Increasing the recommended amount of choline pregnant women should consume may lead to cognitive benefits in their offspring’s early childhood, new research suggests.
In a controlled-feeding study, children whose mothers consumed twice the recommended amount of prenatal choline during the third trimester had better focus during tasks that require sustained attention than the children of women who consumed less choline during pregnancy.
“Adequate choline intake throughout pregnancy is important for fetal development,” co–senior authors Barbara J. Strupp, PhD, and Richard L. Canfield, PhD, Division of Nutritional Sciences, Cornell University, Ithaca, New York, said in a joint email to Medscape Medical News.
They note that “at a bare minimum,…women should increase their choline intake to 450 mg/day. However, 80% to 90% of pregnant women currently consume less than this amount.”
“Based on our study and the results of other studies, maternal choline intake of at least 930 mg/day appears to be completely safe and beneficial for offspring neurobehavioral development,” said Strupp and Canfield.
The findings were published online December 28 in the FASEB Journal.
Long-Lasting Benefits
Physiological demands for choline increase during pregnancy, due to the micronutrient’s numerous roles in fetal development, including brain development.
The current recommendation of 450 mg of choline per day for pregnant women was set in 1998 and is based on the amount of choline needed to prevent liver dysfunction in men, not on endpoints related to brain function in offspring.
In the current controlled-feeding trial, 29 pregnant women consumed 480 mg of choline daily (roughly the adequate intake level) or 930 mg daily during the third trimester.
To achieve these total choline intake levels, all women consumed the same study diet, which provided 380 mg choline per day. They also consumed an additional choline supplement of either 100 or 550 mg choline daily.
The researchers followed up with 20 of the children when they were 7 years old to assess multiple aspects of attentional control.
Children whose mothers consumed 930 mg choline daily performed significantly better on a “challenging” sustained attention task, the primary endpoint, than children whose mothers consumed 480 mg choline daily (P = .02).
Children from the higher maternal choline-intake group had “superior ability to detect visual signals while also correctly identifying non-signal events,” the investigators report.
In addition, emerging evidence from other tests administered to these children at age 7 indicate that the benefits of higher maternal choline intake are not limited to sustained attention but also include improved working memory and problem solving, they write.
Knowledge Gaps
The findings in this cohort of children at age 7 extend the results from the researchers’ earlier study assessing the same children during infancy “and provide new evidence that the beneficial effects of maternal choline supplementation during pregnancy for offspring attentional function endure into early childhood.”
Strupp and Canfield noted the findings are “strong enough to move the needle” in the direction of increasing the current adequate intake levels for choline in pregnancy ― but several key knowledge gaps remain.
“First, our sample size was too small to ensure that the benefits produced by the higher choline dose used in our study would be appropriate for all groups of women,” they said.
A second limitation cited was that choline intake in the participants’ diet was completely controlled by investigators providing all of the food.
“This is a strength for showing that a certain intake level is beneficial but does not automatically generalize to the case where women are consuming their own diets and are advised to increase their choline intake,” the researchers said.
A third limitation was that choline supplementation happened only in the third trimester of pregnancy. “A more realistic intervention would begin supplementation at around the same time that women begin taking prenatal vitamins. This longer period of supplementation might change the dose required to produce beneficial effects on child cognition,” Strupp and Canfield said.
Ideally, what is now needed is one or more large clinical trials with diverse sets of participants, a placebo control group, and two or three choline supplement doses, they added.
“This would allow for the observation of dose-response relationships and to compare results across subgroups of women who vary in genetic and/or dietary characteristics,” Strupp and Canfield noted.
“The information provided by such studies would make it possible to identify an evidence-based recommended daily intake level of choline for pregnant women,” they said.
“Gaining Traction”
Commenting on the findings for Medscape Medical News, Amy Valent, DO, Oregon Health & Science University in Portland, said there has been “a ton of work with regards to micronutrients in pregnancy and choline has been gaining a lot of traction.”
Valent said the study was “well done” and that she is not particularly surprised about the results, “given choline’s known role in fetal development and the environment in the womb is strongly influential on long-term outcomes of children.”
In addition, results from animal studies have suggested that cognitive function can be influenced by choline, she noted.
“I wouldn’t say the results are conclusive, but I think that a lot of us that have been paying attention to the nutrition literature have already been encouraging more choline intake in pregnancy,” said Valent, who was not involved with the current research.
However, the process of actually getting extra choline is “challenging,” she said.
“Choline in the salt form, which is the appropriate form to actually give it from a supplementation perspective, is a huge tablet. It would be impossible to put it into a prenatal supplement. In this study, they liquefy the choline, which is obviously a lot easier to take,” Valent noted.
“The question remains, however, that for people with supposedly a decent diet, how much supplementation is necessary? We don’t really know at this point,” she said.
The study was funded by the National Institute of Food and Agriculture, part of the US Department of Agriculture, and Balchem Corp, which provided the choline supplement used in the study. The funders had no role in the study design, data collection, or analysis and interpretation of the data. Strupp, Canfield, and Valent have reported no relevant financial relationships.
FASEB J. Published online December 28, 2021. Full article
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