Association between maternal choline, foetal brain development and child neurocognition; systematic review and meta-analysis of human studies

Oeid R. August 2022. Association between maternal choline, foetal brain development and child neurocognition; systematic review and meta-analysis of human studies. Advances in Nutrition. doi: 10.1093/advances/nmac082

ABSTRACT 

We studied associations between prenatal and early postnatal choline intake, brain development and neurocognitive function of the child. We conducted a systematic review followed by meta-analysis and critical appraisal of human studies published from 1997 to 2021. Thirty publications were identified. The meta-analysis included 5 of 7 case-control studies studying neural tube defects (NTD) in relation to maternal choline intakes/circulating levels. Low maternal choline intake/circulating levels were associated with a higher odds ratio for NTD amongst 1131 mothers of children with NTD and 4439 control mothers [pooled estimate (95% confidence intervals) = 1.36 (1.11, 1.67)]. The 95% prediction intervals were (0.78, 2.36). Findings and critical evaluation of 10 publications with interventional designs showed that higher maternal choline intakes during the second half of pregnancy and early postnatal period (550 mg up to 1 g/d on top of the diet), or a child intake of 513 to 625 mg/d from supplements were safe and likely to demonstrate favorable effects on several domains of child neurocognition such as memory, attention and visuospatial learning versus the comparators. Findings from observational studies (n =13) partly supported the association between maternal choline intake/serum levels and child neurocognition, but there was low confidence in the use of plasma choline levels as a choline intake marker. In conclusion, low maternal choline intakes were associated with a higher odds ratio for NTDs. The risk could be up to 2.36 fold in some populations. Despite limitations of available trials and observational studies, higher maternal choline intake was likely to be associated with better child neurocognition/neurodevelopment. The results should be used to guide choline intake recommendations in pregnancy and lactation, especially that most young women are not achieving the reference intake of choline. This meta-analysis is registered at PROSPERO: ID; CRD42021233790.

Keywords: Brain; choline; essential nutrient; first trimester; infant; lactation; neural tube defects; neurocognition; pregnancy; prenatal.

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