BACKGROUND Long-chain omega-3 fatty acids are thought to be crucial for optimal neurodevelopment in early life.

OBJECTIVES To investigate the effect of omega-3 supplementation during pregnancy and infancy on child cognitive and developmental outcomes.

METHODS We searched PubMed, Cochrane Library, EMBASE, and PsychInfo through May 2015 without language or publication year restrictions for randomized controlled trials (RCTs) of omega-3 supplementation (>3 months) i.e. docosahexanoic acid (DHA) and eicosapentaenoic acid (EPA), and quantitative measure of neurodevelopment or cognition. Full-text inclusion decisions and data extractions were performed independently and in duplicate. Our primary outcome was the standardized mean difference in Bayley Scales of Infant Development (BSID) score between intervention groups in RCTs. Other outcomes included the Weschler Intelligence Scale for Children, Weschler Preschool and Primary Scale of Intelligence, Kaufman Brief Intelligence Test, Kaufman Assessment Battery for Children, Peabody Picture Vocabulary Test, and other standardized measures.

RESULTS Among 571 abstracts, we identified 15 trials with 20 intervention arms involving 2,525 children. Trials used DHA + EPA (N=6 arms), DHA only (N=2), DHA + arachidonic acid (AA) (N=10), or DHA + EPA + AA (N=2); either prenatally (mean 20 weeks gestation; N=4 arms) or within the first few days of birth (N=16). Mean supplementation duration was 7.3 months; and age at outcome assessment, 16 months. In pooled analyses, both maternal and infant supplementation similarly improved neurodevelopment: standardized mean difference (SMD) in BSID= 0.21 (95% CI: 0.01, 0.41) and 0.24 (0.00, 0.48) respectively (Figure 1). Among BSID subscales, DHA and/or EPA raised the psychomotor developmental index (N=8 arms; SMD 0.40; 95% CI: 0.10, 0.70), while DHA + AA raised the mental developmental index (N=15 arms; SMD 0.17; 95% CI: 0.00, 0.35). Pooled findings for other outcomes will be presented.

CONCLUSION Omega-3 supplementation during either pregnancy or infancy improves child neurodevelopment. These findings indicate the importance of sufficient polyunsaturated fatty acid intake by pregnant women and young children.