Every day in the United States, millions of expectant mothers take a prenatal vitamin on the advice of their doctor.
The counsel typically comes with physical health in mind: folic acid to help avoid fetal spinal cord problems; iodine to spur healthy brain development; calcium to be bound like molecular Legos into diminutive baby bones.
But what about a child’s future mental health? Questions about whether ADHD might arise a few years down the road or whether schizophrenia could crop up in young adulthood tend to be overshadowed by more immediate parental anxieties. As a friend with a newborn daughter recently fretted over lunch, “I’m just trying not to drop her!”
Yet much as pediatricians administer childhood vaccines to guard against future infections, some psychiatrists now are thinking about how to shift their treatment-centric discipline toward one that also deals in early prevention.
In 2013, University of Colorado psychiatrist Robert Freedman and colleagues recruited 100 healthy, pregnant women from greater Denver to study whether giving the B vitamin choline during pregnancy would enhance brain growth in the developing fetus.
The moms-to-be were randomly given either a placebo or a form of choline called phosphatidylcholine. Choline itself is broken down by bacteria in the gut; by giving it in this related form the supplement can more effectively be absorbed into the bloodstream.
Those in the treatment group received 3,600 milligrams of phosphatidylcholine in the morning and 2,700 milligrams at night. Since phosphatidylcholine is roughly 13-15 percent choline, the amount the women received was about 900 milligrams of choline a day, twice that recommended by the Health and Medicine Division of the National Academies (and about the same amount contained in three large eggs).
It could be either 100 milligrams of liquid phosphatidylcholine or placebo once a day for approximately three months. Given that both groups were also getting choline from regular feeding, the dose ensured that those supplemented received well over the Institute of Medicine’s guideline that infants receive at least 125 milligrams a day.
At 5 weeks old, the children were exposed to a series of clicking sounds in the lab while their brain activity was monitored by electroencephalogram, or EEG, a method for recording electrical brain activity via electrodes placed on the scalp. Normally, when exposed to the same sound successively, both infant and adult brains will exhibit “inhibition,” or a far weaker pulse of activity in response to the second sound. We realize that the now familiar tone is insignificant; our brains are unmoved.
However, in some kids this inhibition doesn’t occur — a finding linked with an increased risk for attention problems, social withdrawal and, later in life, It appeared that choline might steer the infant brain away from a developmental course that predicted mental health problems.
A follow-up study at 40 months found that the children who had received choline supplements in utero and after birth had fewer attention problems and less social withdrawal.
Excessive choline consumption — or that over 7,500 milligrams a day — has been associated with drops in blood pressure, sweating, gastrointestinal side effects and a “fishy” body odor. Most American diets contain a significant amount of choline, and supplementation to optimal levels poses no known side effects or risk to fetal development, Freedman says.
The prospects of choline supplementation in pregnancy have piqued medical interest, but also notes of caution. “I think the choline research is really intriguing, and we’re starting to investigate maternal choline levels as well,” says Catherine Monk, an associate professor in psychiatry and obstetrics and gynecology at Columbia University Medical Center. “Some prenatal vitamins do contain it and foods rich in choline are readily available. But we have a lot more research to do before we start recommending it widely.”
“The hardest part is getting this across to the funding agencies and the public,” she says. But this is a serious public health issue in which prevention during pregnancy is far more preferable to the loss of health and consequences that come with mental illness!”
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