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As a mum looking for the best nutrition for her developing baby, you’ve probably heard of DHA. But what is it exactly? Why is it so important during pregnancy and lactation? Where can you get it? And how does it benefit your developing baby?

A healthy pregnancy starts with knowing more. Get off to a head start by learning about everything you need to know about DHA.

What Is DHA?

Before anything, let’s take a closer look at what DHA is.

DHA (docosahexaenoic acid) is a type of omega-3 fatty acid, a kind of fat that is important in dietary nutrition. It is one of the three types of omega-3 fatty acids, alongside ALA (alpha-linolenic acid) and EPA (eicosapentaenoic acid) 1,2 that play an important role in our diet — in particular, during pregnancy and lactation.

ALA is the parent fatty acid of the omega-3 family, and it mostly comes from plants. For your body to use it for something other than energy, it needs to be converted into EPA or DHA. But to get DHA, the body needs to convert ALA to EPA, then from EPA to DHA through another conversion process 1,3,4.

[Infographic: Conversion process of ALA to EPA then to finally DHA]

DHA is available through this conversion process or from its active form — in fish or food fortified with DHA 4.

So why is it important to consume food that is rich in DHA?

In general, the active form of DHA found in food is better than the converted form. This is because the conversion process of ALA to DHA is inefficient in humans. Most dietary ALA undergoes the oxidation process (splitting of the long ALA chains into smaller fragments) in the cells. And only a limited amount is converted to EPA and DHA 4.

Also, it has been shown that higher intake of ALA during pregnancy does not cause a significant rise in DHA in the blood 4 5.

Why Is DHA Important for Pregnant and Lactating Mums?

DHA is a critical component for the development of foetus’ cell membranes, particularly in the brain and retina 1 3. That’s why adequate consumption of DHA by women is important during pregnancy to ensure the proper development of your developing baby.

DHA supplementation is also associated with a number of benefits 6:

  • Lower incidence of preterm labour and delivery,

  • Lower risk of preeclampsia,

  • Increase in birth weight,

  • And reduction in postpartum depression incidences.

During pregnancy, DHA requirements are greater than normal in order to support foetal growth — especially in the third trimester 1 6. In the final stretch of your pregnancy, you can expect your body to increase maternal blood volume, and at the same time, there will be greater DHA requirements for both the placenta and your child 1 6 7.

As a result, pregnant women become depleted in DHA because the foetus utilises most of the available DHA for its nervous system development, obtaining about 67 mg of DHA from the mother every day 8. And because of this high requirement of DHA during pregnancy and lactation, maternal DHA stores often diminish to below pre-pregnancy levels 8.

It’s crucial for pregnant and lactating mothers to maintain the right level of DHA. Therefore, the Ministry of Health Malaysia suggests a DHA intake of 200mg/day for pregnant mothers in order to meet the DHA demands 9.

Why Is DHA Important for the Foetus?

Your child’s need for DHA is two-fold: for brain development as well as the development of the eyes 3 8.

DHA is an essential building block for foetal brain development particularly during the third trimester when the foetus’ brain undergoes a “brain growth spurt”, a period of rapid brain growth 3 8. To support this growth, brain accumulation of DHA starts as early as the second half of the gestation period 3 8.

DHA is also a vital component and the major fatty acids of the eyes. In fact, it comprises 93% of all omega-3 fatty acids in the retina. This suggests that DHA has an important role in eye health and visual development 2 3 8.

Where Do You Get DHA?

Mums can get DHA from various sources in their diet. Listed below are some dietary sources of DHA:

  • Fish (e.g. salmon, tuna, sardines, catfish, pollack,anchovies and herring) 10

  • Algae-derived marine oils 10

  • Eggs fortified with DHA

While fish are an important source of omega-3 fatty acids, there is also a potential danger. Some fish species may be contaminated with methyl mercury, polychlorinated biphenyls or other toxins that can be dangerous to the foetus’ brain development 1 10. These include shark, tilefish, king mackerel and swordfish.

The potential danger is easily managed. By limiting the intake of the fish mentioned above, and sticking to fish that are safe (tilapia, canned light tuna, anchovies, black sea bass, catfish among others) pregnant women can attain the benefits of DHA 12. In addition, the United States Food and Drug Administration (FDA) and Environmental Protection Agency (EPA) recommend limiting fish consumption to two servings (340g seafood) per week for pregnant women 1.

What Do the Experts Say About DHA?

Listed below are some of the expert recommendations on DHA intake in pregnant and lactating women:

  • The Ministry of Health Malaysia suggests a DHA intake of 200 mg/day for pregnant mothers9.

  • The Food and Agriculture Organization of the United Nations (FAO) recommends a minimum intake of 300mg EPA and DHA per day. At least 200mg/day should be DHA for pregnant and lactating adult women11.

  • The Perinatal Lipid Nutrition Project (PeriLip) and The Early Nutrition Programming Project (EARNEST) in collaboration with several international scientific societies suggest an intake of at least 200mg/day of DHA for pregnant and lactating women 3.

  • The European Food Safety Authority (EFSA) recommends an intake of 250mg of EPA plus DHA daily (of which 100 to 200mg should be DHA) 6.

How Do You Know if You Have Enough DHA in Your Diet?

In general, research has shown that the average daily intake of omega-3 fatty acids (ALA + EPA + DHA) among Malaysian adults is far from ideal 12.

Among pregnant Malaysian women, the mean intake of omega-3 was 0.24% kcal when the Recommended Nutrient Intake is 0.45% kcal 12. Unsatisfactory omega-3 nutrition was also reported in lactating women — 0.33% kcal as compared to the 0.50% kcal recommendation 12.

To correct this situation, a number of options are available for pregnant and lactating women: they can eat more fish according to the guidelines above, consume more food fortified with DHA, or take DHA supplements. You can compute for the amount of DHA in these sources by reading food labels and doing a little math for your serving size, just like counting calories.

If Mum Eats Fish, Does She Still Need DHA Supplements?

You may be wondering, if you can get DHA from food like fish, do you still need to take DHA supplements?

The FDA recommends that women who are pregnant and lactating consume two servings (340g of seafood) of fish per week 1 3 13. But even if you do that, you may not be getting the recommended levels of DHA. This is because the content of DHA varies among different fish species 14 15. In Malaysia, the most consumed fish are the Indian mackerel, anchovies and scad. These fish species contain low DHA levels compared to salmon, herring, shad or bluefin tuna 14 15.

As an alternative to getting DHA from the food you eat, DHA supplementation makes it easier to monitor your DHA intake to ensure that you are getting adequate DHA levels each day 16.

How Early Should You Start DHA Supplementation?

Because DHA is crucial throughout pregnancy and during lactation — especially for brain development — it is advisable that women take maternal nutritional supplements (e.g. DHA supplements) at the onset of pregnancy, or even before if you are planning to get pregnant 2 8. This is to ensure that they have adequate nutrition stores so that pregnancy can start in a healthy state while reducing pregnancy complications 8 17.

Knowing all this, you’re well on your way to a healthier pregnancy. A few changes in your diet or the addition of DHA supplements can ensure that your child’s brain development is on track, and they can get the very best start in life.

Article contributed by Dato’ Dr Siti Zaliha, Consultant Obstetrician & Gynaecologist

 

REFERENCES:

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http://nutrition.moh.gov.my/wp-content/uploads/2017/05/FA-Buku-RNI.pdf

10. World Health Organization. 2011. Available at
http://www.who.int/elena/titles/bbc/fish_oil_pregnancy/en/ Accessed on 28 May 2018.

11. Dietary Intakes of EPA and DHA Omega-3 Fatty Acids among US Childbearing-age and Pregnant Women: An Analysis of NHANES 2001-2014. April 2018. Accessed on 2 November 2020
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5946201/

12. Ng TKW, Nalliah S, Hamid A, Wong SR, Chee SL, Augustine CA. IeJSME. 2012;6(2):4-9.

13. BabyCenter. 2016. Available at
https://www.babycenter.com/pregnancy/diet-and-fitness/is-it-safe-to-eat-fish-if-im-pregnant-trying-to-get-pregnant_10319861

14. Wan Rosli WI, Rohana AJ, Gan SH, et al. International Food Research Journal 2012;19:815-821.

15. U.S. Department of Agriculture and U.S. Department of Health and Human Services. 2010. 7th Edition, Washington, DC: U.S. Government Printing Office.

16. Healthline. 2017. Available at
https://www.healthline.com/nutrition/how-much-omega-3.

17. Carvajal JA. BioMed Research International. 2014;2014:526895.