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Choline, a phospholipid compound present in a wide range of foods, is an essential nutrient that plays critical roles in building cell membranes and producing the neurotransmitter acetylcholine. Previous research indicates that supplemental prenatal choline improves cognitive ability, attention, and social behavior in children up to seven years of age. A pair of papers published this year explores the effects of prenatal choline supplementation on pregnancy outcomes and neuropsychiatric disease risk in Black Americans.

Neuropsychiatric diseases – commonly referred to as mental illnesses – impair the ability of affected persons to learn and work, imposing an immense burden on society. Physiological alterations that drive neuropsychiatric diseases impair normal brain function, emotion, and mood, and can arise from both genetic factors and environmental factors present before and after birth. One of the physiological alterations commonly observed with neuropsychiatric diseases is impaired suppression of irrelevant environmental mental stimuli, contributing to low mood, poor cognitive functioning, and sensory sensitivities.

Maternal stressors during pregnancy, including nutritional deficiencies, are associated with an increased risk of neuropsychiatric diseases such as schizophrenia, attention deficit disorder, and autism. Epidemiological research has revealed systemic health disparities that contribute to poorer health outcomes for Black Americans, including higher rates of neuropsychiatric diseases. Nutritional interventions may be effective in preventing and treating neuropsychiatric diseases by promoting healthy brain physiology.

The investigators collected data from two observational studies and a randomized clinical trial. In the first observational study, the investigators collected data from 183 pregnant females of varying ethnic identities from the United States at 14 to 16 weeks' gestation. In a second observational study, the investigators collected data from 166 pregnant females from rural Uganda at 18 to 25 weeks' gestation. Finally, in a randomized trial of choline supplementation, 100 pregnant females consumed 3,600 milligrams of choline each morning and 2,700 milligrams each night from week 16 of gestation until delivery. For each study, the investigators measured plasma concentrations of choline and the stress hormone cortisol; maternal mood and stressors; newborn P50 recording; and infant and childhood behavior measures.

Black American females had lower plasma choline concentrations at 16 weeks’ gestation compared to white American females and rural Ugandan females. These lower choline levels were associated with higher maternal concentrations of cortisol and with shorter gestation and decreased P50 inhibition, which both indicate immature neural development at birth. At three months of age, infants born to Black American mothers who had lower gestational choline presented with decreased attention and relation to caregivers, a risk factor for mental illness.

These findings suggest that the cognitive and behavioral deficits associated with lower prenatal choline may predispose children born to Black American mothers to later neuropsychiatric diseases. Prenatal choline or phosphatidylcholine supplementation may reduce disease risk.

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