Day 39 of 99 Days to FASDay: Choline Shows Promise for FASD

Please note this is new information as of 2020. The original Day 39 and 40 are combined into Day 38.01301F7D-6D25-41B3-8936-4AE3EEB4B9A4

A recent news article from CBS Minnesota about the Results of four-year follow-up of a randomized controlled trial of choline for neurodevelopment in fetal alcohol spectrum disorder caused quite a stir in the FASD world.

The headline was sensational and played on people’s emotions and desire for a “cure.” At this time there is no cure. Science however continues to provide more information and breakthroughs. And while this information is welcome news and promising, there is only a narrow window of opportunity.

The above Report states:

Despite the high prevalence of fetal alcohol spectrum disorder (FASD), there are few interventions targeting its core neurocognitive and behavioral deficits. FASD is often conceptualized as static and permanent, but interventions that capitalize on brain plasticity and critical developmental windows are emerging. We present a long-term follow-up study evaluating the neurodevelopmental effects of choline supplementation in children with FASD 4 years after an initial efficacy trial.

Results:

Children who received choline had higher non-verbal intelligence, higher visual-spatial skill, higher working memory ability, better verbal memory, and fewer behavioral symptoms of attention deficit hyperactivity disorder than the placebo group. No differences were seen for verbal intelligence, visual memory, or other executive functions.

Conclusions:

These data support choline as a potential neurodevelopmental intervention for FASD and highlight the need for long-term follow-up to capture treatment effects on neurodevelopmental trajectories.

When I asked Dr. Wozniak about the findings, he stated:

In general, yes, we believe that choline is most effective when given pre-natally or within the first few years of life.

In terms of specifics, we are testing it in 2-5 year old children. Some of our data suggests that the 2-3 year olds benefited more than the 4-5 year olds. There are now a couple of studies published showing effects with given prenatally as well – also consistent with how we think it works as a modifier of development.

The one published study in older children (5-10 years with an average of 8 years) did not show significant effects. That study was also pretty short term (6 weeks) compared to our 9-month studies.

So, although we cannot say for sure that choline won’t help in older children / adolescents, we can say that the biology points us in the direction of much younger and we can also say that the one published study that did look at older children did not see results.

The researchers also concluded: 

Realistically, nutritional interventions addressing neurodevelopmental disorders need to mesh with a host of other interventions and accommodations to meet a child’s specific profile of behavioral, mental health, cognitive, adaptive, and social needs.

Ultimately, for children and adolescents with FASD, interventions may include a combination of components including nutritional supplementation, parent-education and behavior management training, computerized attentional training, impulse control therapy, special education including literacy and math training, and social skills development.

These components will likely be differentially effective depending on individual cognitive profiles and depending on the developmental windows during which they are administered.

Beyond individual interventions, at the public health level, it is critical to continue to address FASD through robust support of addiction treatment, alcohol abstinence, birth control, and public awareness that there is no safe level of alcohol consumption during pregnancy.

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If you’d like to hear Dr. Wozniak talk about the Studies, check out Episode 26: A Conversation about Choline  on the FASD Success Show Podcast.

Check back tomorrow for another update – this one on the world’s first psychotropic medication algorithm for Fetal Alcohol Spectrum Disorder / Prenatal Alcohol Exposure.

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