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Preterm birth, defined as delivery before 37 completed weeks' gestation, is the leading cause of death in children under five years of age. Preterm birth affects nearly 15 million babies worldwide, 1 of which 26 000 are in Australia. 2 Of these, an estimated 30% are defined as early preterm birth (4. 3% of total fatty acids), omega-3 supplements are not required (as part of pregnancy multivitamins or a standalone supplement). If women are already taking omega-3 as part of a multivitamin, the dose of DHA + EPA should not exceed 250 mg per day. 16 For women with serum total omega-3 levels between 3. 7% and 4. 3%, no changes are required for their use of supplementation. 16 Alternative thresholds for omega-3 depletion and sufficiency that are linked to other clinical outcomes from omega-3 supplementation in pregnancy are currently unavailable. Further, data analysing the effects of omega-3 supplementation in very early pregnancy are limited. Current methods to estimate omega-3 status involve screening maternal dietary intake or direct measurement through blood testing. Unfortunately, dietary screening is only modestly related to omega-3 status18 because it fails to consider maternal age, body mass index, smoking and the effect of genetic polymorphisms on omega-3 status. 22 Blood testing remains the gold standard to determine omega-3 status in early pregnancy;22 however, this is expensive, and most laboratories do not report total serum omega-3 levels as a percentage, leading to confusion for clinicians providing clinical care. In New South Wales and Queensland, it costs about 200 in out-of-pocket expenses to measure omega-3 levels, as the test is not currently eligible for Medicare benefit. 23, 24 Recently, an alternative approach has become available using dried blood spot collection cards (www. omega3index. com. au), which quantifies whole blood omega-3 levels. This method is approved by the Therapeutic Goods Administration and has been validated against traditional gas chromatography methodology with remarkable accuracy (r2, 0. 99). 25 This testing approach is more affordable (~60) and has a three-day turnaround time for both analysis and reporting. Although preterm birth outcomes are linked to different reference ranges for omega-3 levels in whole blood compared with serum, this test as well as others can convert whole blood levels to equivalent serum levels to mirror reporting standards of SAHMRI to facilitate smooth implementation. For the first time in Australia, there is a more affordable option. Measurement of omega-3 levels is required before the initiation of omega-3 supplementation to reduce the risk of preterm birth in pregnant women with low omega-3 status and to minimise potential harm in those who are omega-3 replete. Affordable and accessible testing and consistent approaches to reporting are required to implement nationwide programs to reduce preterm births. Open access publishing facilitated by The University of Newcastle, as part of the Wiley - The University of Newcastle agreement via the Council of Australian University Librarians. No relevant disclosures. Not commissioned; externally peer reviewed.
Fu et al. (Tue,) studied this question.