High Dose DHA in Pregnancy Might Reduce Risk of Early Preterm Birth

It was a randomized, multicentre, double-blind, adaptive-design, superiority trial of 1032 women with singleton pregnancies and 12 to 20 weeks gestation. They were randomly assigned to receive either high dose DHA (1000mg; n=540) or low dose DHA (200 mg; n=492). The planned adaptive design periodically generated allocation ratios favoring the better performing dose. The major outcome assessed was EPB by dose and by enrolment DHA status (low/high). The researchers determined Bayesian posterior probabilities (pp) for planned efficacy and safety outcomes using intention-to-treat.

Key findings of the study were:

• Upon analysis, the researchers found that higher dose had a lower EPB rate [1.7% (9/540) vs 2.4% (12/492)] especially if participants had low DHA status at enrolment [2.0% (5/249) vs 4.1%, (9/219)].
• They noted that the participants with high enrolment DHA status did not realize a dose-effect [1000 mg: 1.4% (4/289); 200 mg: 1.1%].
• They further found that the higher dose was associated with fewer serious adverse events (maternal: chorioamnionitis, premature rupture of membranes and pyelonephritis; neonatal: feeding, genitourinary and neurologic problems, all pp>0.90).

The authors concluded, "Clinicians could consider prescribing 1000 mg DHA daily during pregnancy to reduce EPB in women with low DHA status if they are able to screen for DHA."

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DOI: https://doi.org/10.1016/j.eclinm.2021.100905