When it comes to supporting your baby’s brain development, few nutrients get as much attention as DHA, an essential omega-3 fatty acid. In this episode, we answer a listener’s questions about omega-3s during pregnancy. Learn how much you need, where to get them, and whether a supplement is necessary. Get a breakdown of the difference between ALA, EPA, and DHA, and why the ratio between omega-3 and omega-6 is important. If you consider supplementing your diet with omega-3s, learn what to look for in a high-quality supplement and how to reduce the risks of toxins like PCBs and heavy metals.

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Hi Vanessa,

Thank you so much for all the work you do on the Pregnancy Podcast. I have learned so much from your episodes.

I’m currently 22 weeks pregnant, and I keep hearing about how important omega-3s are, especially DHA, for my baby’s brain development. I’m trying to eat healthy and take a good prenatal vitamin, but I’m not sure if I’m getting enough omega-3s through my diet or if I should be taking a separate supplement.

Can you talk about how much omega-3s pregnant women actually need and what the benefits are? Is it better to get them from food or a supplement? Also, I’ve heard some concerns about mercury in fish and other risks with fish oil. Should I be worried about that?

I want to make sure I’m doing the best thing for my baby’s development, but there’s a lot of conflicting information out there. Any guidance would be appreciated!

Thank you,

Lila

Hi Lila, thank you for your email and for sharing your questions. Anytime you dive into supplements and nutrition, there is always a lot of conflicting information. It can be difficult to sort through recommendations and safety during pregnancy. Let’s discuss omega-3s and the role they play during pregnancy and talk about whether you should consider taking a supplement.

Why Are Omega-3s Important in Pregnancy?

Omega-3s are a type of polyunsaturated fat known as essential fatty acids. Your body cannot produce them on its own, and you must obtain them through your diet or supplements. These fats play a critical role in overall health. Especially during pregnancy, because they contribute to both your well-being and your baby’s development.

A Cochrane review found that pregnant women taking omega-3s reduced the risk of preterm birth, had a reduced risk of a baby with a low birth weight, and a possibly reduced risk of perinatal death and of neonatal care admission. There is evidence to suggest omega-3s have significant beneficial effects on both pregnant and postpartum depression. There is data to show maternal intake of omerga-3s  is linked to a lower risk of developmental delays in problem-solving at 6 months, and in both fine motor skills and problem-solving at 12 months. DHA is also important after you have your baby, during breastfeeding. Research shows that DHA supplementation during breastfeeding influences the fatty acids in breast milk that are essential for brain development.

Omega Fatty Acids

While omega-3s are especially important during pregnancy, they are part of a broader group of fats that includes omega-6 and omega-9 fatty acids.

Omega-9 fatty acids are not essential because your body can synthesize them from other unsaturated fats. Foods such as olive oil, avocados, and nuts, contain Omega-9s and are generally heart-healthy and anti-inflammatory.

Omega-6 fatty acids are essential and are in many vegetable oils, nuts, and seeds. These play a crucial role in brain function and skin health. However, the average Western diet contains too much omega-6. This is largely due to the high consumption of processed foods and oils rich in linoleic acid, such as corn, soybean, safflower, cottonseed, and sunflower. Excessive intake of omega-6s, especially in the absence of adequate omega-3s, can promote inflammation. A major concern is the imbalance in the ratio of omega-6 to omega-3 intake. In the United States, the typical ratio ranges from 10:1 to 25:1. A healthier ratio would be closer to 4:1 or even 1:1. Since omega-3s have anti-inflammatory properties, they also help counteract the effects of too much omega-6.

To improve your balance of omega fatty acids, focus on consuming healthy whole foods and limiting processed foods and vegetable oils that are high in omega-6s. You can also increase your intake of omega-3-rich foods or take a supplement.

Types of Omega-3s

There are three main types of omega-3s. ALA (alpha-linolenic acid) is in plant-based sources like flaxseeds, chia seeds, walnuts, and vegetable oils. DHA (docosahexaenoic acid) is in fatty fish. It is a major structural fat in the brain and eyes. DHA makes up about 97% of the omega-3 fats in the brain and 93% in the retina. EPA (eicosapentaenoic acid) is also in fatty fish such as salmon, sardines, and mackerel. EPA supports heart health and works with DHA in anti-inflammatory processes.

DHA is the most critical omega-3 during pregnancy because of its essential role in fetal brain and eye development. While plant-based omega-3s like ALA are beneficial, your body has a limited ability to convert ALA into the more biologically active forms EPA and DHA. On average, we convert only a small percentage of ALA into EPA. As low as 0.2% in some cases and even less into DHA. Further, an imbalance in the ratio of omega-3s to omega-6s can interfere with the body’s ability to convert ALA into EPA and DHA. Because of this low conversion rate, it is especially important during pregnancy to get enough EPA and DHA from direct sources like fish or supplements.

How Much Omega-3 Do You Need?

There is no universal recommended daily allowance for omega-3s. The National Academy of Medicine states that adequate intake for pregnant women is 1.4 g of ALA, but no specific recommendations for DHA and EPA. The American College of Obstetricians and Gynecologists acknowledges that omega-3s may be important for brain development before and after birth, but do not make any specific recommendation as to daily intake. Most literature suggests consuming at least 500–1000 mg of combined omega-3s (DHA + EPA), with at least 200–300 mg of DHA.

Food Sources of Omega-3s

Ideally, you get all of the nutrients you need from your diet. You can see the omega-3 content of common foods here. The most significant source of DHA is fish, but there are also other sources of omega-3 fatty acids. You can buy eggs that contain omega-3s. Hens that produce these eggs eat a diet enriched with flaxseeds, fish oil, or algae. Pasture-raised hens are higher in omega-3s. If a label states an egg has 225 mg of omega-3s, only a small portion may be DHA; the rest is often ALA. Chicken and beef are not a significant source of DHA but do contain a small amount of omega-3s. Grass-fed beef is higher in omega-3s and has a better omega-6 to omega-3 ratio compared to conventional beef.

Eating Fish During Pregnancy

ACOG recommends 2-3 servings (8-12 ounces in total) of fish per week. They recommend a maximum of six ounces of albacore tuna (commonly canned tuna), avoiding fish with the highest levels of mercury, as well as raw or undercooked fish. The dilemma is that it is nearly impossible to get enough omega-3s, specifically DHA, while limiting your fish intake to 12 ounces per week.

The primary risk of mercury is that it affects the development and function of the brain and nervous system, and is associated with developmental problems and lower IQs in highly exposed children. There are four fish that are high in mercury to avoid. Those are tilefish from the Gulf of Mexico, swordfish, shark, and king mackerel. Beyond that, research shows that higher levels of fish consumption are not associated with impaired neurodevelopment.

A study of 11,875 pregnant women found that maternal seafood consumption of less than 12 oz. (340 g) per week in pregnancy did not protect children from adverse outcomes. They found beneficial effects on child development with maternal seafood intakes of more than 12 oz. per week, suggesting that advice to limit seafood consumption could actually be detrimental. They concluded that the risks from the loss of nutrients were greater than the risks of harm from exposure to trace contaminants. Ultimately, how much fish you consume is up to you and what you are comfortable with. The bottom line is that there is some controversy over how much fish you should be consuming.

Should You Take a Supplement?

Evidence supports the benefits of DHA during pregnancy and the safety of supplementation. If you are not eating fish several times per week, it is worth considering taking an omega-3 supplement. This is a relatively inexpensive and easy intervention with significant benefits for your health and the health and development of your baby.

Tips for Choosing the Right Supplement

The primary sources of DHA are fish and algae. My favorite prenatal vitamin (Zahler Prenatal +DHA) contains DHA, so you can knock out your prenatal vitamin and DHA in one supplement. Very few prenatal vitamins include DHA.

If you are looking for a separate DHA supplement, it’s worth seeking out a high-quality brand rather than simply choosing the cheapest option. Like any supplement, not all DHA supplements are equal. There are concerns about contamination with PCBs (polychlorinated biphenyls) and heavy metals. For this reason, ensure the brand you choose is third-party tested. Algae-based DHA supplements are a great option for vegetarians or individuals who would like to avoid fish.

If you’re looking for a straightforward recommendation, here’s my top choice for an omega-3 supplement, based on quality, third-party testing, and affordability.

Minimizing Side Effects

Potential side effects of fish oil include burping, indigestion, acid reflux, or heartburn. If you experience nausea, try taking it with a meal rather than on an empty stomach. If you are experiencing burping up fish oil or acid reflux, consider freezing the capsules before taking them or splitting your daily dose of fish oil into two separate doses throughout the day.

The chemical structure of omega-3s makes them prone to oxidation, which degrades the oil and can reduce its effectiveness and safety. Oxidation occurs when omega-3s are repeatedly exposed to oxygen, heat, or light. You can opt for a brand that tests for oxidation. Store omega-3 supplements in a cool, dark place, and refrigerate them after opening, if the label indicates this is necessary.

Talking to Your Doctor or Midwife

Always talk to your care provider before taking any supplement during pregnancy. You may also consider testing your omega-3 levels. You can test your omega-3 levels through your care provider or with an at-home Omega-3 Index test, which measures the percentage of omega-3 fatty acids in your red blood cells. In the U.S. and other Western countries, the average Omega-3 Index is around 4%, while research suggests that an ideal range is between 8% and 11%. If your levels are low, supplementing with omega-3s can help you reach a more optimal range. If you have questions about omega-3s or DHA, discuss them with your doctor or midwife.

Additional Resources

• Eating Fish During Pregnancy

• Omega 3 and Fish Oil Supplements During Pregnancy

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