Higher Gestational Choline Levels in Maternal Infection Are Protective for Infant Brain Development
Higher Gestational Choline Levels in Maternal Infection Are Protective for Infant Brain Development
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DOI：
10.1016/j.jpeds.2018.12.010
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发表时间：
2019-05-01
影响因子：
5.1
通讯作者：
Hoffman, M. Camille
中科院分区：
文献类型：
--
作者：
Freedman, Robert;Hunter, Sharon K.;Hoffman, M. Camille
目的探讨母体胆碱能否减少母体感染对1岁时胎儿脑回路发育和婴儿行为表现的影响。研究设计在公立医院产科和助产室进行横断面研究，产前评估母体感染、C反应蛋白和胆碱水平，产后评估新生儿脑神经元抑制情况。结果41%的母亲在孕期16周发生母体感染，母体平均C反应蛋白升高(d‘=0.47，P=0.002)，1个月龄时大脑听觉反应抑制的发生减少(d’=0.39，P<；.001)。1岁时，新生儿大脑抑制能力下降，表现为行为自我调节能力下降。感染母亲的胆碱水平越高，新生儿对大脑听觉反应的抑制程度就越好，从而减轻了感染的影响(β=-0.34[95%CI，-5.35至-0.14]，P=0.002)。在1岁时，母亲感染且孕期胆碱水平较高的婴儿自我调节能力发展较好，接近非感染母亲的儿童水平(b=0.29[95%CI 0.05-0.54]，P=0.03)。结论美国医学协会推荐的母体胆碱水平较高作为产前补充，与孕期常见母体感染的婴儿的自我调节能力较强有关。自律能力减弱的行为问题通常会导致转诊到儿科医生，并可能导致后来的精神疾病。
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 (beta = -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 (b = 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.