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Updated: Nov 20, 2025
Author Spotlight: Studying the Impact of Maternal Dietary Deficiencies on Long-Term Offspring Health Outcomes
Published on: June 28, 2024
Prenatal Nutritional Strategies to Reduce the Risk of Preterm Birth
Karen Patricia Best1,2, Judith Gomersall3,4, Maria Makrides3,5
1Women and Kids Theme, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia, karen.best@sahmri.com.
Insights
Nutritional interventions like omega-3 fatty acids may help prevent preterm birth (PTB). Supplementation is most effective for women with low omega-3 levels, reducing their risk of early PTB.
Area of Science:
- Obstetrics and Gynecology
- Nutritional Science
- Public Health
Background:
- Preterm birth (PTB) affects millions globally, with unclear underlying mechanisms.
- Nutritional interventions are explored for PTB prevention, targeting inflammation, oxidative stress, and muscle contractility.
- While some nutrients show promise, evidence is inconsistent, necessitating large trials.
Purpose of the Study:
- To evaluate the role of omega-3 long-chain polyunsaturated fatty acids (LCPUFAs) in preventing preterm birth.
- To investigate the impact of prenatal omega-3 supplementation based on individual omega-3 status.
Main Methods:
- Systematic review of randomized trials and analysis of large-scale trials like the Omega-3 to Reduce the Incidence of Prematurity (ORIP) trial.
- Examination of PTB and early PTB (EPTB) rates in relation to omega-3 supplementation and baseline omega-3 status.
Main Results:
- Prenatal omega-3 LCPUFA supplementation showed a reduced risk of PTB in a Cochrane Review.
- The ORIP trial indicated no reduction in EPTB, but a PTB reduction in singleton pregnancies.
- Exploratory analyses revealed that omega-3 supplementation benefited women with low baseline omega-3 status, while increasing EPTB risk in those with replete/high status.
Conclusions:
- Individualized omega-3 status assessment may optimize PTB prevention strategies.
- Targeted omega-3 supplementation could be a precise approach to reduce PTB risk in specific populations.
- Further research is needed to confirm the efficacy and optimal use of omega-3 LCPUFAs for PTB prevention.
Abstract:
Worldwide, around 15 million preterm babies are born annually, and despite intensive research, the specific mechanisms triggering preterm birth (PTB) remain unclear. Cost-effective primary prevention strategies to reduce PTB are required, and nutritional interventions offer a promising alternative. Nutrients contribute to a variety of mechanisms that are potentially important to preterm delivery, such as infection, inflammation, oxidative stress, and muscle contractility. Several observational studies have explored the association between dietary nutrients and/or dietary patterns and PTB, often with contrasting results. Randomized trial evidence on the effects of supplementation with zinc, multiple micronutrients (iron and folic acid), and vitamin D is promising; however, results are inconsistent, and many studies are not adequately powered for outcomes of PTB. Large-scale clinical trials with PTB as the primary outcome are needed before any firm conclusions can be drawn for these nutrients. The strongest evidence to date for a nutritional solution exists for omega-3 long-chain polyunsaturated fatty acids (LCPUFAs), key nutrients in fish. In 2018, a Cochrane Review (including 70 studies) showed that prenatal supplementation with omega-3 LCPUFAs reduced the risk of PTB and early PTB (EPTB) compared with no omega-3 supplementation. However, the largest trial of omega-3 supplementation in pregnancy, the Omega-3 to Reduce the Incidence of Prematurity (ORIP) trial (n = 5,544), showed no reduction in EPTB and a reduction in PTB only in a prespecified analysis of singleton pregnancies. Exploratory analyses from the ORIP trial found that women with low baseline total omega-3 status were at higher risk of EPTB, and that this risk was substantially reduced with omega-3 supplementation. In contrast, women with replete or high baseline total omega-3 status were already at low risk of EPTB and additional omega-3 supplementation increased the risk of EPTB compared to control. These findings suggest that determining an individual woman's PUFA status may be the most precise way to inform recommendations to reduce her risk of PTB.
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