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      Suplementación en gestantes con ácido docosahexaenoico y su efecto en los procesos cognitivos infantiles: revisión sistemática Translated title: Supplementation in pregnant women with docosahexaenoic acid and its effect on children’s cognitive processes: systematic review

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          Abstract

          RESUMEN Introducción El ácido docosahexaenoico (DHA) se deposita en regiones cerebrales e interviene en la funcionalidad neuronal. Debido a esta importante participación se considera medular en el desarrollo del sistema nervioso central. El objetivo fue analizar los resultados de estudios sobre la influencia de la suplementación con DHA en gestantes sobre los procesos cognitivos de sus hijos. Material y Métodos Revisión sistemática de ensayos controlados aleatorizados con suplementación con DHA en embarazadas considerando los lineamientos del grupo Cochrane. Se buscaron artículos en MEDLINE, EMBASE, Scopus y la Biblioteca Cochrane desde enero del 2003 a mayo 2018. Se eligieron estudios que compararon los efectos de la suplementación en embarazadas con los del placebo respecto a evaluaciones de los procesos cognitivos. Se evaluó el riesgo de sesgo de los mismos con la herramienta de colaboración Cochrane. Resultados Se hallaron 147 artículos científicos eligiéndose 10 que tuvieron como características metodológicas el ser de doble ciego aleatorizados. Los estudios involucraron 4.506 gestantes entre las 15 y 21 semanas y 2.045 niños. La suplementación se dio entre la semana quince y los tres meses después del parto. Los niños fueron evaluados desde el año y medio hasta los cuatro años. Se utilizaron seis instrumentos y dos baterías de ejecución para medir 19 procesos cognitivos. Solamente dos de los estudios reportaron diferencias significativas entre los sujetos del grupo control y experimental. Debido a la heterogeneidad entre los estudios en relación a los tamaños muestrales, las dosis y a la forma de medir la variable de interés no fue posible realizar metaanálisis. Conclusiones Resulta insuficiente la evidencia científica para afirmar o negar un efecto positivo de la suplementación temprana con DHA en los procesos cognitivos infantiles. La recomendación del uso de suplementos con DHA durante el período gestacional para favorecerlos no se encuentra justificada.

          Translated abstract

          ABSTRACT Introduction Docosahexaenoic acid (DHA) is deposited in brain regions involved in neuronal functionality. Due to this important participation, it is considered to be a key factor in the development of the central nervous system. The objective was to analyze the results of studies on the influence of DHA supplementation in pregnant women on the cognitive processes of their children. Material and Methods Systematic review of randomized controlled trials with DHA supplementation in pregnant women considering the guidelines of the Cochrane group. From January 2003 to May 2018 a search for scientific articles in MEDLINE, EMBASE, Scopus and the Cochrane Library was made. Studies were selected that compared the effects of supplementation in pregnant women with those of placebo with respect to evaluations of cognitive processes. The risk of bias was evaluated with the Cochrane collaboration tool. Results 147 scientific articles were found, choosing 10 that had as their methodological characteristics the double-blind randomized. The studies involved 4,506 pregnant women between 15 and 21 weeks and 2,045 children. Supplementation was given between week fifteen and three months after delivery. The age of the first evaluation varied between one and a half and four years. Six instruments and two execution batteries were used to measure 19 cognitive processes. Only two of the studies reported significant differences between the subjects of control and experimental group. Due to the heterogeneity between the studies in relation to the sample sizes, the doses and the way of measuring the variable of interest, it was not possible to perform a meta-analysis. Conclusions Scientific evidence is insufficient to affirm or deny a positive effect of early supplementation with DHA in children’s cognitive processes. The recommendation of the use of supplements with DHA during the gestational period to favor them is not justified.

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          Most cited references42

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          Omega-3 Polyunsaturated Fatty Acids and Their Health Benefits

          Omega-3 polyunsaturated fatty acids (PUFAs) include α-linolenic acid (ALA; 18:3 ω-3), stearidonic acid (SDA; 18:4 ω-3), eicosapentaenoic acid (EPA; 20:5 ω-3), docosapentaenoic acid (DPA; 22:5 ω-3), and docosahexaenoic acid (DHA; 22:6 ω-3). In the past few decades, many epidemiological studies have been conducted on the myriad health benefits of omega-3 PUFAs. In this review, we summarized the structural features, properties, dietary sources, metabolism, and bioavailability of omega-3 PUFAs and their effects on cardiovascular disease, diabetes, cancer, Alzheimer's disease, dementia, depression, visual and neurological development, and maternal and child health. Even though many health benefits of omega-3 PUFAs have been reported in the literature, there are also some controversies about their efficacy and certain benefits to human health.
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            Maternal seafood consumption in pregnancy and neurodevelopmental outcomes in childhood (ALSPAC study): an observational cohort study.

            Seafood is the predominant source of omega-3 fatty acids, which are essential for optimum neural development. However, in the USA, women are advised to limit their seafood intake during pregnancy to 340 g per week. We used the Avon Longitudinal Study of Parents and Children (ALSPAC) to assess the possible benefits and hazards to a child's development of different levels of maternal seafood intake during pregnancy. 11,875 pregnant women completed a food frequency questionnaire assessing seafood consumption at 32 weeks' gestation. Multivariable logistic regression models including 28 potential confounders assessing social disadvantage, perinatal, and dietary items were used to compare developmental, behavioural, and cognitive outcomes of the children from age 6 months to 8 years in women consuming none, some (1-340 g per week), and >340 g per week. After adjustment, maternal seafood intake during pregnancy of less than 340 g per week was associated with increased risk of their children being in the lowest quartile for verbal intelligence quotient (IQ) (no seafood consumption, odds ratio [OR] 1.48, 95% CI 1.16-1.90; some, 1.09, 0.92-1.29; overall trend, p=0.004), compared with mothers who consumed more than 340 g per week. Low maternal seafood intake was also associated with increased risk of suboptimum outcomes for prosocial behaviour, fine motor, communication, and social development scores. For each outcome measure, the lower the intake of seafood during pregnancy, the higher the risk of suboptimum developmental outcome. Maternal seafood consumption of less than 340 g per week in pregnancy did not protect children from adverse outcomes; rather, we recorded beneficial effects on child development with maternal seafood intakes of more than 340 g per week, suggesting that advice to limit seafood consumption could actually be detrimental. These results show that risks from the loss of nutrients were greater than the risks of harm from exposure to trace contaminants in 340 g seafood eaten weekly.
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              Effect of DHA supplementation during pregnancy on maternal depression and neurodevelopment of young children: a randomized controlled trial.

              Uncertainty about the benefits of dietary docosahexaenoic acid (DHA) for pregnant women and their children exists, despite international recommendations that pregnant women increase their DHA intakes. To determine whether increasing DHA during the last half of pregnancy will result in fewer women with high levels of depressive symptoms and enhance the neurodevelopmental outcome of their children. A double-blind, multicenter, randomized controlled trial (DHA to Optimize Mother Infant Outcome [DOMInO] trial) in 5 Australian maternity hospitals of 2399 women who were less than 21 weeks' gestation with singleton pregnancies and who were recruited between October 31, 2005, and January 11, 2008. Follow-up of children (n = 726) was completed December 16, 2009. Docosahexaenoic acid-rich fish oil capsules (providing 800 mg/d of DHA) or matched vegetable oil capsules without DHA from study entry to birth. High levels of depressive symptoms in mothers as indicated by a score of more than 12 on the Edinburgh Postnatal Depression Scale at 6 weeks or 6 months postpartum. Cognitive and language development in children as assessed by the Bayley Scales of Infant and Toddler Development, Third Edition, at 18 months. Of 2399 women enrolled, 96.7% completed the trial. The percentage of women with high levels of depressive symptoms during the first 6 months postpartum did not differ between the DHA and control groups (9.67% vs 11.19%; adjusted relative risk, 0.85; 95% confidence interval [CI], 0.70-1.02; P = .09). Mean cognitive composite scores (adjusted mean difference, 0.01; 95% CI, -1.36 to 1.37; P = .99) and mean language composite scores (adjusted mean difference, -1.42; 95% CI, -3.07 to 0.22; P = .09) of children in the DHA group did not differ from children in the control group. The use of DHA-rich fish oil capsules compared with vegetable oil capsules during pregnancy did not result in lower levels of postpartum depression in mothers or improved cognitive and language development in their offspring during early childhood. anzctr.org.au Identifier: ACTRN12605000569606.
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                Author and article information

                Journal
                renhyd
                Revista Española de Nutrición Humana y Dietética
                Rev Esp Nutr Hum Diet
                Academia Española de Nutrición y Dietética (Pamplona, Navarra, Spain )
                2173-1292
                2174-5145
                September 2019
                : 23
                : 3
                : 136-152
                Affiliations
                [1] Lima Lima orgnameUniversidad Católica Sedes Sapientiae orgdiv1Facultad de Ciencias de la Salud orgdiv2Departamento de Investigación Peru
                Article
                S2174-51452019000300003 S2174-5145(19)02300300003
                10.14306/renhyd.23.3.637
                7ab1bdbb-5f6a-4674-aed4-6a68c50ef545

                This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.

                History
                : 27 September 2019
                : 09 August 2018
                Page count
                Figures: 0, Tables: 0, Equations: 0, References: 62, Pages: 17
                Product

                SciELO Spain

                Categories
                Investigaciones

                Procesos Mentales,Review,Mental Processes,Pregnant Women,Infant Nutritional Physiological Phenomena,Fatty Acids,Revisión,Mujeres Embarazadas,Fenómenos Fisiológicos Nutricionales del Lactante,Ácidos Grasos

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