Smuts 2003b.

Methods	RCT: parallel (feasibility study)
Participants	52 women randomised (52 randomised to the 2‐egg groups: 25 to the regular‐egg group and 27 to the high‐DHA egg group. (Another 21 women consented to the study but were not randomised and were not given eggs (low‐egg intake group).) Inclusion criteria: women 24‐28 weeks pregnant by obstetric assessments (either date of last menstrual period or US), aged 16‐35 years, were accessible by telephone, and planned to give birth at the Regional Medical Center (Memphis, TN) If women said they ate eggs, they were asked for informed consent to be randomised to ordinary or high‐DHA eggs. Exclusion criteria: any chronic illness, PIH, PE, or pregnancy‐induced diabetes at the time of enrolment. Women were excluded if they had > 4 prior pregnancies. Characteristics: women were mainly African‐African and rarely consumed fish; however they commonly consumed eggs. Setting: Regional Medical Center (Memphis, TN), USA (trial recruitment dates not reported)
Interventions	OMEGA‐3‐ENRICHED FOOD: high‐DHA eggs versus ordinary eggs Group 1: high‐DHA eggs (135 mg DHA/egg): total number = 27 randomised (18 could be analysed) Group 2: ordinary eggs (18 mg DHA/egg): total number = 25 randomised (19 could be analysed) Timing of supplementation: egg consumption started at ˜27 weeks' gestation and continued for ˜13 weeks During the course of the study, women were sent 2 dozen eggs (i.e. 24 eggs) every 2 weeks by courier. After the first delivery, they were interviewed before each subsequent delivery and asked how many eggs they had consumed. In addition, the unused eggs were returned by the courier, counted, the number recorded, and the eggs destroyed. Women were asked to keep a written record of their egg intake on forms supplied to them and to return these with the uneaten eggs; however, few were compliant with this request. DHA + EPA dose/day: low: up to 135 mg DHA; EPA not stated
Outcomes	Women/birth: GA, GWG, caesarean section, gestational diabetes, maternal plasma and RBC lipids just prior to birth, maternal antibiotics, preterm birth, low birthweight, placental weight, PE, birthweight, length at birth; head circumference at birth, birthweight < 37 weeks Babies/infants/children: newborn plasma and RBC lipids; admission to NICU/Special Care Unit; not routine hospital care, meconium
Notes	Funding: OmegaTech, Inc (Boulder, CO) supplied both ordinary and high‐DHA eggs (Gold Circle Farms). Declarations of interest: not reported
Risk of bias
Bias	Authors' judgement	Support for judgement
Random sequence generation (selection bias)	Unclear risk	Method of sequence generation not reported ‐ “using a randomization in blocks of 6 to ensure that the groups remained relatively balanced”.
Allocation concealment (selection bias)	Unclear risk	Quote: “women were randomized to the two egg groups”; no further information provided
Blinding of participants and personnel (performance bias) All outcomes	Unclear risk	Quote: "The ordinary and high‐DHA eggs had white shells but came in cartons of different colors. Carton color remained the same throughout the study" indicating that study personnel and possibly women could deduce which group they were in.
Blinding of outcome assessment (detection bias) All outcomes	Unclear risk	Not reported
Incomplete outcome data (attrition bias) All outcomes	High risk	9/27 in the high DHA and 7/25 in the control group lost to follow‐up; reasons for losses not clearly reported.
Selective reporting (reporting bias)	Unclear risk	No protocol or trial registration entry; unable to determine
Other bias	Unclear risk	Women assigned to consume ordinary eggs were significantly older than those in the high DHA egg group.