Higher Gestational Choline Levels in Maternal Infection Are Protective for Infant Brain Development

J Pediatr. 2019 May;208:198-206.e2. doi: 10.1016/j.jpeds.2018.12.010. Epub 2019 Mar 14.


Objective: To assess whether maternal choline decreases effects of mothers' infections on fetal brain circuit development and on expression of infant behavior at 1 year of age.

Study design: A cross-sectional study was conducted in a public hospital obstetrics and midwifery service, with prenatal assessments of maternal infection, C-reactive protein, and choline level and postnatal assessments of cerebral neuronal inhibition in 162 newborns. At 1 year, 136 parents completed reports of their child's behavior.

Results: Maternal infection at 16 weeks of gestation, experienced by 41% of mothers, raised mean maternal C-reactive protein (d' = 0.47, P = .002) and decreased the development of cerebral inhibition of auditory response at 1 month of age (d' = 0.39, P < .001). Decreased newborn cerebral inhibition manifested as decreased behavioral self-regulation at 1 year. Greater choline levels in mothers with infections were associated with improved newborn inhibition of auditory cerebral response, mitigating the effect of infection (β = -0.34 [95% CI, -5.35 to -0.14], P = .002). At 1 year of age, children of mothers with infection and greater gestational choline levels had improved development of self-regulation, approaching the level of children of mothers without infection (β = 0.29 [95% CI 0.05-0.54], P = .03).

Conclusions: Greater maternal choline, recommended by the American Medical Association as a prenatal supplement, is associated with greater self-regulation among infants who experienced common maternal infections during gestation. Behavioral problems with diminished self-regulation often lead to referrals to pediatricians and might lead to later mental illness.

Keywords: child behavior; choline; fetal development; pregnancy exposure delayed effects; receptors nicotinic; sensory gating.

Publication types

  • Research Support, N.I.H., Extramural

MeSH terms

  • Adult
  • Brain / growth & development*
  • Brain / pathology
  • C-Reactive Protein / analysis
  • Choline / blood*
  • Cross-Sectional Studies
  • Female
  • Fetal Development
  • Humans
  • Infant
  • Infant, Newborn
  • Male
  • Maternal Age
  • Maternal Exposure*
  • Mothers
  • Neurons / metabolism
  • Pregnancy
  • Pregnancy Complications, Infectious / blood*
  • Prenatal Exposure Delayed Effects
  • Respiratory Tract Infections / complications
  • Urinary Tract Infections / complications
  • Young Adult


  • C-Reactive Protein
  • Choline