Marie Louise Østerdal

Duration of pregnancy in relation to fish oil supplementation and habitual fish intake: a randomised clinical trial with fish oil

Objective:To examine the effect of fish oil supplementation on duration of pregnancy, conditional on the womans habitual fish intake.Design:Multicentre 1:1 randomised clinical trial of effect of fish oil in a high-risk population of pregnant women in whom habitual fish intake was assessed at randomisation.Setting:Nineteen university delivery wards in seven European countries.Subjects:Pregnant women with preterm delivery, intrauterine growth retardation (IUGR), or pregnancy-induced hypertension (PIH) in a previous pregnancy (group 1, n=495); with twin pregnancies (group 2, n=367); or with suspicion of IUGR or threatening preeclampsia in the current pregnancy (group 3, n=106). Women were stratified into low, middle, or high fish consumers.Methods:The intervention group received fish oil capsules providing 2.7 g long-chain n-3 fatty acids per day (n-3 poly unsaturated fatty acids (PUFA)) from around week 20 (groups 1 and 2) or 6.3 g n-3 PUFA from week 33 (group 3). The control regimen was capsules with olive oil. Effect on timing of spontaneous delivery was examined by Cox regression, assuming elective delivery (occurring in 40%) as a censoring event. Analyses of effect of fish oil were intention to treat, and all analyses were adjusted for maternal smoking, age, and parity.Results:In group 1, fish oil reduced the hazard rate of spontaneous delivery (HR) by 44% (95% confidence interval 14–64%) and 39% (16–56%) in low and middle fish consumers, respectively, with no detectable effect (−56 to 33%) in high fish consumers. In groups 2 and 3, no significant effect of fish oil was detected in any of the sub-strata defined by baseline fish consumption.Conclusions:In pregnant women with previous pregnancy complications, fish oil supplementation delayed onset of delivery in low and middle, but not in high, fish consumers.Sponsorship:March of Dimes Birth Defects Foundation, Concerted Action (ERB-BMH1-CT92-1906) and PECO (ERB-CIPD-CT94-0235) programmes of the European Commission, and the Danish National Research Foundation. Lube Ltd donated the oil capsules.

Association between a Mediterranean-type diet and risk of preterm birth among Danish women: a prospective cohort study.

Background. Thus far, few factors with a causal relation to preterm birth have been identified. Many studies have focused on the womans diet, but most have been discouraging. The aim of the present study was to examine if maternal intake of a Mediterranean‐type diet (MD) is associated with reduced risk of preterm birth. Methods. The Danish National Birth Cohort assessed diet in mid‐pregnancy by food frequency questionnaires (FFQ). Women consuming MD were those who ate fish twice a week or more, used olive or rape seed oil, consumed 5+ fruits and vegetables a day, ate meat (other than poultry and fish) at most twice a week, and drank at most 2 cups of coffee a day. Results. Of 35,530 non‐smoking women, 1,137 (3.2%) fulfilled all MD criteria, and 540 (1.5%) none. Odds ratios for preterm birth and early preterm birth were 0.61 (95% Confidence Interval (CI): 0.35–1.05) and 0.28 (0.11–0.76), respectively, in MD women compared to women fulfilling none of the MD criteria. Conclusion. Shifting towards a MD during pregnancy may reduce the risk of early delivery in Danish women.

Mediterranean-type diet and risk of preterm birth among women in the Norwegian Mother and Child Cohort Study (MoBa) : a prospective cohort study

Background. Mediterranean diet has been shown to reduce the incidence of preterm birth. We wanted to investigate whether a Mediterranean‐type diet (MD) could be associated with a lower risk of preterm birth in the Norwegian Mother and Child Cohort Study (MoBa). Methods. The data collection was conducted as part of MoBa at the Norwegian Institute of Public Health. In MoBa, women answer a Food Frequency Questionnaire (FFQ) at week 18–22 of pregnancy. The MD criteria were intake of fish ≥2 times a week, fruit and vegetables ≥5 times a day, use of olive/canola oil, red meat intake ≤ times 2 a week, and ≤2 cups of coffee a day. Results. A total of 569 women (2.2%) met the MD criteria, 25,397 women (97.2%) met 1–4 criteria, and 159 women (0.01%) met none of the MD criteria. The number of preterm births in the MD group was 26 (4.6%), in those who met 1–4 criteria it was 1,148 (4.5%), and in those who met none of the criteria it was 10 (6.3%). The women who met the MD criteria did not have reduced risk of preterm birth compared with women meeting none of the MD criteria (OR: 0.73; 95% CI: 0.32, 1.68). Intake of fish twice or more a week was associated with a lower risk of preterm birth (OR: 0.84; 95% CI: 0.74, 0.95). Conclusions. The women who fulfilled the criteria of a MD did not have a reduced risk of preterm birth.

Does leisure time physical activity in early pregnancy protect against pre‐eclampsia? Prospective cohort in Danish women

Objective  To examine the association between physical activity in early pregnancy and risk of pre‐eclampsia.

Intake of vitamin C and E in pregnancy and risk of pre‐eclampsia: prospective study among 57 346 women

Objective  It has been suggested that vitamin C, alone or in combination with vitamin E, may protect against pre‐eclampsia, whereas the safety of high‐dose vitamin E supplements has been questioned. We investigated dietary intakes of vitamins C and E to see if they correlated with the incidence of pre‐eclampsia.

General obstetrics: Fish oil in various doses or flax oil in pregnancy and timing of spontaneous delivery: a randomised controlled trial

Objectives  To test the earlier suggested hypothesis that intake of long‐chain n‐3 fatty acids from fish oil may delay the timing of spontaneous delivery and to test if alpha‐linolenic acid, provided as flax oil capsules, shows the same effect.

Leisure-time physical activity in pregnancy and risk of postpartum depression: a prospective study in a large national birth cohort.

OBJECTIVE To explore the association between physical activity during pregnancy and postpartum depression (PPD) in a large, prospective cohort. METHOD Exposure information from the Danish National Birth Cohort, a large, prospective cohort with information on more than 100,000 pregnancies (1996-2002), was linked to the Danish Psychiatric Central Register and the Danish Register for Medicinal Product Statistics for data on clinically identified cases of depression up to 1 year postpartum. A total of 70,866 women from the Danish National Birth Cohort were included in the analyses. Duration, frequency, and type of physical activity were assessed by a telephone interview at approximately week 12 of gestation. Admission to hospital due to depression (PPD-admission) and prescription of an antidepressant (PPD-prescription) were treated as separate outcomes. RESULTS Through linkage to national registers, we identified 157 cases of PPD-admission and 1,305 cases of PPD-prescription. Women engaging in vigorous physical activity during pregnancy had a lower risk of PPD-prescription compared to women who were not physically active (adjusted odds ratio, 0.81; 95% CI, 0.66-0.99). No association was observed between physical activity and PPD-admission; but, in women who were underweight prior to pregnancy, physical activity was associated with increased risk of PPD-admission. CONCLUSIONS Our data are compatible with a protective effect of vigorous physical activity, but not for other measures of physical activity, against postpartum depression requiring antidepressant therapy. No protective effect could be detected on PPD leading to hospitalization.