Plasma Concentrations of Long Chain N-3 Fatty Acids in Early and Mid-Pregnancy and Risk of Early Preterm Birth

S. F. Olsen, T. I. Halldorsson, A. L. Thorne-Lyman, M. Strøm, S. Gørtz, C. Granstrøm, P. H. Nielsen, J. Wohlfahrt, J. A. Lykke, J. Langhoff-Roos, A. S. Cohen, J. D. Furtado, E. L. Giovannucci, W. Zhou

Research output: Contribution to journalArticlepeer-review

48 Citations (Scopus)


Background: Fish oil supplementation has been shown to delay spontaneous delivery, but the levels and clinical
significance remain uncertain. We examined the association between plasma fatty acids quantified in pregnancy
and subsequent risk of early preterm birth.
Methods: In a case-control design nested in the Danish National Birth Cohort, we identified 376 early preterm
cases (acid plus docosahexaenoic acid (EPA+DHA% of total fatty acids), were measured twice in pregnancy, at gestation
weeks 9 and 25 (medians). Odds ratios and 95% confidence intervals (CI's) for associations between EPA+DHA
and early preterm risk were estimated by logistic regression, adjusted for the woman's age, height, pre-pregnancy BMI, parity, smoking, and socioeconomic factors. Hypotheses and analytical plan were defined and archived a priori.
Findings: Analysis using restricted cubic splines of the mean of 1st and 2nd sample measurements showed a
strong and significant non-linear association (p < 0.0001) in which the risk of early preterm birth steeply increased when EPA+DHA concentrations were lower than 2% and flattened out at higher levels. Women in the
lowest quintile (EPA+DHA < 1.6%) had 10.27 times (95% confidence interval 6.80–15.79, p < 0.0001) increased
risk, and women in the second lowest quintile had 2.86 (95% CI 1.79–4.59, p < 0.0001) times increased risk,
when compared to women in the three aggregated highest quintiles (EPA+DHA ≥ 1.8%).
Interpretation: Low plasma concentration of EPA and DHA during pregnancy is a strong risk factor for subsequent
early preterm birth in Danish women.
Original languageEnglish
Pages (from-to)325-333
Number of pages9
Publication statusPublished - 2018


  • Biomarkers
  • Danish National Birth Cohort
  • Early preterm birth
  • Long chained n-3 fatty acids
  • Prospective study


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