{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,13]],"date-time":"2026-07-13T21:10:53Z","timestamp":1783977053463,"version":"3.55.0"},"reference-count":39,"publisher":"Elsevier BV","license":[{"start":{"date-parts":[[2026,8,1]],"date-time":"2026-08-01T00:00:00Z","timestamp":1785542400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/www.elsevier.com\/tdm\/userlicense\/1.0\/"},{"start":{"date-parts":[[2026,8,1]],"date-time":"2026-08-01T00:00:00Z","timestamp":1785542400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/www.elsevier.com\/legal\/tdmrep-license"},{"start":{"date-parts":[[2026,6,21]],"date-time":"2026-06-21T00:00:00Z","timestamp":1782000000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100007753","name":"It\u00e4-Suomen Yliopisto","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100007753","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100014578","name":"Terveyden ja hyvinvoinnin laitos","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100014578","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100004092","name":"Kuopion Yliopistollinen Sairaala","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100004092","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["clinicalkey.com","clinicalkey.com.au","clinicalkey.es","clinicalkey.fr","clinicalkey.jp","ejog.org","elsevier.com","sciencedirect.com"],"crossmark-restriction":true},"short-container-title":["European Journal of Obstetrics & Gynecology and Reproductive Biology"],"published-print":{"date-parts":[[2026,8]]},"DOI":"10.1016\/j.ejogrb.2026.115266","type":"journal-article","created":{"date-parts":[[2026,6,21]],"date-time":"2026-06-21T22:07:56Z","timestamp":1782079676000},"page":"115266","update-policy":"https:\/\/doi.org\/10.1016\/elsevier_cm_policy","source":"Crossref","is-referenced-by-count":0,"special_numbering":"C","title":["Third-trimester polyunsaturated fatty acid supplementation and increased blood loss at vaginal delivery: A prospective birth cohort study"],"prefix":"10.1016","volume":"324","author":[{"given":"J.","family":"Pasanen","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"P.","family":"Nuttunen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"J.","family":"Hakkarainen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5354-0700","authenticated-orcid":false,"given":"L.","family":"Keski-Nisula","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"S.","family":"Hantunen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"78","reference":[{"key":"10.1016\/j.ejogrb.2026.115266_b0005","doi-asserted-by":"crossref","first-page":"345","DOI":"10.1146\/annurev-food-111317-095850","article-title":"Omega-3 polyunsaturated fatty acids and their health benefits","volume":"9","author":"Shahidi","year":"2018","journal-title":"Annu Rev Food Sci Technol"},{"key":"10.1016\/j.ejogrb.2026.115266_b0010","doi-asserted-by":"crossref","first-page":"1105","DOI":"10.1042\/BST20160474","article-title":"Omega-3 fatty acids and inflammatory processes: from molecules to man","volume":"45","author":"Calder","year":"2017","journal-title":"Biochem Soc Trans"},{"key":"10.1016\/j.ejogrb.2026.115266_b0015","doi-asserted-by":"crossref","first-page":"2446","DOI":"10.1172\/JCI112261","article-title":"Metabolism and effects on platelet function of the purified eicosapentaenoic and docosahexaenoic acids in humans","volume":"76","author":"von Schacky","year":"1985","journal-title":"J Clin Invest"},{"key":"10.1016\/j.ejogrb.2026.115266_b0020","doi-asserted-by":"crossref","first-page":"1083","DOI":"10.1016\/j.nut.2015.03.013","article-title":"Cytokines, angiogenic, and antiangiogenic factors and bioactive lipids in preeclampsia","volume":"31","author":"Das","year":"2015","journal-title":"Nutrition"},{"key":"10.1016\/j.ejogrb.2026.115266_b0025","doi-asserted-by":"crossref","first-page":"10","DOI":"10.1016\/j.prostaglandins.2018.09.005","article-title":"Regulation of platelet function and thrombosis by omega-3 and omega-6 polyunsaturated fatty acids","volume":"139","author":"Adili","year":"2018","journal-title":"Prostaglandins Other Lipid Mediat"},{"key":"10.1016\/j.ejogrb.2026.115266_b0030","doi-asserted-by":"crossref","first-page":"35","DOI":"10.1016\/j.amjcard.2006.11.020","article-title":"Safety considerations with omega-3 fatty acid therapy","volume":"19","author":"Bays","year":"2007","journal-title":"Am J Cardiol"},{"key":"10.1016\/j.ejogrb.2026.115266_b0035","doi-asserted-by":"crossref","first-page":"44","DOI":"10.1016\/j.amjcard.2006.11.021","article-title":"Expert opinion: omega-3 fatty acids and bleeding \u2014 cause for concern?","volume":"19","author":"Harris","year":"2007","journal-title":"Am J Cardiol"},{"key":"10.1016\/j.ejogrb.2026.115266_b0040","unstructured":"Naistalo. Hyvien rasvahappojen k\u00e4ytt\u00f6 raskauden aikana. Terveyskyla. Available at: www.terveyskyla.fi\/naistalo\/raskaus\/raskauden-tuomatmuutokset-ja-yleisethuolenaiheet\/hyvien-rasvahappojen-kaytto-raskauden-aikana (last accessed 24 November 2025)."},{"key":"10.1016\/j.ejogrb.2026.115266_b0045","doi-asserted-by":"crossref","first-page":"3615","DOI":"10.3390\/nu12123615","article-title":"Maternal docosahexaenoic acid status during pregnancy and its impact on infant neurodevelopment","volume":"12","author":"Basak","year":"2020","journal-title":"Nutrients"},{"key":"10.1016\/j.ejogrb.2026.115266_b0050","doi-asserted-by":"crossref","first-page":"S77","DOI":"10.1017\/S0007114512001481","article-title":"Omega 3 fatty acids, gestation and pregnancy outcomes","volume":"107","author":"Larqu\u00e9","year":"2012","journal-title":"Br J Nutr"},{"key":"10.1016\/j.ejogrb.2026.115266_b0055","doi-asserted-by":"crossref","first-page":"16","DOI":"10.1016\/j.plefa.2019.04.006","article-title":"Gestational age and maternal status of DHA and other polyunsaturated fatty acids in pregnancy: a systematic review","volume":"144","author":"Wilson","year":"2019","journal-title":"Prostaglandins Leukot Essent Fat Acids"},{"key":"10.1016\/j.ejogrb.2026.115266_b0060","doi-asserted-by":"crossref","DOI":"10.1016\/j.plefa.2020.102181","article-title":"Effect of omega-3 LCPUFA supplementation on maternal fatty acid and oxylipin concentrations during pregnancy","volume":"162","author":"Best","year":"2020","journal-title":"Prostaglandins Leukot Essent Fat Acids"},{"key":"10.1016\/j.ejogrb.2026.115266_b0065","doi-asserted-by":"crossref","first-page":"4","DOI":"10.1186\/s40748-022-00139-9","article-title":"Evidence-based recommendations for an optimal prenatal supplement for women in the US: vitamins and related nutrients","volume":"8","author":"Adams","year":"2022","journal-title":"Matern Health Neonatol Perinatol"},{"key":"10.1016\/j.ejogrb.2026.115266_b0070","doi-asserted-by":"crossref","DOI":"10.1016\/j.mce.2021.111466","article-title":"Fatty acids in normal and pathological pregnancies","volume":"539","author":"Mauro","year":"2022","journal-title":"Mol Cell Endocrinol"},{"key":"10.1016\/j.ejogrb.2026.115266_b0075","doi-asserted-by":"crossref","first-page":"382","DOI":"10.1111\/j.1471-0528.2000.tb13235.x","article-title":"Randomised clinical trials of fish oil supplementation in high risk pregnancies","volume":"107","author":"Olsen","year":"2000","journal-title":"BJOG"},{"key":"10.1016\/j.ejogrb.2026.115266_b0080","doi-asserted-by":"crossref","first-page":"38","DOI":"10.1016\/j.placenta.2019.12.002","article-title":"Fat-soluble nutrients and omega-3 fatty acids as modifiable factors influencing preterm birth risk","volume":"98","author":"Thoene","year":"2020","journal-title":"Placenta"},{"key":"10.1016\/j.ejogrb.2026.115266_b0085","doi-asserted-by":"crossref","first-page":"1074","DOI":"10.3390\/nu13051704","article-title":"Supplementation of omega 3 during pregnancy and the risk of preterm birth: a systematic review and meta-analysis","volume":"13","author":"Serra","year":"2021","journal-title":"Nutrients"},{"key":"10.1016\/j.ejogrb.2026.115266_b0090","article-title":"Omega-3 fatty acid addition during pregnancy","volume":"15","author":"Middleton","year":"2018","journal-title":"Cochrane Database Syst Rev"},{"key":"10.1016\/j.ejogrb.2026.115266_b0095","doi-asserted-by":"crossref","first-page":"808","DOI":"10.3945\/ajcn.112.050021","article-title":"DHA supplementation and pregnancy outcomes","volume":"97","author":"Carlson","year":"2013","journal-title":"Am J Clin Nutr"},{"key":"10.1016\/j.ejogrb.2026.115266_b0100","first-page":"469","article-title":"A randomized trial of docosahexaenoic acid supplementation during the third trimester of pregnancy","volume":"101","author":"Smuts","year":"2003","journal-title":"Obstet Gynecol"},{"key":"10.1016\/j.ejogrb.2026.115266_b0105","doi-asserted-by":"crossref","DOI":"10.1155\/2019\/7074042","article-title":"Cod-liver oil improves metabolic indices and hs-CRP levels in gestational diabetes mellitus patients: a double-blind randomized controlled trial","volume":"2019","author":"Yang","year":"2019","journal-title":"J Diabetes Res"},{"key":"10.1016\/j.ejogrb.2026.115266_b0110","doi-asserted-by":"crossref","first-page":"8","DOI":"10.1016\/j.tjog.2019.11.002","article-title":"Efficacy of n-3 fatty acids supplementation on the prevention of pregnancy-induced hypertension or preeclampsia: a systematic review and meta-analysis","volume":"59","author":"Bakouei","year":"2020","journal-title":"Taiwan J Obstet Gynecol"},{"key":"10.1016\/j.ejogrb.2026.115266_b0115","first-page":"637","article-title":"Impact of n-3 polyunsaturated fatty acid intake in pregnancy on maternal health and birth outcomes: systematic review and meta-analysis from randomized controlled trials","volume":"305","author":"Abdelrahman","year":"2022","journal-title":"Arch Gynecol Obstet"},{"key":"10.1016\/j.ejogrb.2026.115266_b0120","doi-asserted-by":"crossref","first-page":"1378","DOI":"10.3945\/ajcn.111.033217","article-title":"Fish-oil supplementation in pregnancy does not reduce the risk of gestational diabetes or preeclampsia","volume":"95","author":"Zhou","year":"2012","journal-title":"Am J Clin Nutr"},{"key":"10.1016\/j.ejogrb.2026.115266_b0125","doi-asserted-by":"crossref","first-page":"2532","DOI":"10.1111\/aogs.14987","article-title":"Does omega-3 supplementation increase profuse postpartum hemorrhage? a hospital-based register study","volume":"103","author":"Lichtenstein","year":"2024","journal-title":"Acta Obstet Gynecol Scand"},{"key":"10.1016\/j.ejogrb.2026.115266_b0130","doi-asserted-by":"crossref","first-page":"17","DOI":"10.1186\/s12884-016-1217-0","article-title":"Risk factors for severe postpartum hemorrhage: a case\u2013control study","volume":"17","author":"Nyfl\u00f8t","year":"2017","journal-title":"BMC Pregnancy Childbirth"},{"key":"10.1016\/j.ejogrb.2026.115266_b0135","doi-asserted-by":"crossref","first-page":"305","DOI":"10.1097\/AOG.0000000000004228","article-title":"Risk factors for atonic postpartum hemorrhage: a systematic review and meta-analysis","volume":"137","author":"Ende","year":"2021","journal-title":"Obstet Gynecol"},{"key":"10.1016\/j.ejogrb.2026.115266_b0140","doi-asserted-by":"crossref","first-page":"446","DOI":"10.3109\/07853890.2013.803739","article-title":"New population-based references for birth weight, length, and head circumference in singletons and twins from 23 to 43 gestation weeks","volume":"45","author":"Sankilampi","year":"2013","journal-title":"Ann Med"},{"key":"10.1016\/j.ejogrb.2026.115266_b0145","doi-asserted-by":"crossref","first-page":"665","DOI":"10.1097\/OGX.0000000000001061","article-title":"Postpartum hemorrhage: a comprehensive review of guidelines","volume":"77","author":"Giouleka","year":"2022","journal-title":"Obstet Gynecol Surv"},{"key":"10.1016\/j.ejogrb.2026.115266_b0150","doi-asserted-by":"crossref","first-page":"381","DOI":"10.1186\/s12884-018-2013-9","article-title":"Kuopio birth cohort \u2013 design of a finnish joint research effort for identification of environmental and lifestyle risk factors for the wellbeing of the mother and the newborn child","volume":"18","author":"Huuskonen","year":"2018","journal-title":"BMC Pregnancy Childbirth"},{"key":"10.1016\/j.ejogrb.2026.115266_b0155","doi-asserted-by":"crossref","first-page":"344","DOI":"10.1097\/GRF.0000000000000782","article-title":"Postpartum hemorrhage \u2014 epidemiology, risk factors, and causes","volume":"66","author":"Patek","year":"2023","journal-title":"Clin Obstet Gynecol"},{"key":"10.1016\/j.ejogrb.2026.115266_b0160","doi-asserted-by":"crossref","first-page":"332","DOI":"10.1186\/s12884-021-03818-1","article-title":"Prevalence and risk factors of severe postpartum hemorrhage: a retrospective cohort study","volume":"21","author":"Liu","year":"2021","journal-title":"BMC Pregnancy Childbirth"},{"key":"10.1016\/j.ejogrb.2026.115266_b0165","doi-asserted-by":"crossref","first-page":"1468","DOI":"10.1016\/S0140-6736(25)00448-9","article-title":"Causes of and risk factors for postpartum haemorrhage: a systematic review and meta-analysis","volume":"26","author":"Yunas","year":"2025","journal-title":"Lancet"},{"key":"10.1016\/j.ejogrb.2026.115266_b0170","doi-asserted-by":"crossref","first-page":"424","DOI":"10.1111\/j.1471-0528.2005.00477.x","article-title":"Relationship between dietary intake of cod liver oil in early pregnancy and birthweight","volume":"112","author":"Olafsdottir","year":"2005","journal-title":"BJOG"},{"key":"10.1016\/j.ejogrb.2026.115266_b0175","unstructured":"Nordic Council of Ministers. Health risks related to high intake of preformed retinol (vitamin A) in the Nordic countries. Copenhagen: Thema Nord; 2003. p502."},{"key":"10.1016\/j.ejogrb.2026.115266_b0180","first-page":"890","article-title":"Effects of n-3 polyunsaturated fatty acid supplementation on pregnancy outcomes: a systematic review and meta-analysis","volume":"18","author":"Hao","year":"2022","journal-title":"Arch Med Sci"},{"key":"10.1016\/j.ejogrb.2026.115266_b0185","doi-asserted-by":"crossref","first-page":"1022","DOI":"10.1017\/S0007114524002095","article-title":"PUFA and intrahepatic cholestasis of pregnancy: a two-sample Mendelian randomisation analysis","volume":"132","author":"Li","year":"2024","journal-title":"Br J Nutr"},{"key":"10.1016\/j.ejogrb.2026.115266_b0190","first-page":"77","article-title":"Factors associated with hemorrhage in cesarean deliveries","volume":"77","author":"Combs","year":"1991","journal-title":"Obstet Gynecol"},{"key":"10.1016\/j.ejogrb.2026.115266_b0195","doi-asserted-by":"crossref","first-page":"206","DOI":"10.1016\/j.ejogrb.2024.07.015","article-title":"Carbetocin versus oxytocin for the prevention of postpartum haemorrhage during caesarean section in patients at high risk of bleeding","volume":"300","author":"Delavallade","year":"2024","journal-title":"Eur J Obstet Gynecol Reprod Biol"}],"container-title":["European Journal of Obstetrics & Gynecology and Reproductive Biology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/api.elsevier.com\/content\/article\/PII:S0301211526003349?httpAccept=text\/xml","content-type":"text\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/api.elsevier.com\/content\/article\/PII:S0301211526003349?httpAccept=text\/plain","content-type":"text\/plain","content-version":"vor","intended-application":"text-mining"}],"deposited":{"date-parts":[[2026,7,13]],"date-time":"2026-07-13T20:27:24Z","timestamp":1783974444000},"score":1,"resource":{"primary":{"URL":"https:\/\/linkinghub.elsevier.com\/retrieve\/pii\/S0301211526003349"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,8]]},"references-count":39,"alternative-id":["S0301211526003349"],"URL":"https:\/\/doi.org\/10.1016\/j.ejogrb.2026.115266","relation":{},"ISSN":["0301-2115"],"issn-type":[{"value":"0301-2115","type":"print"}],"subject":[],"published":{"date-parts":[[2026,8]]},"assertion":[{"value":"Elsevier","name":"publisher","label":"This article is maintained by"},{"value":"Third-trimester polyunsaturated fatty acid supplementation and increased blood loss at vaginal delivery: A prospective birth cohort study","name":"articletitle","label":"Article Title"},{"value":"European Journal of Obstetrics & Gynecology and Reproductive Biology","name":"journaltitle","label":"Journal Title"},{"value":"https:\/\/doi.org\/10.1016\/j.ejogrb.2026.115266","name":"articlelink","label":"CrossRef DOI link to publisher maintained version"},{"value":"article","name":"content_type","label":"Content Type"},{"value":"\u00a9 2026 The Authors. Published by Elsevier B.V.","name":"copyright","label":"Copyright"}],"article-number":"115266"}}