Dietary Choline Intake During Pregnancy and Congenital Heart Defects in a Chinese Population

Background/Objectives: The impact of choline on congenital heart defects (CHDs) in humans remains unclear. This study aimed to investigate the associations between maternal dietary intakes of choline and choline derivatives during pregnancy and CHD. Methods: This case-control study included 474 cases and 948 controls from hospitals in Northwest China. Pregnant women admitted for delivery were enrolled and completed a validated food frequency questionnaire to assess their dietary intake during pregnancy. A standardized questionnaire was also administered to collect additional pregnancy-related information. Mixed logistic regression models were used to estimate ORs (95%CIs) for CHD in association with choline intake. Results: Higher intakes of total choline, phosphatidylcholine, sphingomyelin, glycerophosphocholine, and phosphocholine in pregnancy were associated with reduced risks of total CHD, ventricular septal defects, and atrial septal defects, with all trend tests showing statistical significance (all p < 0.05). The ORs (95%CIs) of total CHD, comparing the highest with the lowest tertiles of intake, were 0.38 (0.24-0.61) for total choline, 0.51 (0.38-0.70) for phosphatidylcholine, 0.37 (0.26-0.51) for sphingomyelin, 0.34 (0.21-0.53) for glycerophosphocholine, and 0.53 (0.34-0.82) for phosphocholine. The inverse associations remained unchanged according to maternal age, work, education, parity, passive smoking, anemia, medication use, or folate/iron supplements use in pregnancy; however, these associations appeared to be more pronounced among pregnant women in urban areas. Conclusions: Higher maternal intake of dietary choline during pregnancy may be associated with a lower risk of CHD. Promoting choline intake in pregnant women could serve as a potential strategy for the primary prevention of fetal CHD in China.