Van Goor 2009.

Methods	RCT: ISRCTN58176213
Participants	183 women randomised (3 groups ‐ see below) Inclusion criteria: apparently healthy women with a low‐risk first or second pregnancy Exclusion criteria: preterm births (< 37 weeks) or GA > 42 weeks and any maternal or neonatal complications; vegetarians or vegans Characteristics: low background DHA intake (fish intake once a week) Setting: Groningen, the Netherlands: assumed to be during antenatal care (recruited by midwives and obstetricians)
Interventions	SUPPLEMENTATION: DHA + AA versus DHA versus placebo Group 1: DHA + AA (220 mg each/day): total number randomised: 58 (41) Group 2: DHA (220 mg/day) + 1 soy capsule/day: 63 (41) Group 3: placebo (2 soy capsules/day); equivalent to 535 mg LA/day: total number randomised: n = 62 (36) Timing of supplementation: mean 16.5 weeks GA (range 14‐20 weeks) till 12 weeks postpartum (formula not supplied if child not breast fed) DHA + EPA dose/day: low: 220 mg DHA
Outcomes	Women/birth: preterm birth; GA; GDM; fatty acids in plasma (at 16 and 36 weeks GA); EPDS at 16 and 36 weeks GA and 6 weeks pp; blues questionnaire within 1 week pp; DHA and AA in breastmilk (2 and 12 weeks pp); sleep quality (36 weeks GA and 4 weeks pp); Obstetric Optimality Score (74 items covering socioeconomic status, non‐obstetric conditions during pregnancy, obstetric history, diagnostic and therapeutic measures, parturition and neonatal condition immediately after birth; food frequency questionnaires (16 and 36 weeks GA, 12 weeks pp); fatty acids (in umbilical cord); birthweight; duration of breastfeeding Babies/infants/children: general movement quality; NOS; Hempel neurological examination; BSID II (Dutch version); weight at 18 months; height at 18 months; head circumference at 18 months; cerebral palsy (EPDS and Hempel reported as median and ranges only)
Notes	Funding: Friesland Foods, the Netherlands Declarations of interest: none declared
Risk of bias
Bias	Authors' judgement	Support for judgement
Random sequence generation (selection bias)	Unclear risk	Block randomisation; not further reported
Allocation concealment (selection bias)	Unclear risk	Quote: “randomized into three groups”
Blinding of participants and personnel (performance bias) All outcomes	Low risk	Double‐blind placebo‐controlled
Blinding of outcome assessment (detection bias) All outcomes	Unclear risk	Not reported
Incomplete outcome data (attrition bias) All outcomes	High risk	58/183 (32%) “lost interest” (23 placebo; 20 DHA; 15 DHA/AA); 6 pregnancy complications (3 placebo, 1 DHA, 2 DHA/AA), leaving 119 for analysis
Selective reporting (reporting bias)	Low risk	Most expected outcomes were reported (although numbers per group were not reported for EPDS > 12 and blues score > 12)
Other bias	Low risk	Baseline characteristics similar