Effect of DHA & Effect of DHA & GLA in pregnancyGLA in pregnancy

Essential fatty acid (EFA)Essential fatty acid (EFA)They are polyunsaturated fatty acid needed by the body for maintenance of optimal health.They cannot be synthesized by the human body and is therefore must be obtained from dietary source. (Indian J Pediatr 2005; 72 (3) : 239-242)

There are 2 types of EFA: Omega-3 fatty acid & Omega-6 fatty acid

Omega-3 fatty acid Omega-6 fatty acid

Alpha-linolenic acid (18:3) ALA

Ecosapatothenic acid (20:5)EPA

Docosapatothenic acid(22:5)DPA

Docosahexaenoic acid (22:6)DHA

Linoleic acid (18:2)LAGamma-linolenic acid

(18:3)GLADiho-gamma- linolenic

acid (20:3)DOGLAArchidonic acid (20:4) AA

Adrenic acid (22:4)Docosapatothenic acid

(22:5)DPA

Role of EFA in pregnancyRole of EFA in pregnancy

•Formation of healthy cell membranes

•Proper development and functioning of the brain and nervous system

•Production of hormone-like substances like prostaglandins

•Responsible for regulating blood pressure, blood viscosity, vasoconstriction, immune and inflammatory responses.

Docosahexaenoic acid (DHA)Docosahexaenoic acid (DHA)

DHA is a carboxylic acid with a 22- carbon chain & 6 cis double bonds (C22H32O2)

•DHA is predominant component of brain•It is found in all tissues most abundant in neural, retinal & CV conducting tissue.•It facilitates synaptic transmission & supports myelination•It influences the speed that information is acquired & processed (Canad J Psychiatry 2003:48: 195-203)

DHA and its Psycho-motor functions

Vision 60% of PUFA in retina is DHA

Cognitive functions like Learning & memory, Language coordination, Problem solving

40% of PUFA in brain is DHA

DHA is important throughout lifeDHA is important throughout life

DHA in pregnancy:

(Early Human Dev 1980, 4: 121-129)•Pregnancy fetus depends upon maternal sources of DHA from lipid Stores, maternal diet & nutritional supplements.•Placenta selectively transports DHA from mother to fetus•During third trimester accretion of DHA in fetus liver, brain and retina at the rate of 0.59g/day

Indian J Pediatr 2005; 72(3) : 239-242)•Pregnant women must take adequate amount of DHA in their diet through nutritional supplements in order to optimize their own health & also the health & mental development of their offspring's.

(Pediatrics 2003:111 (1) : e39-44, Am J Clin Nutr 2001; 73 : 316-322)•DHA supplementation in mother increases the mental performance of their children

(Obselet Gynecol 2003; 101 (3): 469-479)•DHA supplementation increases the duration of gestation & birth weights during pregnancy

(J Epidemiol Comm Hlth 1993; 47 (6) : 436-440) •DHA supplementation enhances Uteroplacental perfusion, oxygen delivery, vasodilatation and thinning of blood in pregnant women & reduces the risk of toxemia in pregnant women

Health benefits of DHA supplementation Health benefits of DHA supplementation in pregnancyin pregnancy

RecommendationsRecommendationsHealth and Welfare Canada 1990: omega-3 fatty acid (ALA) 0.5% of total energy

Food and Nutrition Board, USA, 2002 adequate Intakes (AI) for Omega-3 Fatty Acids

10% AI from DHA+EPA

Life Stages Age Males (g/day) Females (g/day)

Infants 0-6 months

0.5 0.5

Infants 7-12 months

0.5 0.5

Children 1-3 yrs 0.7 0.7

Children 4-8 yrs 0.9 0.9

Children 9-13 yrs 1.2 1.2

Children 14-18 yrs 1.6 1.1

Adults 19 yrs & older

1.6 1.1

Pregnancy All ages - 1.4

Breastfeeding

All ages - 1.3

National Institutes of Health (NIH) 1999 (DHA) 0.35 % by weight of daily total fat

WHO & FAO pregnancy (AI)

2.6 g omega-3 fatty acid & 100-300 mg DHA daily (Prostaglandin Leukot Essent Fatty Acid 2000; 63: 119-121)

RecommendationsRecommendations

Adult 0.1% of total energy (2000 Kcal/day)

Young children (3 years)

150 mg/day

Pregnancy 300 mg/day

Lactation 300 mg/day

DHA supplementationDHA supplementation

•Major sources of DHA are animal sources such as fish but they contain traces of contaminants.

•Vegetarian diets are poor sources of DHA (Prostaglandins, Leukotrienes and essential Fatty Acids, 81, (2),137-141)

•Most of the DHA is destroyed while cooking

•Pregnant woman can ensure adequate intake of DHA by adding to their diet a nutritional supplement that contains DHA.

Gamma lenolenic acid (GLA)Gamma lenolenic acid (GLA)GLA is a carboxylic acid with a 18- carbon chain & 3 cis double bonds (C18H30O2)

Importance of GLA in pregnancy

(J. Clin. Endocrinol. 1975, Meta., 40, 108-115)•Plasma angiotensin II (AII) concentration rise from early in gestation

(Am. J. Obset. Gynec., 1961, 82, 246-251, ; 1965, 91, 837-842 )•Vascular reactivity to AII is reduced in pregnancy

(Br. J. Clin. Pharmac. 1985, 19, 335-342)•This is due to higher circulating level of vasodilator prostaglandin found in the body

(Am. J. Obstet. Gynec., 1968, 100, 218-221,; J. Clin. Invest., 1973, 52, 2682-2689)•In pregnancy induced hypertension (PIH) , vascular sensitivity to AII becomes greater

(Prostaglandins, 1980, 20, 105-110,; Prostaglandins Medicine, 1979, 3, 223-234,; Lancet,1980, ii, 702)•In PIH there is a diminished vascular capacity to synthesize prostaglandin (Br. J. Clin. Pharmac. 1985, 19, 335-342)•Dietary supplementation with lenolenic acid, GLA for prostaglandin production is associated with a diminution in pressor response to AII

(Br. J. Clin. Pharmac. 1985, 19, 335-342)•GLA supplementation helps in prevention of PIH

GLA Supplementation during pregnancy FDA has not developed any RDA for GLA (Br. J. Clin. Pharmac. 1985, 19, 335-342) Dietary supplementation with 32mg of GLA for a week is associated with diminution in pressor response to AII in pregnant women

Dietary GLA supplementationDietary GLA supplementation

( J. Nutr, 1998, 128: 1411-1414) •GLA supplementation is needed when there is a reduced capacity of LA conversion to GLA in the body

(Eur. J. Clin. Nutr, 1997, 51: 619-624,; Gamma-linolenic acid. Rev. Contemp. Physiol, 1990, 1: 1-41,; Ann. Intern. Med. 1993, 119: 897-873)•This can be due to some patho physiological/physiological states like diabetes, cardiovascular disease etc

•Dietary GLA have superior biopotancy compared to LA

( J. Nutr, 1998, 128: 1411-1414) •Most of the time after GLA supplementation DGLA accumulates in the body instead of AA

( J. Nutr, 1998, 128: 1411-1414) •The increased level of DGLA attenuates the biosynthesis of AA metabolites (series 2 prostaglandin) which is a pro inflammatory prostaglandin

( J. Nutr, 1998, 128: 1411-1414) •GLA bypasses a key regulatory rate limiting enzymatic step (delta 6 desaturase) that controls the PUFA (n-6 series) production.

(Atherioscler. Thromb. Vasc. Biol. 1995. 15: 1397-1403,; Atheritis Rheum. 1996, 39: 1808-1817) •Metabolites of GLA elongation product, DGLA exert clinical efficacy in a variety of diseases including suppression of chronic inflammation, vasodialation and lowering blood pressure

GLA metabolismGLA metabolism

(J Nutr 128: 1411-1414, 1998) LA is converted into GLA (delta 6 desaturase enzyme)

GLA is elongated into DGLA

DGLA is converted into AA (delta 5 saturase enzyme)

DGLA produces prostaglandin-1 series which are anti-inflammatory DGLA produces 15-(S)-hydroxy-S,11, 13 eicosatrienoic acid which controls the production of AA metabolite which are proinflammatory