Marine Oils

Drug Levels and Effects:




Summary of Use during Lactation:


Marineoils, such as fishoilor algaloil, are a rich source of omega-3 fatty acids, especially the essential fatty acids, docosahexaenoic acid (DHA) and eicosapentaenoic acid (EPA). Algaloilis high in DHA and low in EPA, whereas fishoilhas more EPA than DHA. DHA and EPA are normal components of breastmilk in which concentrations reflect maternal intake. Higher milk levels result in higher infant plasma and erythrocyte levels of omega-3 fatty acid-derived phospholipid; one study found that breastmilk DHA was a better predictor of infant erythrocyte DHA than direct supplementation of the infants with fishoil.[1] Current dietary recommendations for nursing mothers is at least 300 mg of DHA and 220 mg of EPA daily.[2] Supplementation with omega-3 fatty acids has been studied for reduction of postpartum depression in nursing mothers and for improving various infant outcomes. A meta-analysis of 35 randomized, controlled trials found that women with a diagnosis of severe depression obtained benefit from omega-3 fatty acids, but those with mild depression did not.[3]

A meta-analysis of 6 randomized, controlled trials on infant neurodevelopmental outcomes found that maternal supplementation with essential fatty acids during pregnancy and breastfeeding for the first 4 months postpartum did not improve the child's problem solving ability, intelligence, or psychomotor or motor development. Weak evidence for improved vision and attention was found in one study.[4] Two studies published since the meta-analysis was performed reported evidence of some small positive effects of maternal fishoilsupplementation on infant neurodevelopment,[5][6] and one found negative effects.[7] A review of studies in developing countries concluded that DHA supplementation during lactation and in infants may be beneficial for growth and development of young children 6 to 24 months of age.[8] Another meta-analysis of 5 randomized, controlled trials found that maternal supplementation with omega-3-polyunsaturated fatty acids during lactation did not prevent asthma, food allergy or atopy.[9] A study of supplementation of women with fishoilduring pregnancy and for 4 months postpartum during breastfeeding found that supplementation had no effect on their infants' growth or fat mass at various times up to 12 months of age.[10]

Fishoilup to 3 grams daily is "generally recognized as safe" (GRAS) as a food by the US Food and Drug Administration. The most common complaint is burping a fishy taste after ingestion. Rarely, allergic reactions are reported with nutoil-derived omega-3 fatty acids in patients allergic to nuts.

Dietary supplements do not require extensive pre-marketing approval from the US Food and Drug Administration. Manufacturers are responsible to ensure the safety, but do not need to prove the safety and effectiveness of dietary supplements before they are marketed. Dietary supplements may contain multiple ingredients, and differences are often found between labeled and actual ingredients or their amounts. A manufacturer may contract with an independent organization to verify the quality of a product or its ingredients, but that does not certify the safety or effectiveness of a product. Because of the above issues, clinical testing results on one product may not be applicable to other products. More detailed informationabout dietary supplementsis available elsewhere on the LactMed Web site.


Drug Levels:


Numerous studies have examined the effect of omega-3 fatty acid ingestion during pregnancy and lactation on breastmilk fatty acid composition. Only studies in which supplementation was started postpartum are reviewed below.

Maternal Levels.

Five nursing mothers were supplemented with fishoilcontaining 1080 mg of EPA and 720 mg of DHA daily for 21 days, beginning at 2 weeks postpartum. Milk samples were collected daily before the dose; once weekly, milk samples were also collected at 4, 8, 12 and 16 hours after the dose. On day 21, pre-dose milk levels of DHA (by 89%), EPA (by 525%) and another omega-3 fatty acid (docosapentaenoic acid; by 143%) were significantly increased over their initial levels. Mean and peak levels increased each week during the study on each of the days were sequential levels were measured. Peak omega-3 fatty acid levels occurred 12 hours after ingestion.[11]

New mothers intending to breastfeed for at least 12 weeks were randomized to receive placebo (n = 12) or algal-derived DHA in a dose of 0.2 (n = 10), 0.4 (n = 12), 0.9 (n = 10) or 1.3 (n = 8) grams daily starting at day 5 postpartum. At 12 weeks postpartum, DHA levels in breastmilk were linearly proportional to the dose of DHA ingested, expressed as the following percentages of total breastmilk fatty acids: 0.21% (placebo), 0.35% (0.2 grams), 0.46% (0.4 grams), 0.86% (0.9 grams), and 1.13% (1.3 grams).[12]

Mothers who were breastfeeding at least 75% were randomized to receive supplements of either high-DHA algaloil(n = 6), high-DHA eggs (n = 6), low EPA fishoil(n = 6) or regular eggs (n = 6) beginning at 2 weeks postpartum. Supplementation provided doses of < 230 mg, 170 mg, 260 mg and <35 mg="" daily="" of="" dha,="" respectively.="" after="" 6="" weeks="" of="" supplementation,="" breastmilk="" dha="" was="" increased="" in="" all="" supplemented="" groups="" and="" correlated="" with="" dha="" intake.="" breastmilk="" dha="" was="" decreased="" in="" the="" regular="" egg="">

Ten mothers of preterm infants (<29 weeks gestational age) were given 1200 mg of DHA daily beginning within the first week postpartum and continued for 8 to 12 weeks. A group of 22 mothers who met the same criteria, but without maternal supplementation served as a reference group. The average DHA breastmilk concentration in supplemented mothers increased 5-fold over the baseline value within the first week of supplementation. Breastmilk DHA in the supplemented group was about 12 times higher than in the reference group at 49 days postpartum.[14]

A double-blind study randomized 51 mothers of newborn, term infants to receive normal diet (control), normal diet plus 224 mg daily of DHA from algaloil, or normal diet plus 150 grams of fatty fish 3 times weekly. Supplemented mothers maintained consistent DHA levels in colostrum, transitional and mature milk. Mothers on normal diets had a decrease in DHA from colostrum to mature milk. The amount in mature milk was significantly less than that in the milk of supplemented mothers.[15]

Infant Levels.

Five nursing mothers were supplemented with fishoilcontaining 1080 mg of EPA and 720 mg of DHA daily for 21 days, beginning at 2 weeks postpartum. The infants' average erythrocyte content of EPA increased by 636% and docosapentaenoic acid increased by 260% on day 21 compared to baseline. The ratio of omega-6 to omega-3 fatty acids decreased significantly by 22%. DHA content was increased only slightly, but the difference was not statistically significant.[11]

New mothers intending to breastfeed for at least 12 weeks were randomized to receive placebo (n = 12) or algal-derived DHA in a dose of 0.2 (n = 10), 0.4 (n = 12), 0.9 (n = 10) or 1.3 (n = 8) grams daily starting at day 5 postpartum. At 12 weeks, their breastfed infants had blood samples measured for plasma and erythrocyte DHA-derived phospholipid. The DHA-phospholipid levels increased proportionately up to a milk DHA level of about 0.8% of total milk lipids, then reached a plateau where higher milk DHA concentrations did not further increase infant DHA-phospholipid levels. Infant EPA-phospholipid levels also increase slightly, while omega-6 fatty acid phospholipids decreased.[16]

Mothers who were breastfeeding at least 75% were randomized to receive supplements of either high-DHA algaloil(n = 6), high-DHA eggs (n = 6), low EPA fishoil(n = 6) or regular eggs (n = 6) beginning at 2 weeks postpartum. Supplementation provided doses of < 230 mg, 170 mg, 260 mg and <35 mg="" daily="" of="" dha,="" respectively.="" after="" 6="" weeks="" of="" supplementation,="" infant="" plasma="" dha-phospholipid="" was="" increased="" in="" all="" supplemented="" groups,="" with="" the="" highest="" in="" the="">oilgroup. DHA increased only slightly in the regular egg group.[13]

Ten mothers of preterm infants (<29 weeks gestational age) were given 1200 mg of DHA daily beginning within the first week postpartum and continued for 8 to 12 weeks. A group of 22 mothers who met the same criteria, but without maternal supplementation served as a reference group. Infants were exclusively fed their mother's breastmilk if possible, but some were partially formula fed. At 49 days of age, the infants whose mothers were given DHA supplementation received an estimated 55 mg/kg daily of DHA and the reference group infants received 7 mg/kg daily of DHA.[14]


Effects in Breastfed Infants:


Relevant published information was not found as of the revision date.


Possible Effects on Lactation:


Relevant published information was not found as of the revision date.


References:


1. Meldrum SJ, D'Vaz N, Casadio Y et al. Determinants of DHA levels in early infancy: Differential effects of breast milk and direct fishoilsupplementation. Prostaglandins Leukot Essent Fatty Acids. 2012;86:233-9. PMID:22572105
2. Simopoulos AP, Leaf A, Salem N Jr. Workshop on the Essentiality of and Recommended Dietary Intakes for Omega-6 and Omega-3 Fatty Acids. J Am Coll Nutr. 1999;18:487-9. PMID:10511332
3. Appleton KM , Rogers PJ, Ness AR. Updated systematic review and meta-analysis of the effects of n-3 long-chain polyunsaturated fatty acids on depressed mood. Am J Clin Nutr. 2010;91:757-70. PMID:20130098
4. Delgado-Noguera MF, Calvache JA, Bonfill Cosp X. Supplementation with long chain polyunsaturated fatty acids (LCPUFA) to breastfeeding mothers for improving child growth and development. Cochrane Database Syst Rev. 2010;CD007901. PMID:21154388
5. Makrides M, Gibson RA, McPhee AJ et al. Neurodevelopmental outcomes of preterm infants fed high-dose docosahexaenoic acid: a randomized controlled trial. JAMA. 2009;301:175-82. PMID:19141765
6. Jensen CL, Voigt RG, Llorente AM et al. Effects of early maternal docosahexaenoic acid intake on neuropsychological status and visual acuity at five years of age of breast-fed term infants. J Pediatr. 2010;157:900-5. PMID:20655543
7. Cheatham CL, Nerhammer AS, Asserhoj M et al. Fishoilsupplementation during lactation: effects on cognition and behavior at 7 years of age. Lipids. 2011;46:637-45. PMID:21512889
8. Huffman SL, Harika RK, Eilander A, Osendarp SJ. Essential fats: how do they affect growth and development of infants and young children in developing countries? A literature review. Matern Child Nutr. 2011;7 (Suppl 3):44-65. PMID:21929635
9. Klemens C, Berman D, Mozurkewich E. The effect of perinatal omega-3 fatty acid supplementation on inflammatory markers and allergic diseases: a systematic review. BJOG. 2011;118:916-25. PMID:21658192
10. Hauner H, Much D, Vollhardt C et al. Effect of reducing the n-6:n-3 long-chain PUFA ratio during pregnancy and lactation on infant adipose tissue growth within the first year of life: an open-label randomized controlled trial. Am J Clin Nutr. 2011;95:383-94. PMID:22205307
11. Henderson RA, Jensen RG, Lammi-Keefe CJ et al. Effect of fishoilon the fatty acid composition of human milk and maternal and infant erythrocytes. Lipids. 1992;27:863-9. PMID:1491604
12. Makrides M , Neumann MA, Gibson RA. Effect of maternal docosahexaenoic acid (DHA) supplementation on breast milk composition. Eur J Clin Nutr. 1996;50:352-7. PMID:8793415
13. Jensen CL, Maude M, Anderson RE, Heird WC. Effect of docosahexaenoic acid supplementation of lactating women on the fatty acid composition of breast milk lipids and maternal and infant plasma phospholipids. Am J Clin Nutr. 2000;71 (1 Suppl):292S-9S. PMID:10617985
14. Marc I, Plourde M, Lucas M et al. Early docosahexaenoic acid supplementation of mothers during lactation leads to high plasma concentrations in very preterm infants. J Nutr. 2011;141:231-6. PMID:21169226
15. Scopesi F, Calevo MG, Risso FM et al. The impact of a DHA enriched diet on breast milk composition. Early Hum. Dev. 2011;87 (Suppl.):S96. Abstract.
16. Gibson RA, Neumann MA, Makrides M. Effect of increasing breast milk docosahexaenoic acid on plasma and erythrocyte phospholipid fatty acids and neural indices of exclusively breast fed infants. Eur J Clin Nutr. 1997;51:578-84. PMID:9306083



Substance Identification:




Substance Name:

MarineOils

CAS Registry Number:

8016-13-5

Drug Class:


  • Complementary Therapies

  • Food

  • Phytotherapy

  • Plants, Medicinal


  • Administrative Information:




    LactMed Record Number:


    978


    Last Revision Date:


    Disclaimer:Information presented in this database is not meant as a substitute for professional judgment. You should consult your healthcare provider for breastfeeding advice related to your particular situation. The U.S. government does not warrant or assume any liability or responsibility for the accuracy or completeness of the information on this Site.