Suche
Relation
Freedman R, Hunter SK, Law AJ, et al. Effects of maternal choline and respiratory coronaviruses on fetal brain development.J Psychiatr. Res. 2020;128:1-4.
Study objective
To investigate the influence of maternal choline levels on the inflammatory immune response triggered by viral respiratory tract infections during pregnancy and the subsequent influence on infant neurological development.
Draft
Researchers analyzed a subset of data from a 2019 study that asked pregnant women about viral infections during pregnancy, tested blood C-reactive protein (CRP) and choline levels, and analyzed trends associated with infant development at 3 months.1
Participant
Ninety-six pregnant women, including 43 who had a viral respiratory infection before 16 weeks of gestation and 53 who did not.
Study parameters assessed
Researchers asked participants at 16 weeks of pregnancy whether they had had viral respiratory infections that caused illness in the previous 6 weeks. If the answer was yes, women were asked to rate their symptom severity; Researchers confirmed this self-report with a retrospective chart review. Maternal choline and CRP values were taken at 16 weeks. When infants were 3 months old, mothers completed the Infant Behavior Questionnaire-Revised Short Form (IBQ-R).
Primary outcome measures
History of viral respiratory infection, maternal CRP and choline levels, and infant IBQ-R scores at 3 months, particularly the assessments of regulation and attention.
Key insights
Viral respiratory tract infections correlated with elevated CRP levels in women at 16 weeks of pregnancy. There were no differences in infant regulation and attention scores in women with serum choline levels of at least 7.5 µmol/L compared to uninfected women. Infants born to mothers who reported viral respiratory tract infections and had serum choline levels less than 7.5 μmol/L had significantly lower attention scores (2.64) compared with infants born to mothers without infection (5.00).
Practice implications
The association between maternal choline intake during pregnancy and infant outcomes is a hot topic in prenatal nutrition. This article contributes to a growing body of work suggesting that all providers working with pregnant women should assess maternal choline intake.
The study currently reviewed used a subset of data suggesting that viral infection during the early second trimester may have negative neurological effects that are seen later in the infant's neurological development, at least in those women who have lower choline levels after 16 weeks of pregnancy.
Studies in animals have shown that inflammation during pregnancy can affect later brain function in offspring. For example, a rodent study suggested that there is a vulnerable window at the beginning of the second trimester, when inhibitory interneurons in the hippocampus are susceptible to maternal inflammation.2
While the cohort used for the current study did not have overt SARS-Cov-2 infection, the authors suggest that the same protective benefit that maternal choline appeared to have against common upper respiratory tract infections in their study may be relevant to coronavirus-induced inflammation. In support of their hypothesis, they cite a small case series of 9 women in Wuhan, China, who found elevated CRP levels in pregnant women with coronavirus infection.3
This article contributes to a growing body of work suggesting that all providers working with pregnant women should assess maternal choline intake.
We are still in the early stages of understanding the SARS-Cov-2 virus. There is no information about how it might affect vulnerable populations such as pregnant women and infant development. Although this study does not present new data specifically on COVID, it examines previous data and offers an interesting hypothesis that may be relevant to coronavirus infections.
The average choline intake among American women is 278 mg per day.4This is well below the 450 milligrams recommended by the U.S. Food and Drug Administration for pregnant women. Many prenatal vitamins contain little to no choline, leaving most women choline deficient and likely below the 7.5 µmol/L level that appears to provide the infant with neuroprotection from maternal inflammation.
This fact, as well as the growing body of research supporting the safety and potential benefits of adequate amounts of choline in pregnancy,5.6There is a strong case for monitoring maternal choline intake during pregnancy and suggesting dietary modification or supplementation to achieve desired intake. The possibility of adding a protective layer to infant brain development during a viral pandemic makes adopting this idea more attractive, even as we wait for more conclusive data in the future.