Based on a review of some of the articles we have determined, we found

that the LCPUFA n-3 supplementation affected the increase in birth weight. This
is based on a related article entitled Effect of fish oil supplementation in
pregnancy on bone, lean, and fat mass at six years: randomised clinical trial,
Supplementation with n-3 LCPUFA in the third trimester of pregnancy resulted
in a higher BMI in the children from age 1 to 6 years but no increase in the
number of obese children. Body composition assessed by dual energy x ray
absorptiometry scans confirmed that the higher BMI was not the result of a higher
fat percentage but reflected a proportional increase in lean mass, bone mass, and
fat mass, suggesting a general growth stimulating effect of the n-3 LCPUFA
supplementation. That trial is the first to show that n-3 LCPUFA supplementation
in the third trimester of pregnancy leads to a higher BMI in offspring through
childhood, whereas previous trials and systematic reviews showed no effect of n-3
LCPUFA supplementation during pregnancy and/or lactation on BMI or growth
development in childhood.7 8 9 21 22 . The dose of n-3 LCPUFA in that trial was 2.4 g
per day, which is higher than in most previous studies, in which 900 mg or 1.5 g
was administered,7 9 25 26
. In line with that findings, one previous trial
supplementing mothers with 1.5 g n-3 LCPUFA (40% eicosapentaenoic acid)
during the first four months of lactation showed a significantly higher BMI and
increased waist circumference in the n-3 LCPUFA supplemented children at 2.5
years,29 but no differences were seen at 7 or 13 years of age. 8 The n-3 LCPUFA
supplementation in pregnancy led to a 0.4 kg higher weight at age 6 years, but our
dual energy x ray absorptiometry data obtained at 3.5 and 6 years showed no
difference in bone mass, fat mass, or lean mass percentages. Instead, they
observed a proportional increase in all three compartments in the children from
the n-3 LCPUFA supplemented group. Furthermore, we did not find any
differences between the intervention groups with regard to IOTF grades or
children in the highest or lowest 10% of BMI at 6 years. This suggests that mainly
children with a BMI in the normal range were affected by the n-3 LCPUFA
intervention. Also, the effect of n-3 LCPUFA supplementation on bone mineral
content and bone mineral density might imply a positive health benefit in terms of
decreased risk of later fragile bones.31
 The article explained that supplementation of n-3 LCPUFA in the third
trimester of pregnancy increases BMI rather than fat presentation in children aged
1-6 years. This is a factor that does not influence the addition of LCPUFA n-3
supplementation to an increased risk of obesity. This statement is supported by
previous studies with n-3 LCPUFA supplementation in mothers who breastfeed
during the first four months of breastfeeding affect BMI of children aged 2.5 years
and there is no difference in children aged 7 or 13 years. The increase also occurs
in bone mass in which there is also an increase in bone mineral content and bone
density. Thus it implies the health benefits of LCPUFA n-3 supplementation on
health in terms of reducing the risk of brittle bones in the future.

In another article titled Maternal Fish Oil Supplementation in

Pregnancy: A 12 Year Follow-Up of a Randomized Controlled Trial,
LCPUFA n-3 supplementation during pregnancy does not affect the cognitive,
language, or fine motori of children aged 12 years starting in the absence
significant difference in children aged 2½ years. So it is pointed out that LCPUFA
n-3 supplementation has no effect on the development of children in old age.

Their data indicate that n-3 LCPUFA supplementation during pregnancy

does not influence the cognition, language or fine motor skills of children in late
primary school (12 years of age). The significant differences observed in hand-
eye coordination at 2½ years of age could no longer be detected, and may have
been diluted by other environmental factors.
Fatty acid analyses indicate that the supplementation effect of raising n-3
LCPUFA status in cord blood was no longer present at 12 years. This suggests
that the nutritional intake of the participants in the intervening years diluted the
effect of the supplementation during pregnancy. Yet, akin to other reported
correlational studies, current n-3 LCPUFA intakewas important for neurological
performance [10,11].
In our main reference article entitled Fish Oil Supplementation in
Pregnancy Increases Gestational Age, Size for Gestational Age, and Birth Weight
in Infants: A Randomized Controlled Trial, mentions the effect of LCPUFA n-3
supplementation that n-3 LCPUFA supplementation at age the womb 24 months
or mid-trimester 2 to 1 week after birth causes an increase in birth weight and
extended pregnancy for 2 days from the day that has been predicted. However, the
article also explained that the increase in birth weight was not only due to
prolongation of pregnancy, but rather because of intrauterine growth which
caused an increase in size for GA. Research in this article is not yet strong for a
reduction in preterm delivery or children born small for GA after n-3 LCPUFA
supplementation in pregnancy, which has been suggested in epidemiologic
observational studies (9).

Daily supplementation with n–3 LCPUFAs compared with control from

pregnancy wk 24 until 1 wk after birth resulted in a 2-d prolongation of
pregnancy and a 97-g higher birth weight among mother-child pairs of the
population-based Danish COpenhagen Prospective Studies on Asthma in
Childhood2010
Our study is among the largest RCTs on n–3 LCPUFA supplementation in
pregnancy, investigating pregnancy length and fetal growth. Still, the number of
participating mothers (n=699) limited the opportunities to investigate if the
increased size for GA also led to a reduction in children born small for GA,
because we only had 13 children in that category (14) . It is an important strength
of our study that we found consistent results for different measurements of fetal
size for GA, i.e., the Marsál percentage and Skjærven percentage, and a
nonsignificant effect on fetal growth estimated as growth rate from week 20 of
pregnancy based on ultrasound scans.
In this RCT, we have confirmed earlier findings showing that fish-oil
supplementation during pregnancy leads to a prolongation of pregnancy and an
increase in birth weight (4). Furthermore, we demonstrate a significantly larger
size for GA in the n–3 LCPUFA–supplemented group. This suggests that the
increase in birth weight is not solely explained by the prolonged duration of
pregnancy, but is also a consequence of increased intrauterine growth. To our
knowledge this has not been shown before.
Our findings are in line with the results from the majority of other studies,
demonstrating a prolongation of pregnancy of between 2 and 4 d and an increase
in birth weight of between 70 and 170 g after fish oil supplementation (4, 5).
The biological mechanism by which n–3 LCPUFAs can prolong
pregnancy remains unclear, but many studies have suggested that eicosanoids
regulate initiation of labor (19) and a proposed explanation has been that fish oil
supplementation alters the balance of prostaglandins derived from the n–3
LCPUFAs and the n–6 LCPUFAs involved in parturition (20). It has previously
been suggested that the fish oil induced increase in birth weight is only caused by
the prolongation of pregnancy (6). However, our data show that n–3 LCPUFA
supplementation also has an impact on the intrauterine growth, leading to an
increased size for GA. A possible mechanism for the increased fetal growth could
be that n–3 LCPUFAs increase the ratio of prostacyclin to thromboxane, thereby
reducing blood viscosity and facilitating increased placental blood flow, which
benefits fetal growth (21).
 Unfortunately, our study was not sufficiently powered to demonstrate a
reduction in preterm delivery or children born small for GA after n–3 LCPUFA
supplementation in pregnancy, which has been suggested in epidemiologic
observational studies (9). Larger studies are therefore needed to establish if it
would be of clinical relevance for the health of the mother and child to
recommend the routine use of n–3 LCPUFA supplementation during pregnancy
(22).
This impact on 3 different organ systems indicates that n–3 LCPUFA
concentrations in pregnancy have an important role for these children’s
development and this potential should be further explored.
Related to the effect of education level on increasing birth weight is
explained in the article entitled Does Maternal Education Really Improve
Child Health? and Prenatal Care in Combination with Maternal Educational
Level Has a Synergetic Effect on the Risk of Neonatal Low Birth Weight:
New Findings in a Retrospective Cohort Study in Kunshan City, China that
the level of education influences prenatal visits during pregnancy to avoid the risk
of adverse births. In the article Prenatal Care in Combination with Maternal
Educational Level Has a Synergetic Effect on the Risk of Neonatal Low Birth
Weight: New Findings in a Retrospective Cohort Study in Kunshan City,
China further explained about pregnant women with a higher level of education
more easily changed their biological, psychosocial, and behavioral factors
influencing pregnancy, including poor nutrition, smoking and physical labor, than
women with a lower level of education [19, 27]. In addition, education is a
recognized factor affecting a person's health awareness, attitude, and practice.
Women with higher educational attainment may be more likely than other women
to demonstrate health care-seeking and influence the content of their care through
their requests for and adherence to providers advice on positive pregnancy-related
behaviors, which may contribute to reducing their risk of LBW deliveries [28].

As proved in other studies [16, 18, 19], this study verified maternal
education as an important socioeconomic factor related to the neonatal birth
weight. A higher level of maternal education may be associated with higher
family income and better nutrition of children, which may lead to improvement in
infant birth weight. What is interesting in our study is that the maternal
educational level and the number of prenatal care visits have a synergetic
protective interaction on decreasing the neonatal LBW risk, which have not been
previously reported.
 Powered by the article Does Maternal Education Really Improve Child
Health? which explains that the mother's higher education level affects the
provision of nutrition to her children. Data obtained by children with PEM
(protein energy malnutrition) and education qualifications from mothers, shows
that the higher the educational qualifications of mothers the better the level of
nutrition in the same environmental conditions.

In this study it was observed that as the educational status of the mother
improved there was a decrease in the percentage of children with severe grade of
protein energy malnutrition. Out of 449 children only one child had grade IV
PEM (TABLE-2). The percentage of distribution of normal children were more
(70.6%) in group 4 which included the mothers whose educational status was 11
standard and above. It was observed that the percentage of grade I and grade II
protein energy malnutrition was more in group 1 mothers 44.2% and 22.6%
respectively. Group 1 includes illiterate mothers. In Group 2 and Group 3
mothers the percentage of distribution of grade 1 malnutrition was almost the
same(FIGURE -1) .The percentage of distribution of grade 3 PEM was more in
Group- 1 mothers (70.6%). This results indicate that the higher the educational
qualification better the nutritional grade. In this study the environmental
condition were same for all the mothers. The observed results may be due to the
fact that maternal education has created awareness in the mothers regarding the
access to the health delivery system and nutrition during illness. This possibly
could be the reason for the improved health status observed in the children of
mothers with better education .
In a study done Sleath et al they have found that younger mothers with
lower literacy skills are more likely to report a barrier for giving medication to
the children and also found it difficult to access the health service[9].
In addition, another factor that is influenced by the level of maternal
education is the nutritional status of children by the importance of breastfeeding.

On exploring other factors which possibly would have affected the

nutritional status in the children of better educated mothers, it has been reported
that breast feeding is of considerable importance for nutrition and development
[6]. Skafida etal acknowledges the importance of maternal education on
breastfeeding and found that higher educational qualifications are associated
with an increased rate of breast feeding take up [7].
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