Omega-3 Cautions in Pregnancy, Children, Kidney Disease and Liver Disease

Start with your clinician

Pregnancy, childhood, kidney disease and liver disease are situations where a clinician or pharmacist should decide about omega-3 products. This page reports what the sources say; it gives no personal amounts. If a child swallowed a large amount of any supplement, or anyone may have had an allergic or poisoning emergency, call 911 or Poison Help at 1-800-222-1222 (US). For other countries see Poison Help by country.

Evidence labels

Established (clear in the sources), mixed, insufficient, and Proper evidence not found (we searched and found nothing usable). Study amounts are not advice.

Infants and children

• Prescription labels say safety and effectiveness in pediatric patients have not been established. [4][6]
• EFSA said the data were insufficient to set an upper intake level for EPA, DHA or DPA, and noted that at the intake levels obtained from foods, long-chain omega-3 has not been associated with adverse effects in healthy adults and children. [7]
• In a French trial of 162 children aged 6 to 15 with ADHD, two children given DHA and EPA, and none on placebo, had a severe adverse event (hospitalization for worsening ADHD symptoms); the trial found no benefit. [8] This is one small trial and cannot show cause.
• Proper evidence not found: we found no source we could read that gives safe amounts of over-the-counter omega-3 gummies or liquids for children. Ask a pediatrician. See omega-3 for children and teens.

Kidney disease

A 2020 meta-analysis of 60 trials (4,129 people with chronic kidney disease, median follow-up 6 months) found low to very low certainty evidence that omega-3 may reduce cardiovascular death in people on hemodialysis, and called bleeding risk (relative risk 1.40, 95% CI 0.78 to 2.49) and gastrointestinal side effects (1.14, 0.79 to 1.67) uncertain. [9] Ask your kidney team or pharmacist before adding any omega-3 product. More: omega-3, kidney disease and fatty liver.

Liver disease

Prescription omega-3 labels say that in patients with hepatic impairment, ALT and AST levels should be monitored periodically, and some patients had ALT increases. [4] A 2020 meta-analysis of 22 trials (1,366 people) found omega-3 reduced liver fat in non-alcoholic fatty liver, which is an evidence finding rather than a safety clearance. [10] Proper evidence not found: we did not find a source we could read on omega-3 safety in advanced liver disease such as cirrhosis. Liver conditions need clinician-led care. See Liver safety and supplements.