Randomized controlled trial of maternal omega-3 long-chain PUFA supplementation during pregnancy and early childhood development of attention, working memory, and inhibitory control

Background: Docosahexaenoic acid (DHA) accumulates in the hippocampus and frontal lobes of the fetal brain during the last trimester of pregnancy. These areas of the brain contribute to attention and working memory and inhibitory control (WMIC). Objective: We evaluated the effect of maternal omega-3 (n-3) long-chain polyunsaturated fatty acid supplementation in pregnancy on child attention and WMIC. Design: A total of 185 term-born children of mothers who were randomly allocated to consume 800 mg DHA/d (treatment) or a placebo (control) from similar to 20 wk of gestation until birth were assessed with multiple measures of attention and WMIC at a mean (+/- SD) of 27 +/- 2 mo. Primary outcomes were the average time it took to be distracted when playing with a toy (distractibility) and the accuracy of remembering a new hiding location while inhibiting a learned response to search in the previous location (WMIC). Results: Assessments were completed by 81 children in the treatment group (mean +/- SD age: 835 +/- 50.4 d) and 77 children in the control group (839 +/- 65.6 d). There was no effect of supplementation on primary outcomes [distractibility mean difference: -0.2 s (95% CI: -0.7, 0.4 s); WMIC mean difference: 8.9 mm (95% CI: -10.6, 28.3 mm)]. There was no difference between DHA-supplemented and control groups except that treatment- group children looked away from the toys fewer times than controls when presented with multiple toys competing for attention but less accurately remembered a repeated hiding location. These secondary effects were not consistent with any other outcomes and may have been a result of chance. Cord plasma DHA was not consistently associated with attention and WMIC. Conclusion: Maternal DHA supplementation during pregnancy does not enhance attention or WMIC in term- born preschoolers. The DHA for Maternal and Infant Outcomes trial was registered at www.anzctr.org.au as ACTRN1260500056906.