Journal Articles

Feasibility and Acceptability of Maternal Choline Supplementation in Heavy Drinking Pregnant Women: A Randomized, Double-Blind, Placebo-Controlled Clinical Trial.

June 21, 2018

Jacobson SW1,2,3, Carter RC4,5, Molteno CD3, Meintjes EM2,6, Senekal MS7, Lindinger NM2, Dodge NC1, Zeisel SH8, Duggan CP9, Jacobson JL1,2,3Feasibility and Acceptability of Maternal Choline Supplementation in Heavy Drinking Pregnant Women: A Randomized, Double-Blind, Placebo-Controlled Clinical Trial 2018 May 11. doi: 10.1111/acer.13768.

1 Department of Psychiatry and Behavioral Neurosciences , Wayne State University School of Medicine, Detroit, Michigan.
2 Department of Human Biology , Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa.
31Department of Psychiatry and Mental Health , Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa.
4Division of Pediatric Emergency Medicine , Morgan Stanley Children’s Hospital of New York, New York, New York.
5Institute for Human Nutrition , Columbia University Medical Center, New York, New York.
6MRC/UCT Medical Imaging Research Unit , Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa.
7Division of Nutrition , Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa.
8Nutrition Research Institute , University of North Carolina at Chapel Hill, Kannapolis, North Carolina.
9Division of Gastroenterology, Hepatology and Nutrition, Center for Nutrition, Boston Children’s Hospital/Harvard Medical School, Boston, Massachusetts.

Abstract

BACKGROUND:

Choline, an essential nutrient, serves as a methyl-group donor for DNA methylation and is a constituent of the neurotransmitter acetylcholine and a precursor to major components of cell membranes. Findings from animal studies suggest that choline supplementation during pregnancy can mitigate adverse effects of prenatal alcohol exposure on growth and neurocognitive function. We conducted a randomized, double-blind exploratory trial to examine feasibility and acceptability of a choline supplementation intervention during pregnancy.

METHODS:

Seventy heavy drinkers, recruited in mid-pregnancy, were randomly assigned to receive a daily oral dose of 2 g of choline or a placebo from time of enrollment until delivery. Each dose consisted of an individually wrapped packet of powder that, when mixed with water, produced a sweet tasting grape-flavored drink. Adherence was assessed by collecting used and unused drink packets on a monthly basis and tabulating the number used. Side effects were assessed in monthly interviews. Blood samples obtained at enrollment and at 4 and 12 weeks after randomization were assayed for plasma choline concentration.

RESULTS:

Adherence was good-to-excellent (median doses taken = 74.0%; interquartile range = 53.9 to 88.7%) and was not related to a range of sociodemographic characteristics or to alcohol consumption ascertained using a timeline follow-back interview. By 4 weeks, plasma choline concentrations were significantly higher in the choline supplementation than the placebo arm, and this group difference continued to be evident at 12 weeks. The only side effect was a small increase in nausea/dyspepsia. No effects were seen for diarrhea, vomiting, muscle stiffness, blood pressure, or body odor changes.

CONCLUSIONS:

This study demonstrated that a choline supplementation program with very heavy drinkers during pregnancy is feasible even among highly disadvantaged, poorly educated women. The broad acceptability of this intervention is indicated by our finding that adherence was not related to maternal education, intellectual function, depression, nutritional status, or alcohol use.

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