Background Proper nutrition in early childhood is essential to ensure optimal growth and development. Use of ‘better-for-you’ features on food packaging position products as healthier for children. This study aims to systematically explore the use of better-for-you labelling on infant and toddler food packaging. Methods A cross-sectional audit of health and nutrition claims, text and images used as ‘better-for-you’ features present on infant and toddler food packaging. Data on infant and toddler food packaging were collected from five large grocery stores in Adelaide, Australia in 2019. The content of 282 unique commercial products (n=215 infant foods, n=67 toddler foods) were analysed for explicit and implicit features positioning them as better-for-you, including health and nutrition claims as well as text and images representing ‘natural.’ Results At least one feature of better-for-you positioning was identified on all food packaging coded. All products had characteristics coded as ‘natural’. Almost one-fifth (17%) of the products included statements in addition to mandatory allergen labelling that their products were ‘free from’ certain allergens, or gluten. One-third of the labels had statements related to enhancing development of taste, oro-motor skills and other aspects of childhood development. Of the fruit and vegetable-based infant foods displaying a sugar statement suggesting a low sugar content, 85% were sweetened with fruit puree. Conclusions The use of better-for-you features on infant and toddler food packaging is common and pervasive. Allergen-free and developmental claims are being used to position infant and toddler foods as better-for-you. Regulation of toddler food products separately from adult food is required, as is tighter regulation of the appropriate use of sugar and fruit puree statements on infant and toddler food packaging.

Objectives The risk factors for prematurity are multifactorial and include low omega-3 status. Omega-3 supplementation in pregnancy has been found to reduce prematurity risk, particularly among women with low omega-3 levels. This study aimed to identify maternal characteristics that predict whether women with a singleton pregnancy will benefit from omega-3 supplementation to reduce their risk of prematurity. Design Exploratory analyses of a multicentre, double-blind randomised trial. Setting 6 tertiary care centres in four states in Australia. Participants 5328 singleton pregnancies in 5305 women recruited before 20 weeks of gestation. Interventions Fish oil capsules containing 900 mg omega-3 long-chain polyunsaturated fatty acids per day versus vegetable oil capsules consumed from enrolment until 34 weeks’ gestation. Outcome measures Early preterm birth (EPTB, <34 weeks’ gestation) and preterm birth (PTB, <37 weeks’ gestation) analysed using logistic regression models with interactions between treatment group and a range of maternal biological, clinical and demographic characteristics. Results Omega-3 supplementation reduced the odds of EPTB for women with low total omega-3 status in early pregnancy (OR=0.30, 95% CI 0.10–0.93). No additional maternal characteristics influenced whether omega-3 supplementation reduced the odds of EPTB. For PTB, women were more likely to benefit from omega-3 supplementation if they were multiparous (OR=0.65, 95% CI 0.49–0.87) or avoided alcohol in the lead up to pregnancy (OR=0.62, 95% CI 0.45–0.86). Conclusions Our results support previous findings that women with low total omega-3 levels in early pregnancy are most likely to benefit from taking omega-3 supplements to reduce their risk of EPTB. Understanding how other maternal characteristics influence the effectiveness of omega-3 supplementation on reducing PTB requires further investigation. Trial registration number ACTRN12613001142729.

Objective: To assess the feasibility of embedding omega‐3 fatty acid testing and targeted supplementation (the Omega‐3 Test‐and‐Treat Program) into routine antenatal care to reduce the risk of preterm birth. Study design: Prospective implementation evaluation study, using the Quality Enhancement Research Initiative (QUERI) framework. Setting, participants: Women with singleton pregnancies undergoing routine antenatal screening during early pregnancy (before 20 weeks’ gestation) and their health care providers, South Australia, 19 April 2021 – 30 June 2022. Intervention: Addition of omega‐3 fatty acid testing option to SA Pathology test referral forms for the South Australian Maternal Serum Antenatal Screening (SAMSAS) program, with the aim of identifying women with low omega‐3 fatty acid levels during early pregnancy and providing evidence‐based supplementation guidance for reducing the risk of preterm birth. Main outcome measures: Program feasibility (uptake and fidelity); representativeness of women tested for omega‐3 fatty acid status; and omega‐3 fatty acid status, by proportion of total serum fatty acids (low, < 3.7%; moderate, 3.7–4.3%; sufficient, > 4.3%). Results: A total of 4801 requests for omega‐3 fatty acid tests (26.1% of 18 362 SAMSAS referrals) were submitted to SA Pathology during the initial implementation phase of the Omega‐3 Test‐and‐Treat Program. The monthly number of test requests increased from 15 (2.4% of 627 SAMSAS referrals) in April 2021 to 340 (29.4% of 1156 SAMSAS referrals) in June 2022. The socio‐demographic and clinical characteristics of women referred for omega‐3 fatty acid testing were similar to those for women who were not. Serum samples were insufficient for omega‐3 fatty acid testing in 19 cases; of the 4782 tests performed, omega‐3 fatty acid levels were low in 702 (14.7%), moderate in 1638 (34.2%), and sufficient in 2442 tests (51.1%). Of 5057 samples received by the Omega‐3 Laboratory, 4935 (97.6%) were analysed within 72 hours. Thirty‐three of 4801 omega‐3 fatty acid test referrals (0.7%) were for women beyond 20 weeks of pregnancy; 58 referrals (1.2%) were for women with non‐singleton pregnancies. Conclusion: The Omega‐3 Test‐and‐Treat Program is a feasible approach to reducing the risk of preterm birth with a targeted nutritional intervention that could be integrated into routine antenatal care in Australia.

Purpose of review: This is a review of the most up-to-date research on the effectiveness of omega-3 fatty acids for reducing the risk of prematurity in well nourished women with access to high-quality obstetric care. It will provide an overview of the translation of the evidence on omega-3 screening into policy, and the latest research on how to implement the policy into practice. Recent findings: Findings of the included clinical studies support that omega-3 supplementation for women with a singleton pregnancy who have a low omega-3 status reduces the risk of early preterm birth. Summary: There is evidence that screening and providing appropriate advice to women with a singleton pregnancy who have a low omega-3 status can reduce their risk of early preterm birth, and avoiding supplementation for women who are replete will avoid unnecessary supplementation and potential harm.