What a mother eats during pregnancy can help shape her baby's development. Now, a new study suggests that getting additional choline, a nutrient found in foods such as eggs, meat, fish and soy, may have benefits that last well beyond birth.
In a randomized clinical trial involving 206 pregnant women, researchers found that children whose mothers received choline supplements performed better on cognitive tests at age 4 and showed fewer signs of social withdrawal than children whose mothers received a placebo. The findings, published in the American Journal of Obstetrics & Gynecology, offer promising evidence of choline's role in early brain development, although the researchers say more studies are needed.
Choline helps support the development of the brain and nervous system, making it particularly important during pregnancy. Yet many pregnant women don't get the recommended amount through their diets, and some prenatal vitamins contain little or no choline.
To investigate whether additional choline could make a difference, researchers at the University of Colorado Anschutz assigned pregnant women to receive either a daily supplement containing phosphatidylcholine, a form of choline found naturally in foods, or a placebo. The women began taking the supplements around 16 weeks into pregnancy and continued until delivery.
At age 4, children in the supplement group scored an average of nearly eight points higher on a standardized cognitive test than children in the placebo group. The tests measured abilities such as memory, problem-solving and understanding visual information.
Researchers also found differences in social behavior. About 4% of children in the supplement group showed elevated signs of social withdrawal, compared with 24% in the placebo group. These behaviors can include avoiding interactions with others, showing less interest in social activities or making less eye contact.
The researchers also observed fewer children with certain behaviors sometimes associated with autism spectrum disorder. However, the findings were based on behavioral screening rather than confirmed diagnoses and involved a small number of children. The study does not establish that choline supplements can prevent autism.
Not every outcome improved. The supplements did not significantly reduce attention problems, another area the researchers examined.
While the findings are encouraging, there are reasons for caution. Although 206 women participated in the trial, only 103 children completed the cognitive testing at age 4. Parents also reported their children's social behaviors, and families with higher levels of maternal education were more likely to remain in the study. These factors make it difficult to know whether the results would hold true in a larger, more diverse group.
The amount of choline used in the study also matters. Researchers tested a supplement that provided approximately 1,285 milligrams of choline daily, considerably more than the 450 milligrams recommended during pregnancy. Although no significant supplement-related safety concerns were reported, the study doesn't establish that higher doses are necessary or appropriate for every pregnant woman.
Choline is naturally found in a variety of foods, including eggs, meat, fish, dairy products and soy foods such as tofu and edamame. Some vegetables, beans and whole grains also contribute choline to the diet. Getting enough through food can be challenging for some people, but that doesn't necessarily mean everyone needs a supplement.
The findings add to growing evidence that prenatal nutrition may influence children's development for years after birth. They also bring attention to a nutrient that often receives less attention than folate or iron during pregnancy. For now, pregnant women who are concerned about getting enough choline can discuss their diets and prenatal vitamins with their health care providers before adding supplements.
The study was supported by the National Institutes of Health, the Institute for Children's Mental Health and The Anschutz Foundation. One researcher disclosed previous unpaid advisory and consulting work involving genetic tests related to choline metabolism.