PROVIDE study design.
(Adapted from Nayak et al., 2016)
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Study type
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Prospective cohort study
|
|
Duration of the study
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One year
|
|
Study group
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Group 1: 700 mothers and new-borns from slums in Bangladesh
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Group 2: 372 mother-infant pairs from urban slums in Kolkata India
|
|
Clinical characteristics:
Postpartum weight, Kg
Stay home mother, %
Higher Education, %
|
49.4 ± 9.4
589 (86.2)
109 (16.0)
|
49.4 ± 9.7
355 (95.4)
126 (33.9)
|
|
Income, 1,000 currency units
|
12.8 ± 9.5
|
N/A
|
Key findings of this study 2
Figure1: Key findings of the the performance of rotavirus and oral poliovirus vaccines in
developing countries (PROVIDE) study. Adapted from: Nayak et al., 2016. SFA: Saturated fatty acid; PUFA:
Polyunsaturated fatty acid
Conclusion:
The ratio of w-3: w-6 fatty acid in a pregnant woman’s erythrocyte membranes directly correlates to
the dietary intake of these components. Also, socioeconomic factors such as maternal education and
household prosperity influence the composition of breast milk with regards to the amount of
LCPUFA. In addition, maternal biological factors such as height and infant birth order also influence
breast milk composition.
Reference:
- Dwarkanath P, Muthayya S, Thomas T, Vaz M, Parikh P, Mehra R, Kurpad AV. Polyunsaturated
fatty acid consumption and concentration among South Indian women during pregnancy. Asia
Pacific journal of clinical nutrition. 2009 Jan;18(3):389-94.
- Nayak U, Kanungo S, Zhang D, Ross Colgate E, Carmolli MP, Dey A, Alam M, Manna B, Nandy
RK, Kim DR, Paul DK. Influence of maternal and socioeconomic factors on breast milk fatty acid
composition in urban, low-income families. Maternal & child nutrition. 2017 Oct;13(4):e12423.
IMPORTANT NOTICE: MOTHER’S MILK IS BEST FOR YOUR BABY
The World Health Organization (WHO)* has recommended that pregnant women and new mothers
be informed of the benefits and superiority of breast-feeding, in particular, the fact that it provides
the best nutrition and protection from illness for babies. Mothers should be given guidance on the
preparation for and maintenance of lactation, with special emphasis on the importance of the well-
balanced diet both during pregnancy and after delivery. Unnecessary introduction of partial bottle
feeding or other foods and drinks should be discouraged since it will have a negative effect on
breast-feeding. Similarly, mothers should be warned of the difficulty of reversing a decision not to
breastfeed. Before advising a mother to use an infant formula, she should be advised of the social
and financial implications of her decision. For example, if a baby is exclusively bottle-fed, more than
one can (500g) per week will be needed, so the family circumstances and cost should be kept in
mind. Mother should be reminded that breast milk is not only the best but also the most economical
food for babies. If a decision to use infant formula is taken, it is important to give instruction on
correct preparation methods, emphasizing that unboiled water, unsterilized bottles or incorrect
dilution can lead to illness.
*See: International Code of Marketing of Breast Milk Substitutes, adopted by the World Health
Assembly in Resolution WHA 34.22, May 1981.
Importance of Breastfeeding:
Immediately after delivery, breast milk is yellowish and sticky. This milk is called colostrum, which is
secreted during the first week of delivery. Colostrum is more nutritious than mature milk because it
contains more protein, more anti-infective properties which are of great importance for the infant’s
defense against dangerous neonatal infections. It also contains higher levels of, Vitamin ‘A’, (ii)
breast miIk- A) is, a complete and balanced food and provides all the nutrients needed by the infant
[for the first six months of life] (B) has anti-infective properties that protect the infants from
infection in the early months (C) is always available; (D) needs no utensils or water (which might,
carry germs) or fuel for its preparation, (iii) breastfeeding is much cheaper than feeding infant milk
substitutes as the cost of the extra food needed by the mother is negligible compared to the cost of
feeding infant milk substitutes, (iv) mothers who breast-feed usually have longer periods of infertility
after child birth than non-lactators; (b) details of management of breast feeding, as under:- (i)
breast-feeding- (A) immediately after delivery enables the contraction of the womb and helps the
mother to regain her figure quickly; (B) is successful when the infant suckles frequently and the
mother wanting to breast-feed is confident in her ability to do so (ii) in order to promote and
support breast-feeding the mother’s natural desire to breast feed should always be encouraged by
giving, where needed, practical advice and making sure that she has the support of her relatives. (iii)
adequate care for the breast and nipples should be taken during pregnancy. (iv) it is also necessary
to put the infant to the breast as soon as possible after delivery, (v) let the mother and the infant
stay together after the delivery, the mother and her infant should be allowed to stay together (in
hospital, this is called “rooming-in”); (vi) give the infant colostrum as it is rich in many nutrients and
anti-infective factors protecting the infants from infections during the few days of its birth; (vii) the
practice of discarding colostrum and giving sugar water, honey water, butter or other concoctions
instead of colostrum should be very strongly discouraged; (viii) let the infants suckle on demand; (ix)
every effort should be made to breast-feed the infants whenever they cry; (x) mother should keep
her body and clothes and that of the infant always neat and clean.
Breast-feeding is the best form of nutrition for babies and provides many benefits to babies and
mothers. It is important that, in preparation for and during breast-feeding, you eat a healthy,
balanced diet. Combined breast and bottle-feeding in the first weeks of life may reduce the supply of
your own breastmilk and reversing the decision not to breast-feed is difficult.
Always consult your Healthcare Professional for advice about feeding your baby. The social and
financial implications of using infant formula should be considered. Improper use of an infant
formula or inappropriate foods or feeding methods may present a health hazard. If you use infant
formula, you should follow manufacturer’s instructions for use carefully – failure to follow the
instructions may make your baby ill.
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