Written by Jessica Patella, ND. Early choline supplementation was associated with better infant brain function.
Schizophrenia affects 51 million people worldwide (1). Risk factors for future development of schizophrenia include maternal malnutrition, depression, anxiety, infection and cigarette smoking (2-5). The primary nutrient involved in schizophrenia is choline and previous research has found a decrease in choline increases the risk of schizophrenia in the fetus (6). Choline is a main component of cell walls and due to the increased demand for this nutrient during pregnancy, the mother must increase her intake (7). Natural sources of choline include meats and eggs (7).
A recent study on the effect of choline on later schizophrenia risk is the first randomized trial under the U.S. Food and Drug Administration (FDA) for the purpose of ameliorating a pathophysiological deficit (7). The research included 100 health pregnant women randomly assigned to receive choline or placebo. All mothers received standard prenatal care, including standard folate and multivitamin supplements and ultrasound examinations.
Starting in the second trimester at 17.2 weeks of pregnancy, women took either 3,600 mg of phosphatidylcholine in the morning and 2,700 mg of phosphatidylcholine in the evening (n=46) or placebo (n=47), until delivery (averaging 900 mg of choline per day; the equivalent to 3 large eggs). After birth, the infants received 100 mg of phosphatidylcholine in a liquid form once daily (n=46) or placebo (n=47) until 3 months of age (7). The choline supplementation was well tolerated without adverse side effects (7).
Previous research has shown the P50 response as an accurate measure of future schizophrenia risk (8). The P50 response, is a ratio mathematically determined by the brain response to auditory stimulation (7). A P50 ratio of over 0.5 is considered intact brain function and under 0.5 is considered lowered inhibition and related to schizophrenia (7).
In the infants at 33 days of age the P50 ratio over 0.5 was observed in 43% of the infants that received placebo and 76% of the infants that received choline (p=0.009), showing a significant difference. At the second recording, at 3 months of age and the final data collection, 72% of the infants that received placebo and 76% of the infants that received choline had a P50 ratio of over 0.5, showing no significant difference between the two groups by 3 months (7).
This was the first randomized controlled trial of choline supplementation in pregnancy for any reason (7). The study is a relatively small sample size and should be repeated. The study also does not determine if choline supplementation will actually prevent later mental illness, which is a challenge since schizophrenia usually takes decades to appear (7).
In conclusion, choline supplemented during the second and third trimesters of pregnancy and in the infant up to 3 months of age showed improvement in brain function at 1 month, determined by developmental P50 brain stimulation delay (7). The researchers suggest a population-wide supplementation of choline (because of its safety) to determine the ultimate outcome of possible prevention of schizophrenia. The researchers added that the beneficial effects of folic acid on preventing neural tube defects were not established until they were applied to the whole population (7).
Source: Ross, Randal G., et al. “Perinatal choline effects on neonatal pathophysiology related to later schizophrenia risk.” American Journal of Psychiatry 170.3 (2013): 290-298.
Posted January 29, 2013.
Jessica Patella, ND, is a naturopathic physician specializing in nutrition and homeopathic medicine and offers a holistic approach to health. She earned her ND from Southwest College of Naturopathic Medicine in Tempe, AZ, and is a member of the North Carolina Association of Naturopathic Physicians. Visit her website at www.awarenesswellness.com
References:
- Schizophrenia Statistics. The Mental Health Initiative.
- Brown AS, Derkits EJ: Prenatal infection and schizophrenia: a review of epidemiologic and translational studies. Am J Psychiatry 2010; 167:261–280.
- Mäki P, et al: Schizophrenia in the offspring of antenatally depressed mothers in the northern Finland 1966 birth cohort: relation- ship to family history of psychosis. Am J Psychiatry 2010; 167: 70–77.
- Ekblad M, et al: Prenatal smoking exposure and the risk of psychiatric morbidity into young adulthood. Arch Gen Psychiatry 2010; 67:841–849.
- Susser E, et al: Schizophrenia after prenatal famine: further evidence. Arch Gen Psychiatry 1996; 53:25–31.
- Zeisel SH: Choline: critical role during fetal development and dietary requirements in adults. Annu Rev Nutr 2006; 26: 229–250.
- Ross, et al: Perinatal Choline Effects on Neonatal Pathophysiology Related to Later Schizophrenia Risk. Am J Psychiatry: AiA:1-9.
- Cheng WP, et al: Probing the relative contribution of the first and second responses to sensory gating indices: a meta-analysis. Psychophysiology 2011; 48: 980–992.
