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S.K. had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. She also takes the final responsibility for the decision to submit for publication. Conceptualization, S.K., D.P., N.T., U.R., and A.D.S.; Data curation, D.K.; Formal analysis, D.K. and R.G.; Funding acquisition, S.K. and D.P.; Investigation, S.K., G.P., S.B.M., and Y.K.; Methodology, S.K. and U.R.; Project administration, S.K., M.C., and K.P.; Resources, K.P., M.K.S., and D.P.; Software, D.K.; Supervision, K.P., M.K.S., N.T., and A.D.S.; Validation, R.G.; Writing—original draft, S.K.; Writing—review and editing, D.K., M.C., D.P., N.T., U.R., and A.D.S. All authors have read and agreed to the published version of the manuscript.

The Department of Obstetrics and Gynecology at KAHER’s JN Medical College (JNMC) Belagavi is deeply acknowledged. The Unit Chiefs (M.B. Bellad, Anita Dalal, Yeshita Pujar, and M.C. Metgud) deserve a special mention in providing valuable inputs and support during each phase of this study. We are indebted to the JNMC’s Blood Bank in the charge of Shrikant Viragi and his whole team for facilitating all on site biochemical work in the study. We are truly grateful to the resource and support teams at the Centre for Chronic Disease Control (CCDC) and Public Health Foundation of India (PHFI), Delhi. This trial is funded by Wellcome Trust-DBT India Alliance (December 2015–December 2020). The Young Scientist Award by DST SERB India (2013–16) helped us establish the DHANI trial. The funding sources had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and the decision to submit the manuscript for publication. Neither the product provider nor the sponsors had an opportunity to review a pre-submission copy of the article.

The authors declare no conflict of interest. The funders had no role in the design of the study; in the collection, analyses, or interpretation of data; in the writing of the manuscript; or in the decision to publish the results.


Research Funding:

The trial was funded by India Alliance IA/CPHE/14/1/501498. The DST Young Scientist Award (SR/FT/LS-156/2011) also provided partial funding for setting up a part of the cohort. The supplements were donated by DSM Nutritional Products via their Mumbai office.


  • docosahexaenoic acid (DHA)
  • long chain omega-3 fatty acids
  • maternal supplementation
  • pregnancy outcomes
  • anthropometry
  • birth weight
  • birth length
  • head circumference

Prenatal Maternal Docosahexaenoic Acid (DHA) Supplementation and Newborn Anthropometry in India: Findings from DHANI

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Journal Title:



Volume 13, Number 3


Type of Work:

Article | Final Publisher PDF


Long-chain omega-3 fatty acid status during pregnancy may influence newborn anthropometry and duration of gestation. Evidence from high-quality trials from low- and middle-income countries (LMICs) is limited. We conducted a double-blind, randomized, placebo-controlled trial among 957 pregnant women (singleton gestation, 14–20 weeks’ gestation at enrollment) in India to test the effectiveness of 400 mg/day algal docosahexaenoic acid (DHA) compared to placebo provided from enrollment through delivery. Among 3379 women who were screened, 1171 were found eligible; 957 were enrolled and were randomized. The intervention was two microencapsulated algal DHA (200 × 2 = 400 mg/day) or two microencapsulated soy and corn oil placebo tablets to be consumed daily from enrollment (≤20 weeks) through delivery. The primary outcome was newborn anthropometry (birth weight, length, head circumference). Secondary outcomes were gestational age and 1 and 5 min Appearance, Pulse, Grimace, Activity, and Respiration (APGAR) score. The groups (DHA; n = 478 and placebo; n = 479) were well balanced at baseline. There were 902 live births. Compliance with the intervention was similar across groups (DHA: 88.5%; placebo: 87.1%). There were no significant differences between DHA and placebo groups for birth weight (2750.6 ± 421.5 vs. 2768.2 ± 436.6 g, p = 0.54), length (47.3 ± 2.0 vs. 47.5 ± 2.0 cm, p = 0.13), or head circumference (33.7 ± 1.4 vs. 33.8 ± 1.4 cm, p = 0.15). The mean gestational age at delivery was similar between groups (DHA: 38.8 ± 1.7 placebo: 38.8 ± 1.7 wk, p = 0.54) as were APGAR scores at 1 and 5 min. Supplementing mothers through pregnancy with 400 mg/day DHA did not impact the offspring‘s birthweight, length, or head circumference.

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© 2021 by the authors.

This is an Open Access work distributed under the terms of the Creative Commons Attribution 4.0 International License (https://creativecommons.org/licenses/by/4.0/).
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