Jun 18, 20203 min read

The Buzz: Choline Studies, Fetal Brain Development, and COVID-19 Relevance

Updated: Jun 22, 2020

Written by Moriah Thomason, PhD June 17, 2020

Do higher choline levels protect the fetal brain?

New studies provide evidence that higher choline levels appear to mitigate the adverse effects of the inflammation on a child’s behavior at 3 months of age.

In a recent study, Robert Freedman and colleagues measured maternal choline at 16-weeks gestation in 96 women; approximately half of whom had contracted respiratory infections during pregnancy. They measured the essential nutrient choline in the mother’s serum

(the portion of the blood that does not include clotting factors) and used the

Infant Behavior Questionnaire (IBQ)-Revised Short Form to measure infant development at 3 months age.

These researchers found that mothers with respiratory viral infections in early gestation were more likely to be depressed and anxious, based on the Center for Epidemiological Studies of Depression (CESD) and State-Trait Anxiety Inventory-State (STAI-S) inventories, p = 0.002 and p = 0.02, respectively).

Within the group of mothers that had viral infections, higher choline was associated with increased regulation, particularly attention. Additionally, in higher choline mothers there was not a difference between infection and non-infection groups on infant Regulation and Attention. Maternal depression and anxiety were not related to infant IBQ outcomes. The increased significance of effects in mothers with infection in this study may represent an interaction between the adverse effect of the infection and the positive effect of higher choline levels.

The major conclusion of the study is that higher prenatal choline levels may help protect the fetus's developing brain even if the mother contracts a viral respiratory infection in early pregnancy.

This is consistent with prior literature. Of the four double-blind placebo-controlled studies of choline or supplementation in pregnancy, three have found significant effects on infant cognition or behavior (Ross et al., 2016; Jacobson et al., 2018; Caudill et al., 2018); one did not (Cheatham et al., 2012).

Graphical abstract (Freedman et al, 2020)

What else do we know about choline?

Electroencephalographic (EEG) studies have evidenced choline-related change in fetal brain development.

A prior randomized placebo-controlled clinical trial study by Ross and colleagues (2013) revealed differences in infant EEG measures related to choline supplementation during pregnancy. They studied 100 women, half of whom were provided with supplementation to twice normal dietary levels. Using EEG recordings, researchers measured infant cerebral activity at 5-weeks.

The findings of this study supported that infant achievement of response inhibition was related to the mothers' choline supplementation. Babies of mothers' that had received the supplement had a much larger chance (76%) of showing the inhibition then the babies of those that did not (43%).

Why is this relevant to COVID-19?

As an essential part of the body's immune response, inflammation is both a protective and risk factor associated with infection by all viruses. While we all continue to learn more about the health implications of COVID-19, there is no evidence that the virus can be transmitted directly to the fetus during pregnancy. Thus, when considering the risk of contracting COVID-19 during pregnancy and potential impact on the fetus, it may be best to think of the virus as you would any infection. In response to infection, a mother's body mounts an immune response. While inflammation is a normal response to infection, it has been linked to infant brain development. It is important to note that not all inflammation is the same, and the impact of the body's response to virus on the fetus will vary by individual and according to the timing of infection during pregnancy. Although we are still learning about the body's immune response to this novel coronavirus, the suggested benefits of choline could potentially mitigate the risks associated with inflammation.

As with any serious illness during pregnancy, seeking the support of medical care is important for lessening the potential impact. If you are concerned that you have or may contract COVID-19 during pregnancy, it is important to know the facts. Currently, there are no known teratogenic (a fancy word for substances causing fetal abnormalities) effects associated with COVID-19. As a mother, focus on what you can control and know that by taking care of yourself, you are taking care of your baby.

We know that choline is produced naturally in small amounts by the liver, and that the body relies heavily on dietary sources to provide optimal amounts of choline. Four out of the five major food groups contain sources of choline; lean beef, poultry, fish, eggs, crustaceous vegetables, whole grains, nuts, milk, and eggs all contain choline. A healthy and balanced diet is important during pregnancy and postpartum for many reasons, and providing your body with choline is one of them!