Prenatal and Postnatal Choline Supplementation in Fetal Alcohol Spectrum Disorder

Abstract

Fetal alcohol spectrum disorder (FASD) is common and represents a significant public health burden, yet very few interventions have been tested in FASD. Cognitive deficits are core features of FASD, ranging from broad intellectual impairment to selective problems in attention, executive functioning, memory, visual–perceptual/motor skills, social cognition, and academics. One potential intervention for the cognitive impairments associated with FASD is the essential nutrient choline, which is known to have numerous direct effects on brain and cognition in both typical and atypical development. We provide a summary of the literature supporting the use of choline as a neurodevelopmental intervention in those affected by prenatal alcohol. We first discuss how alcohol interferes with normal brain development. We then provide a comprehensive overview of the nutrient choline and discuss its role in typical brain development and its application in the optimization of brain development following early insult. Next, we review the preclinical literature that provides evidence of choline’s potential as an intervention following alcohol exposure. Then, we review a handful of existing human studies of choline supplementation in FASD. Lastly, we conclude with a review of practical considerations in choline supplementation, including dose, formulation, and feasibility in children.

Choline Supplementation Modifies the Effects of Developmental Alcohol Exposure on Immune Responses in Adult Rats

“…Currently, choline supplementation is being investigated as an intervention to help reduce the severity of FASD [ 21 ]. Many clinical studies have examined the beneficial effects of both prenatal and postnatal choline supplementation on neurobehavioral and cognitive function in children with FASD [ 36 , 37 , 38 , 39 ].…”

“…Identification of treatments that reduce the severity of FASD is critical, specifically regarding interventions that can improve neurodevelopment and cognitive function. One potential intervention that is currently being investigated in FASD is the essential nutrient choline [ 21 ]. Choline is critical for normal brain development and cognitive function, with studies showing life-long memory enhancement in typically developing subjects that received perinatal choline supplementation [ 22 , 23 , 24 , 25 , 26 , 27 , 28 ].…”

Postnatal Choline Supplementation Rescues Deficits in Synaptic Plasticity Following Prenatal Ethanol Exposure

“…Interventions that include exercise and/or environmental enrichment [ 9 , 54 , 55 , 56 , 57 , 58 , 59 ], antioxidant supplementation [ 10 , 11 , 60 ], and other pharmaceutical therapies [ 61 ] have all shown some efficacy in mitigating ethanol’s effects. However, recent studies have demonstrated beneficial effects of the nutrient choline [ 29 , 62 ], and choline supplementation is emerging as one of the most promising treatments for FASD [ 32 , 62 ]. The present data illustrate that choline can mitigate the effects of PNEE on alterations in hippocampal plasticity.…”

Brain Iron and Mental Health Symptoms in Youth with and without Prenatal Alcohol Exposure

“…Nutritional interventions, such as choline supplementation, show promise for promoting neurodevelopment in infants and children with PAE [ 90 , 91 , 92 ]. This opens the question of whether iron supplementation may be a viable intervention for individuals with PAE.…”