Written by Joyce Smith, BS. Study suggests that maternal supplementation with choline protects early brain development by decreasing the negative effects of viral respiratory infections including COVID-19, even when the maternal viral infection occurs in early gestation.
Common respiratory infections during pregnancy increase the risk of attention deficit disorder, autism spectrum disorder and even schizophrenia 1-3. The Centers for Disease Control (CDC) suggest that infection with COVID-19 during pregnancy will, like other coronaviruses, affect fetal development 4. While COVIID-19 is not directly transmitted to the fetus 5, the virus incites a maternal immune response that adversely affects brain development. According to a 2014 study by Canetta et al, high maternal C-reactive protein (CPR) at the beginning of the second trimester is associated with an increased risk of schizophrenia in the offspring 6.
Freedman and colleagues, in a 2019 study, demonstrated that bacterial and viral infections during the gestation window of 10 to 16 weeks increased maternal CRP levels and inflammation, and that higher maternal choline levels at 16 months gestation appeared to diminish the effects of inflammation in the children’s behaviors at 3 months of age 7. In their current 2020 study, the team analyzed 7 a subset of data using the data gleaned from their prior studies of women who developed bacterial and viral infections during the first 16 weeks of pregnancy when fetal development is most vulnerable. Based on the guidelines issued by the U.S. Centers for Disease control (CDC) 4, they assumed that COVID-19 infection during pregnancy would have an affect on fetal development similar to that of past respiratory coronaviruses. To that end, the team compared 36 pregnant women who had developed moderate to severe respiratory infections by the 16th week of gestation to 53 mothers who reported no infections. They measured CRP and choline levels in both groups at week 16 and at other time points. When infants reached 3 months of age, their mothers completed an extensive Infant Behavior Questionnaire-Revised Short Form (IBQ-R; a parent-report measure of infant behaviors) 8.
Data analysis revealed that mothers with respiratory viral infections in early gestation were younger and more prone to depression and anxiety. Viral infection was associated with higher CRP in infected women than in uninfected women (11.0 mg/L 1.4 versus 7.5 mg/L, P = 0.047). When comparing the CPR range for the infected women to a case series of 9 COVID-19 infected mothers from Wuhan, China, CRP levels were very similar, ranging from 0.6–38.8 mg/L. in the infected women to 3.3 to 33.4 mg/L in the Chinese mothers 9. In addition, three-month IBQ-R scores showed significant improvement in infants whose infected mothers had choline levels greater than 7.5 μM (levels at or above the minimum level of 550 mg per day advised by the FDA) compared to infants whose infected mothers had choline levels less than 7.5 μM. The babies had a greater ability to maintain attention and to bond with their parents and caretakers.
The effects of choline in COVID-19 infection on infant development are presently yet unknown, and no mother in this study had an infection requiring intensive care medical support or COIVD-19. While the inflammatory reactions of the infected pregnant women in this study varied considerably, researchers found their range to be similar to the range of CRP levels in Chinese pregnant women who were infected with COVID-19. The study validates that when moderately severe respiratory virus infections occur during pregnancy, phosphatidylcholine or choline supplements along with other prenatal vitamins may help maintain higher prenatal choline levels and protect the early fetal brain development of the infants.
Source: Freedman, Robert, Sharon K. Hunter, Amanda J. Law, Angelo D’Alessandro, W. Kathleen Noonan, Anna Wyrwa, and M. Camille Hoffman. “Maternal choline and respiratory coronavirus effects on fetal brain development.” Journal of Psychiatric Research (2020).
© 2020 Elsevier Ltd. All rights reserved.
Posted July 6, 2020.
Joyce Smith, BS, is a degreed laboratory technologist. She received her bachelor of arts with a major in Chemistry and a minor in Biology from the University of Saskatchewan and her internship through the University of Saskatchewan College of Medicine and the Royal University Hospital in Saskatoon, Saskatchewan. She currently resides in Bloomingdale, IL.
References:
- Mednick SA, Machon RA, Huttunen MO, Bonett D. Adult schizophrenia following prenatal exposure to an influenza epidemic. Arch Gen Psychiatry. 1988;45(2):189-192.
- Hornig M, Bresnahan MA, Che X, et al. Prenatal fever and autism risk. Mol Psychiatry. 2018;23(3):759-766.
- Werenberg Dreier J, Nybo Andersen AM, Hvolby A, Garne E, Kragh Andersen P, Berg-Beckhoff G. Fever and infections in pregnancy and risk of attention deficit/hyperactivity disorder in the offspring. Journal of child psychology and psychiatry, and allied disciplines. 2016;57(4):540-548.
- CDC. Data on COVID-19 during Pregnancy. https://www.cdc.gov/coronavirus/2019-ncov/cases-updates/special-populations/pregnancy-data-on-covid-19.html. Accessed June 29, 2020.
- Kimberlin DW, Stagno S. Can SARS-CoV-2 infection be acquired in utero?: more definitive evidence is needed. Jama. 2020;323(18):1788-1789.
- Canetta S, Sourander A, Surcel HM, et al. Elevated maternal C-reactive protein and increased risk of schizophrenia in a national birth cohort. The American journal of psychiatry. 2014;171(9):960-968.
- Freedman R, Hunter SK, Law AJ, et al. Higher Gestational Choline Levels in Maternal Infection Are Protective for Infant Brain Development. J Pediatr. 2019;208:198-206.e192.
- Freedman R, Hunter SK, Law AJ, et al. Maternal choline and respiratory coronavirus effects on fetal brain development. J Psychiatr Res. 2020;128:1-4.
- Chen H, Guo J, Wang C, et al. Clinical characteristics and intrauterine vertical transmission potential of COVID-19 infection in nine pregnant women: a retrospective review of medical records. Lancet. 2020;395(10226):809-815.
