Thursday, March 22, 2018

Review Examines Evidence to Support Use of Prenatal Supplements to Prevent Mental Illness

Previous studies suggest that certain prenatal supplements can enhance fetal brain development, but less is known about whether these supplements decrease the subsequent risk of mental illness in offspring. A review published Wednesday in AJP in Advance suggests that while prenatal nutrients may offer some protective mental health benefits to the offspring, there are some health risks.

AJP Editor Robert Freedman, M.D., of the University of Colorado School of Medicine and colleagues conducted a literature search for human studies that included the keyword “micronutrients” combined with “pregnancy” or “fetal development” that were published between 1990 and 2017. Thirty-five human studies and trials of individual nutrients were identified that included reports on subsequent child behavior, emotion, or cognition in one or more articles. Freedman and colleagues identified four supplements as a result of this literature review: folic acid, omega-3 fatty acids, phosphatidylcholine, and vitamins D and A.

Key findings of the review included the following:

  • Folic acid and phosphatidylcholine supplements appear to reduce social and emotional problems in young children that are associated with later mental illness. More research is needed to establish whether these supplements can reduce the risk of psychiatric disorders such as schizophrenia.
  • Vitamin A and D supplements appear to decrease the risk for schizophrenia and autism. However, at higher doses these vitamins can be toxic to both mother and child. The authors wrote, “Supplementation should not be greater than the amount in standard multivitamins.” (The daily recommendation in the United States for vitamin D is 600 IU for pregnant women and 400 IU for infants.)
  • Omega-3 fatty acid supplements during pregnancy appear to increase the risk for schizophrenia and attention-deficit/hyperactivity disorder (ADHD) symptoms; however, other studies show that omega-3 supplements can substantially reduce the risk of premature birth, which is also a risk factor for ADHD.

Freedman and colleagues noted that more research is needed to understand the relationship between prenatal nutrients and mental health of offspring; of the 35 studies they analyzed for the review, only five were randomized, controlled clinical studies. “To obtain [substantive] evidence for any nutrient will require new research agendas that emphasize prenatal clinical trials of interventions, early biomarkers of their effectiveness developed in translational models, and then longer-term follow-up through childhood developmental stages into adulthood,” the authors wrote.

“In the absence of definitive evidence, parents currently planning pregnancy now have difficult decisions about nutrient supplements,” the authors continued. “The mother is unlikely to receive fully effective levels of the currently studied nutrients from diet alone. Adverse effects of supplements are few at the doses studied, but it would be premature to conclude that they are nonexistent. Conversely, there is only one opportunity in each child’s life for intervention to enhance fetal brain development and protect the child against developmental risks that arise in this period.”

To read more about this topic, see the Psychiatric News article “Long Career Studying Choline Leads to Public Health Payoff.”

(Image: pio3/Shutterstock)


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