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Am J Perinatol 2024; 41(S 01): e939-e948
DOI: 10.1055/s-0042-1759775
Original Article

Maternal Plasma Choline during Gestation and Small for Gestational Age Infants

Maria C. Hoffman
1   Division of Maternal and Fetal Medicine, Departments of Obstetrics and Gynecology and Psychiatry, University of Colorado School of Medicine, Aurora, Colorado
,
Sharon J. Hunter
2   Department of Psychiatry, University of Colorado School of Medicine, Aurora, Colorado
,
Angelo D'Alessandro
3   Department of Biochemistry and Molecular Genetics, University of Colorado School of Medicine, Aurora, Colorado
,
Uwe Christians
4   Department of Anesthesiology, iC42 Clinical Research and Development, University of Colorado School of Medicine, Aurora, Colorado
,
Amanda J. Law
5   Department of Psychiatry, Cell and Developmental Biology, and Medicine, University of Colorado School of Medicine, Aurora, Colorado
,
Robert Freedman
2   Department of Psychiatry, University of Colorado School of Medicine, Aurora, Colorado
› Author Affiliations Funding This study was supported by National Institute of Child Health and Human Development (K12HD001271-11), National Center for Advancing Translational Sciences (UL1TR001082), The Institute for Children's Mental Disorders, and The Anschutz Foundation. The funding sources had no role in the design, conduct, or reporting of the study.
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Abstract

Objective Small for gestational age (SGA) infants are at increased risk for neonatal morbidity and developmental problems in childhood. No current interventions during human pregnancy address this problem. This study investigated the possible relationship between maternal choline concentration during pregnancy and SGA infants.

Study Design Maternal plasma choline concentrations were sampled at 16 and 28 weeks' gestation from women in a public prenatal clinic. Additional factors assessed were maternal age, body mass index, infection, C-reactive protein, hair cortisol, and compliance with prenatal vitamins and folate. Infants below the 10th percentile for gestational age were classified as SGA. Binary logistic regression was used to identify significant associated factors in pregnancies resulting in SGA infants compared with pregnancies resulting in non-SGA infants.

Results Thirteen (8%) of 159 women had SGA infants. Maternal plasma choline concentrations were low for pregnant participants whose infants were SGA, with the 28-week concentration significantly lower compared with other participants. Plasma choline concentrations ≥7 μM at 28 weeks, consistent with a minimally adequate dietary intake of choline-containing foods, were achieved by only 2 (15%) of mothers with SGA infants, compared with 51% of mothers whose infants were not SGA. Choline concentrations <7 μM at 28 weeks' gestation were associated with an odds ratio for SGA of 16.6 (95% confidence interval: 1.5–189.2, p = 0.023). Other significant factors were female sex and maternal C-reactive protein plasma concentration during gestation.

Conclusion This observational study suggests that higher maternal choline levels may influence the risk for SGA. Maternal plasma choline concentrations are not routinely available in clinical laboratories. However, plasma choline levels can be increased by the mothers' intake of choline or phosphatidylcholine supplements. No nutritional intervention is currently recommended to prevent SGA, but the evidence from this study suggests that further consideration of the role of maternal choline may be warranted.

Key Points

  • More females are small for gestational age.

  • Low maternal choline is related to small infants.

  • Maternal choline ≥7 μM at 28 weeks appears optimal.

Keywords

infant - small for gestational age - choline - birth weight - pregnancy - nutrition


Publication History

Received: 22 April 2022

Accepted: 01 November 2022

Article published online:
30 December 2022

© 2022. Thieme. All rights reserved.

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