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Alcohol Clin Exp Res. 2018 Jul;42(7):1327-1341. doi: 10.1111/acer.13769. Epub 2018 Jun 15.

Efficacy of Maternal Choline Supplementation During Pregnancy in Mitigating Adverse Effects of Prenatal Alcohol Exposure on Growth and Cognitive Function: A Randomized, Double-Blind, Placebo-Controlled Clinical Trial.

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Department of Psychiatry and Behavioral Neurosciences, Wayne State University School of Medicine, Detroit, Michigan.
Department of Human Biology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa.
Department of Psychiatry and Mental Health, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa.
Division of Pediatric Emergency Medicine, Morgan Stanley Children's Hospital of New York, New York, New York.
Institute for Human Nutrition, Columbia University Medical Center, New York, New York.
Department of Psychology, University of Delaware, Newark, Delaware.
Department of Psychology, University of Wollongong, New South Wales, Australia.
Department of Pediatrics, Sanford School of Medicine, University of South Dakota, Sioux Falls, South Dakota.
College of Medicine, University of Arizona, Tucson, Arizona.
Nutrition Research Institute, University of North Carolina at Chapel Hill, Kannapolis, North Carolina.
MRC/UCT Medical Imaging Research Unit, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa.
Division of Gastroenterology, Hepatology and Nutrition, Center for Nutrition, Boston Children's Hospital/Harvard Medical School, Boston, Massachusetts.



We recently demonstrated the acceptability and feasibility of a randomized, double-blind choline supplementation intervention for heavy drinking women during pregnancy. In this study, we report our results relating to the efficacy of this intervention in mitigating adverse effects of prenatal alcohol exposure (PAE) on infant growth and cognitive function.


Sixty-nine Cape Coloured (mixed ancestry) heavy drinkers in Cape Town, South Africa, recruited in mid-pregnancy, were randomly assigned to receive a daily oral dose of either 2 g of choline or 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. The primary outcome, eyeblink conditioning (EBC), was assessed at 6.5 months. Somatic growth was measured at birth, 6.5, and 12 months, recognition memory and processing speed on the Fagan Test of Infant Intelligence, at 6.5 and 12 months.


Infants born to choline-treated mothers were more likely to meet criterion for conditioning on EBC than the placebo group. Moreover, within the choline arm, degree of maternal adherence to the supplementation protocol strongly predicted EBC performance. Both groups were small at birth, but choline-treated infants showed considerable catch-up growth in weight and head circumference at 6.5 and 12 months. At 12 months, the infants in the choline treatment arm had higher novelty preference scores, indicating better visual recognition memory.


This exploratory study is the first to provide evidence that a high dose of choline administered early in pregnancy can mitigate adverse effects of heavy PAE on EBC, postnatal growth, and cognition in human infants. These findings are consistent with studies of alcohol-exposed animals that have demonstrated beneficial effects of choline supplementation on classical conditioning, learning, and memory.


Choline Supplementation; Eyeblink Conditioning; Fetal Alcohol Spectrum Disorders; Fetal Alcohol Syndrome; Growth; Prenatal Alcohol Exposure

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