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Omega-3 long chain polyunsaturated fatty acids to prevent preterm birth: a systematic review and meta-analysis
Gabriele Saccone1, Vincenzo Berghella
1Department of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine, University of Naples Federico II, Naples, Italy; and the Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, Pennsylvania.
Insights
Omega-3 supplementation during pregnancy did not significantly reduce preterm birth rates. This review found no improvement in neonatal outcomes for women taking omega-3 supplements.
Area of Science:
- Obstetrics and Gynecology
- Nutritional Science
- Perinatal Medicine
Background:
- Preterm birth remains a leading cause of neonatal morbidity and mortality worldwide.
- Omega-3 fatty acids are proposed to have anti-inflammatory properties that may prevent preterm birth.
Purpose of the Study:
- To evaluate the efficacy of omega-3 supplementation in reducing the incidence of preterm birth and improving neonatal outcomes.
Main Methods:
- A systematic review and meta-analysis of randomized controlled trials (RCTs) was conducted.
- Searches included major databases (MEDLINE, EMBASE, Cochrane) for RCTs comparing omega-3 supplementation to placebo or no treatment in asymptomatic singleton pregnancies.
- Nine RCTs involving 3,854 women met the inclusion criteria.
Main Results:
- Omega-3 supplementation did not significantly reduce the rate of preterm birth before 37 weeks (7.7% vs. 9.1%).
- No significant differences were observed in birth weight, NICU admission, necrotizing enterocolitis, sepsis, or perinatal death.
- A potential reduction in perinatal death was noted in subgroups receiving omega-3 before 21 weeks gestation or in trials with low risk of bias, though this was not a primary outcome.
Conclusions:
- Omega-3 supplementation during pregnancy does not appear to reduce the incidence of preterm birth.
- Current evidence does not support the use of omega-3 for improving overall neonatal outcomes in unselected pregnant populations.
Objective:
To evaluate the efficacy of omega-3 in reducing the incidence of preterm birth.
Data Sources:
Searches were performed in MEDLINE, OVID, Scopus, ClinicalTrials.gov, the PROSPERO International Prospective Register of Systematic Reviews, EMBASE, and the Cochrane Central Register of Controlled Trials with the use of a combination of keywords related to "fish oil," "pregnancy," and "omega-3."
Methods Of Study Selection:
We included all randomized controlled trials of asymptomatic women with singleton gestations who were randomized to prophylactic treatment with either omega-3 supplementation or control (either placebo or no treatment). Exclusion criteria included trials in women with multiple gestations, intrauterine growth restriction, gestational hypertension or preeclampsia at randomization, prior preterm birth, and trials with polyunsaturated fatty acids as control.
Tabulation, Integration, And Results:
Nine randomized trials including 3,854 eligible women were identified. Women who received omega-3 had a similar rate of preterm birth before 37 weeks of gestation compared with women in the control group (7.7% compared with 9.1%, respectively; relative risk 0.90, 95% confidence interval [CI] 0.72-1.11). There were no significant differences in birth weight, neonatal intensive care unit admission, necrotizing enterocolitis, sepsis, or perinatal death in the omega-3 compared with control groups, respectively. There were no significant differences in the subgroup analyses, except for the rate of perinatal death, which was lower (0.3% compared with 1.2%; relative risk 0.27, 95% CI 0.09-0.80) in the women who received omega-3 before 21 weeks of gestation and in trials with low risk of bias (0.3% compared with 1.0%; relative risk 0.28, 95% CI 0.09-0.89) compared with women in the control group. However, in no randomized controlled trial was perinatal death the primary outcome.
Conclusion:
Omega-3 supplementation during pregnancy does not reduce the incidence of preterm birth or improve neonatal outcome.
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