Summary: Choline, an essential nutrient, can help prevent fetal brain development problems in infants whose mothers experience common infections, such as influenza, during pregnancy.
Source: University of Colorado Anschutz Medical Campus
Choline, an essential B vitamin nutrient, can prevent fetal brain developmental problems that often occur after prenatal maternal infections such as colds and influenza (flu).
The study, published today in the Journal of Pediatrics, is led by members of the University of Colorado School of Medicine faculty at the CU Anschutz Medical Campus. The findings are critical because viruses, such as the flu, in pregnant women, have been linked with fetal brain problems and mental illness like Attention Deficit Disorder and Schizophrenia later in life.
“Mothers want to give their babies the best possible start in life. Colds and flu are often unavoidable, even if the mother has had a flu shot. But colds and flu during pregnancy double the risk of future mental illnesses. More and more information shows that choline helps the baby’s brain develop properly,” said Robert Freedman, MD, professor of psychiatry, University of Colorado School of Medicine. “We found that higher levels of choline prevent fetal brain problems from developing, even when the mother is infected. Choline supplements in pregnancy can have a lifelong benefit for the infant.”
The study was conducted at the University of Colorado and Denver Health Medical Center’s Prenatal Clinic, with prenatal assessments of maternal infection, C-Reactive Protein (CRP, a marker of maternal inflammation) and the mothers’ choline levels. The baby’s brain development before birth was assessed by measuring the baby’s brain waves soon after birth. The harmful effects of maternal infections were seen in a reduction of the normal inhibition, also known as response inhibition, of newborns’ brain waves to repeated sounds. Simply put, response inhibition is the ability to cease or delay an action and to be able to reflect rather than display impulsive behavior.
Newborns’ response inhibition decreased by 27 percent when mothers had an infection, such as a cold or flu, during the first 16 weeks of pregnancy.
This effect was prevented if the mother had higher choline levels in the first 16 weeks.
Parents completed reports of their child’s behavior when the child was one year of age.
Children whose mothers were infected, and had lower choline levels, had significantly decreased ability to pay attention, play quietly and cuddle with their parents. These effects did not occur if the mother had higher choline levels.
These characteristics are summarized in a scale of Self Regulation, which was reduced 28 percent in children of women with infection and lower choline levels. Higher choline levels improved Self Regulation in the children of women with infection to normal levels.
Five of 53 children whose mothers had an infection (9.4 percent) had Regulation levels in the lowest fifth percentile of a normal sample, compared to one of 83 children of mothers without an infection. This effect did not occur if their mothers had choline levels greater than 7 micromolar during gestation. This level was achieved by only 25 percent of the women, despite encouragement to eat foods with more choline in their diet.
The body creates some choline on its own and it is also naturally present in certain foods, including liver, red meat, and eggs. However, up to 75 percent of pregnant women consume less choline during pregnancy than recommended (450 mg of choline per day). Additionally, little or no amounts are present in prenatal vitamins. Supplements, available without a prescription and now recommended by the American Medical Association, can help mothers make sure they have high choline levels that their babies need.
This study was conceived and initiated by the late Randal G. Ross.
Higher Gestational Choline Levels in Maternal Infection Are Protective for Infant Brain Development
Objective To assess whether maternal choline decreases effects of mothers’ infections on fetal brain circuit development and on expression of infant behavior at 1 year of age.
Study design A cross-sectional study was conducted in a public hospital obstetrics and midwifery service, with prenatal assessments of maternal infection, C-reactive protein, and choline level and postnatal assessments of cerebral neuronal inhibition in 162 newborns. At 1 year, 136 parents completed reports of their child’s behavior.
Results Maternal infection at 16 weeks of gestation, experienced by 41% of mothers, raised mean maternal C-reactive protein (d’ = 0.47, P = .002) and decreased the development of cerebral inhibition of auditory response at 1 month of age (d’ = 0.39, P < .001). Decreased newborn cerebral inhibition manifested as decreased behavioral self-regulation at 1 year. Greater choline levels in mothers with infections were associated with improved newborn inhibition of auditory cerebral response, mitigating the effect of infection (β = −0.34 [95% CI, −5.35 to −0.14], P = .002). At 1 year of age, children of mothers with infection and greater gestational choline levels had improved development of self-regulation, approaching the level of children of mothers without infection (β = 0.29 [95% CI 0.05-0.54], P = .03).
Conclusions Greater maternal choline, recommended by the American Medical Association as a prenatal supplement, is associated with greater self-regulation among infants who experienced common maternal infections during gestation. Behavioral problems with diminished self-regulation often lead to referrals to pediatricians and might lead to later mental illness.