Maternal choline and respiratory coronavirus effects on fetal brain development
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Updated: Dec 20, 2025
Author Spotlight: Studying the Impact of Maternal Dietary Deficiencies on Long-Term Offspring Health Outcomes
Published on: June 28, 2024
Robert Freedman1, Sharon K Hunter1, Amanda J Law2
1Department of Psychiatry, University of Colorado School of Medicine, Aurora, CO, 80045, USA.
Insights
Prenatal viral infections may impact fetal development, but adequate choline intake (≥7.5 µM) during pregnancy can support infant attention and bonding. Higher choline levels appear to mitigate negative effects of maternal infection on early infant behavior.
Area of Science:
- Maternal-fetal medicine
- Neurodevelopmental biology
- Nutritional science
Background:
- Prenatal viral infections, including COVID-19, may adversely affect fetal development via maternal inflammatory responses.
- Choline is a vital nutrient for fetal brain development and function.
- The impact of prenatal viral infections on infant neurobehavioral outcomes in relation to maternal choline status is not well understood.
Purpose of the Study:
- To investigate the association between prenatal viral infections during early gestation and infant behavioral development at 3 months of age.
- To determine if maternal choline levels during pregnancy modulate the effects of prenatal viral infections on infant behavior.
Main Methods:
- Plasma choline levels were measured at 16 weeks gestation in mothers with and without early-pregnancy respiratory viral infections.
- Infant behavior was assessed at 3 months using the Infant Behavior Questionnaire-Revised (IBQ-R), focusing on Surgency, Negativity, and Regulation.
- Statistical analyses compared infant behavioral outcomes based on maternal infection status and choline levels (≥7.5 µM vs. <7.5 µM).
Main Results:
- Infants born to mothers with moderately severe viral infections and higher choline levels (≥7.5 µM) showed significantly enhanced Regulation (attention and bonding) compared to infants of infected mothers with lower choline levels.
- Maternal choline levels ≥7.5 µM appeared to protect against the negative effects of viral infection on infant Regulation, as no significant differences were observed compared to uninfected mothers.
- Lower maternal choline levels (<7.5 µM) in the context of prenatal viral infection were associated with poorer infant Regulation outcomes.
Conclusions:
- Adequate maternal choline intake during early gestation may protect fetal neurodevelopment and support positive early infant behavioral regulation, even following maternal viral infection.
- Dietary choline or supplementation could be a strategy to mitigate potential adverse effects of prenatal infections on infant brain development and behavior.
- These findings highlight the critical role of choline in supporting infant development in the face of environmental challenges during pregnancy.
Abstract:
Prenatal COVID-19 infection is anticipated by the U.S. Centers for Disease Control to affect fetal development similarly to other common respiratory coronaviruses through effects of the maternal inflammatory response on the fetus and placenta. Plasma choline levels were measured at 16 weeks gestation in 43 mothers who had contracted common respiratory viruses during the first 6-16 weeks of pregnancy and 53 mothers who had not. When their infants reached 3 months of age, mothers completed the Infant Behavior Questionnaire-Revised (IBQ-R), which assesses their infants' level of activity (Surgency), their fearfulness and sadness (Negativity), and their ability to maintain attention and bond to their parents and caretakers (Regulation). Infants of mothers who had contracted a moderately severe respiratory virus infection and had higher gestational choline serum levels (≥7.5 mM consistent with U.S. Food and Drug Administration dietary recommendations) had significantly increased development of their ability to maintain attention and to bond with their parents (Regulation), compared to infants whose mothers had contracted an infection but had lower choline levels (<7.5 mM). For infants of mothers with choline levels ≥7.5 μM, there was no effect of viral infection on infant IBQ-R Regulation, compared to infants of mothers who were not infected. Higher choline levels obtained through diet or supplements may protect fetal development and support infant early behavioral development even if the mother contracts a viral infection in early gestation when the brain is first being formed.
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