 A systematic review of randomized controlled trials of DHA supplementation of pregnant and breastfeeding women failed to find any clear and consistent short or long-term benefit for cycle motor, mental, visual, or physical development. Maybe DHA supplementation during pregnancy is no effect because the body isn't stupid and protects the growth of the baby's brain by drying off maternal stores of DHA, upregulating maternal DHA synthesis, and preferentially shuttling it to the fetus. But what if moms don't start out with large maternal stores? In other words, maybe DHA failed to help women who were already getting enough, but maybe women with very low intakes would benefit from DHA supplementation. Well, first it's interesting to note that even by 1978, researchers were suggesting plant-based diets as the diet of choice in the treatment of our number one killer, but babies breastfed by vegan moms have significantly less DHA in their bloodstream, presumably because the moms had significantly less DHA in their breast milk. The question is whether these differences are of any consequence. The growth and development of vegan and vegetarian children are normal, as long as they're getting their B12. No evidence that neural or intellectual functions are impaired. In fact, the two studies we have on vegetarian kids showed that they had higher IQs, though that may have been because their parents tended to be better educated. But even though the kids seem fine, it doesn't rule out the possibility that there may be some subtle differences in visual or neural functioning. It'd be interesting to compare the function of babies getting vegan breast milk levels versus general population levels. You can see vegans had 14 vegetarians, 30 omnivores, 37. This study compared 0 to 32, 64, and 96, and 32 worked better than 0, but more than 32 didn't add anything. This could explain why the general population at 37 doesn't benefit from additional DHA supplementation. But what about down at 14? Most studies down at that level showed no advantage over 0, though one study found a benefit supplementing at as low as 5, but that doesn't help us. Now, just because babies breastfed by vegan moms have significantly lower DHA levels in the blood, it doesn't necessarily mean they have lower levels in their brain, which is where it counts. What we need is a randomized control trial in non-fish eaters of DHA supplementation. Until then, it's going to remain uncertain. So what should pregnant breastfeeding women who avoid fish do in the meanwhile? Low intakes of DHA doesn't necessarily equate with fetal DHA inadequacy, but this new data suggests that some infants may not be getting enough, and could benefit from their moms supplementing. And so I recommend pregnant and breastfeeding women on plant-based diets do follow the consensus guidelines to get about 200 mg of preformed DHA from an uncontaminated source like algae oil, which is probably the best combination for all women, given the state of our world, to minimize exposure to toxic pollutants such as dioxins, PCBs, and mercury.