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Omega-3 fatty acid addition in pregnancy to reduce the risk of preterm birth

        1. Omega-3 fatty acid addition in pregnancy to reduce the risk of preterm birth

First published: July 2019
The RACGP gratefully acknowledges the contribution of Philippa Middleton, South Australian Health and Medical Research Institute, Adelaide, to the development of this intervention.


Omega-3 LCPUFA supplementation in pregnancy.


Women with singleton pregnancies from 12 weeks of pregnancy to reduce the risk of a preterm birth (<37 weeks) and early preterm birth (<34 weeks)


Omega-3 long chain polyunsaturated fatty acid (LCPUFA), also known as docosahexaenoic acid (DHA) and eicosapentaenoic acid (EPA), are most commonly found in fish and fish oils. Only 10% of Australian women of childbearing age meet the recommended dietary DHA intake.

Of all pregnancy complications, preterm birth (<37 weeks) has the highest burden in terms of mortality and morbidity. There are about 15 million preterm births worldwide per year. Preterm births account for 85% of all perinatal complications and death and is the leading cause of death in children aged <5 years.


May increase risk of prolonged gestation although there was no difference in induction rate for post-term labour in the Cochrane review.


Use a supplement with at least 500 mg DHA/day. The supplement does not need to be more than 1000 mg DHA plus EPA overall – higher doses do not appear to provide extra benefit. There is no need to continue supplementation after the birth.

Tips and Challenges

The doses of omega-3s tested are difficult to achieve through dietary sources alone

Most prenatal supplements do not contain enough omega-3s to reach the required amount to prevent preterm birth.

Currently available omega-3 supplements that contain the doses suggested by the review cost approximately $25 for a 60-day supply (about 40c per day).

Algal oil supplements are an alternative to fish oil supplements for vegetarians.

The quality of fish oil supplements has been raised as an issue for consumers. A 2015 study from the University of Auckland and the University of Newcastle found that only 3 out of 32 fish oil supplements contained EPA and DHA levels equal or higher than labelled. The best-before date, cost and country of origin were not indications of a supplement’s quality.

It is difficult to provide guidance on this other than to advise consumers:

  • to check the use-by date of supplements

  • not to consume the supplements if they smell odd

  • to store supplements in a cool, dark place.


NHMRC Level 1 evidence.

South Australian Health & Medical Research Institute (SAHMRI). Taking omega-3s to give your baby a great start in life.

  1. Middleton P, Gomersall JC, Gould JF, et al. Omega-3 fatty acid addition during pregnancy. Cochrane Database of Systematic Reviews 2018, Issue 11. Art. No.: CD003402. DOI: 10.1002/14651858.CD003402.pub3
  2. South Australian Health & Medical Research Institute (SAHMRI). Information for health care professionals. Omega-3 long-chain fats to prevent pre-term birth.
  3. Choice. Omega-3 supplements.
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