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.
Alcohol Clin Exp Res. 2018 Jul;42(7):1315-1326. doi: 10.1111/acer.13768. Epub 2018 Jun 13.
Choline, an essential nutrient, serves as a methyl-group donor for DNA methylation and is a constituent of the neurotransmitter acetylcholine and a precursor to major components of cell membranes. Findings from animal studies suggest that choline supplementation during pregnancy can mitigate adverse effects of prenatal alcohol exposure on growth and neurocognitive function. We conducted a randomized, double-blind exploratory trial to examine feasibility and acceptability of a choline supplementation intervention during pregnancy.
Seventy heavy drinkers, recruited in mid-pregnancy, were randomly assigned to receive a daily oral dose of 2 g of choline or a 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. Adherence was assessed by collecting used and unused drink packets on a monthly basis and tabulating the number used. Side effects were assessed in monthly interviews. Blood samples obtained at enrollment and at 4 and 12 weeks after randomization were assayed for plasma choline concentration.
Adherence was good-to-excellent (median doses taken = 74.0%; interquartile range = 53.9 to 88.7%) and was not related to a range of sociodemographic characteristics or to alcohol consumption ascertained using a timeline follow-back interview. By 4 weeks, plasma choline concentrations were significantly higher in the choline supplementation than the placebo arm, and this group difference continued to be evident at 12 weeks. The only side effect was a small increase in nausea/dyspepsia. No effects were seen for diarrhea, vomiting, muscle stiffness, blood pressure, or body odor changes.
This study demonstrated that a choline supplementation program with very heavy drinkers during pregnancy is feasible even among highly disadvantaged, poorly educated women. The broad acceptability of this intervention is indicated by our finding that adherence was not related to maternal education, intellectual function, depression, nutritional status, or alcohol use.
胆碱是一种必需营养素，可为 DNA 甲基化提供甲基供体，是神经递质乙酰胆碱的组成部分，也是细胞膜主要成分的前体。动物研究的结果表明，妊娠期间补充胆碱可以减轻产前酒精暴露对生长和神经认知功能的不良影响。我们进行了一项随机、双盲探索性试验，以检验妊娠期间补充胆碱干预的可行性和可接受性。
在妊娠中期招募了 70 名重度饮酒者，随机分配接受每日口服 2g 胆碱或安慰剂，从入组到分娩。每个剂量由一个单独包装的粉末包组成，当与水混合时，会产生一种甜葡萄味的饮料。通过每月收集使用和未使用的饮料包并计算使用数量来评估依从性。每月访谈评估副作用。在入组时以及随机分组后 4 周和 12 周采集血样，测定血浆胆碱浓度。
依从性良好至极好（中位数剂量=74.0%；四分位距=53.9 至 88.7%），与一系列社会人口特征或使用时间线回溯访谈确定的酒精摄入量无关。在 4 周时，胆碱补充组的血浆胆碱浓度明显高于安慰剂组，这种组间差异在 12 周时仍然明显。唯一的副作用是恶心/消化不良略有增加。未观察到腹泻、呕吐、肌肉僵硬、血压或体味变化的影响。
这项研究表明，即使在高度不利和教育程度低的妇女中，妊娠期间对重度饮酒者进行胆碱补充计划也是可行的。我们发现，这种干预措施的广泛可接受性表明，依从性与母亲的教育程度、智力功能、抑郁、营养状况或酒精使用无关。
