School of Biomedical Sciences, The University of Queensland, St Lucia, QLD, Australia.
Child Health Research Centre, The University of Queensland, South Brisbane, QLD, Australia.
Alcohol Clin Exp Res. 2018 Sep;42(9):1591-1611. doi: 10.1111/acer.13817. Epub 2018 Jul 13.
Prenatal alcohol exposure results in cognitive, behavioral, and neurological deficits in offspring. There is an urgent need for safe and effective treatments to overcome these effects. Maternal choline supplementation has been identified as a potential intervention. Our objective was to review preclinical and clinical studies using choline supplementation in known cases of fetal alcohol exposure to determine its effectiveness in ameliorating deficits in offspring. A systematic search of 6 electronic databases was conducted and studies selected by reviewing titles/abstracts against specific inclusion/exclusion criteria. Study characteristics, population demographics, alcohol exposure, and intervention methods were tabulated, and quality of reporting was assessed. Data on cognitive, behavioral, and neurological outcomes were extracted and tabulated. Quantitative analysis was performed to determine treatment effects for individual study outcomes. A total of 189 studies were retrieved following duplicate removal. Of these, 22 studies (2 randomized controlled trials, 2 prospective cohort studies, and 18 preclinical studies) met the full inclusion/exclusion criteria. Choline interventions were administered at different times relative to alcohol exposure, impacting on their success to prevent deficits for specific outcomes. Only 1 clinical study showed significant improvements in information processing in 6-month-old infants from mothers treated with choline during pregnancy. Preclinical studies showed significant amelioration of deficits due to prenatal alcohol exposure across a wide variety of outcomes, including epigenetic/molecular changes, gross motor, memory, and executive function. This review suggests that choline supplementation has the potential to ameliorate specific behavioral, neurological, and cognitive deficits in offspring caused by fetal alcohol exposure, at least in preclinical studies. As only 1 clinical study has shown benefit, we recommend more clinical trials be undertaken to assess the effectiveness of choline in preventing deficits across a wider range of cognitive domains in children.
产前酒精暴露会导致后代认知、行为和神经发育缺陷。因此，迫切需要安全有效的治疗方法来克服这些影响。补充胆碱已被确定为一种潜在的干预措施。我们的目的是综述已知胎儿酒精暴露病例中使用胆碱补充的临床前和临床研究，以确定其改善后代缺陷的效果。通过对 6 个电子数据库进行系统检索，并根据具体的纳入/排除标准审查标题/摘要来选择研究。对研究特征、人群人口统计学、酒精暴露和干预方法进行制表，并评估报告质量。提取和制表了认知、行为和神经发育结果的数据。对个别研究结果进行了定量分析，以确定治疗效果。在去除重复项后，共检索到 189 项研究。其中，22 项研究（2 项随机对照试验、2 项前瞻性队列研究和 18 项临床前研究）符合全部纳入/排除标准。胆碱干预是在与酒精暴露相关的不同时间进行的，这影响了它们预防特定结果缺陷的成功程度。只有 1 项临床研究显示，在怀孕期间接受胆碱治疗的母亲的 6 个月大婴儿的信息处理能力有显著提高。临床前研究表明，胆碱补充可以显著改善因产前酒精暴露而导致的各种结果的缺陷，包括表观遗传/分子变化、粗大运动、记忆和执行功能。这项综述表明，胆碱补充至少在临床前研究中，有可能改善因胎儿酒精暴露而导致的后代特定的行为、神经和认知缺陷。由于只有 1 项临床研究显示出了益处，我们建议进行更多的临床试验，以评估胆碱在预防儿童更广泛的认知领域缺陷方面的有效性。
