Supplementation with long chain polyunsaturated fatty acids (LCPUFA) to breastfeeding mothers for improving child growth and development

Background Long chain polyunsaturated fatty acids (LCPUFA), especially docosahexaenoic acid (DHA), are the most abundant fatty acids in the brain and are necessary for growth and maturation of an infant's brain and retina. LCPUFAs are named “essential” because they cannot be synthesised efficiently by the human body and come from maternal diet. It remains controversial whether LCPUFA supplementation to breastfeeding mothers is beneficial for the development of their infants. Objectives To assess the effectiveness and safety of supplementation with LCPUFA in breastfeeding mothers in the cognitive and physical development of their infants as well as safety for the mother and infant. Search methods We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (6 August 2014), CENTRAL (Cochrane Library 2014, Issue 8), PubMed (1966 to August 2014), EMBASE (1974 to August 2014), LILACS (1982 to August 2014), Google Scholar (August 2014) and reference lists of published narrative and systematic reviews. Selection criteria Randomised controlled trials or cluster‐randomised controlled trials evaluating the effects of LCPUFA supplementation on breastfeeding mothers (including the pregnancy period) and their infants. Data collection and analysis Two review authors independently assessed eligibility and trial quality, performed data extraction and evaluated data accuracy. Main results We included eight randomised controlled trials involving 1567 women. All the studies were performed in high‐income countries. The longest follow‐up was seven years. We report the results from the longest follow‐up time point from included studies. Overall, there was moderate quality evidence as assessed using the GRADE approach from these studies for the following outcomes measured beyond 24 months age of children: language development and child weight. There was low‐quality evidence for the outcomes: Intelligence or solving problems ability, psychomotor development, child attention, and child visual acuity. We found no significant difference in children's neurodevelopment at long‐term follow‐up beyond 24 months: language development (standardised mean difference (SMD) ‐0.27, 95% confidence interval (CI) ‐0.56 to 0.02; two trials, 187 participants); intelligence or problem‐solving ability (three trials, 238 participants; SMD 0.00, 95% CI ‐0.36 to 0.36); psychomotor development (SMD ‐0.11, 95% CI ‐0.48 to 0.26; one trial, 113 participants); motor development (SMD ‐0.23, 95% CI