D'Almedia 1992.

Methods	RCT (3 arms)
Participants	100 women (from 2 of the 3 arms) Inclusion criteria: primiparous and multiparous women, aged 14‐40 years and ≤ 16 weeks' gestation. Exclusion criteria: none reported Characteristics: 76% had a recent history of malaria or fever of unknown origin, 34% had a history of sickle cell trait or disease, 37% had a history of anaemia, 21% had a history of pregnancy hypertension or other hypertension and 4% had a previous preterm birth. Setting: Luanda, Angola
Interventions	SUPPLEMENTATION + OTHER AGENT: GLA + EPA + DHA (omega 6/omega 3) versus placebo Group 1: 8 capsules/day evening primrose oil + fish oil, providing a total of 296 mg GLA, 144 mg EPA and 80 mg DHA/day: total number randomised = 50 Group 2: 8 capsules olive oil/day (without vitamin E): total number randomised = 50 (The third arm (magnesium oxide: n = 50) was not considered for this review): Timing of supplementation: 6 months DHA + EPA dose/day: low: 80 mg DHA + 144 mg EPA
Outcomes	Women: PIH, PE (hypertension (rise in SBP > 30 mmHg and/or a rise in DBP > 15 mmHg); oedema (visible fluid accumulation in the ankles and feet), and proteinuria (protein > 1 determined by test tape) any time during the pregnancy), eclampsia. Babies/infants/children: birthweight (< 2000 g and > 3000 g (not used for LGA outcome)).
Notes	Funding: GLA, EPA, DHA tablets and placebo tablets were prepared by Efamol Research Institute and Efamol Ltd Declarations of interest: not reported Reported dietary intake of women in all groups at study entry was poor.
Risk of bias
Bias	Authors' judgement	Support for judgement
Random sequence generation (selection bias)	Low risk	Women "randomly assigned using a random number table"
Allocation concealment (selection bias)	Low risk	Quote: "the code of the capsules was not made known by the manufacturer, until the end of the treatment period"
Blinding of participants and personnel (performance bias) All outcomes	Low risk	Olive oil and evening primrose oil + fish oil capsules identical (but both different to magnesium oxide), so fully blinded with regard to the fish oil/evening primrose and placebo comparison.
Blinding of outcome assessment (detection bias) All outcomes	Low risk	Outcome assessments partially blinded ‐ olive oil and evening primrose oil + fish oil capsules identical (but both different to magnesium oxide), so fully blinded with regard to the fish oil/evening primrose and placebo comparison.
Incomplete outcome data (attrition bias) All outcomes	Unclear risk	Not specifically reported
Selective reporting (reporting bias)	Unclear risk	Outcomes such as preterm birth and perinatal mortality were not reported
Other bias	Unclear risk	Baseline nutritional profiles (determined by dietary recall) differed (placebo group higher caloric intake; higher animal protein; higher total fat; higher “fish fat”; higher cholesterol; higher fibre; higher potassium)