By Mark Couch
(December 2017) Can mental illness be prevented in the womb?
That’s a question
M. Camille Hoffman, MD, MSCS, associate professor of obstetrics and
gynecology and psychiatry, is investigating. Specifically, Hoffman is
studying the impact of a nutritional supplement, choline, on maternal
outcome and delivery and on the child’s development up to age 4.
“My research is focused on developmental origins of mental health, or setting fetal trajectories, in the realm of mental and behavioral life-course health,” Hoffman said.
of those conditions is schizophrenia, a chronic and severe mental
disorder with symptoms that are often not fully recognized until the
person is between ages 16 and 30. Other mental health conditions, such
as bipolar disorder, autism spectrum disorders, ADHD, may also be
improved by choline consumption during pregnancy.
vitamin-like nutrient found in eggs, meat, poultry, fish, peanuts, and
dairy products, was recognized as an essential nutrient by the Institute
of Medicine in 1998 and recently was endorsed by the American Medical
Association to be included in prenatal vitamins.
Hoffman’s study supplements the pregnant woman’s diet with extra amounts of choline.
most populations, moms will encounter the recommended daily amount of
choline (450mg) unless they’re vegan or allergic to eggs or avoid some
of the most choline-dense foods in general,” Hoffman said.
extra choline is not known to pose any risks to the pregnant women and
their babies and in some situations, the woman’s life conditions may
also affect the transfer of choline to the developing baby.
if a mom is consuming adequate amounts of choline, the recommended
daily amount is about half of what a pregnant woman needs for this good
fetal brain development,” Hoffman said. “And other situations like
stress, illness, infections, maternal mental and physical illness will
lead to moms sometimes sequestering it or not adequately transferring
choline to the baby.”
The potential of the extra choline (about
900mg daily in the study), though, could be significant, especially when
compared with the break-through finding that folic acid supplementation
had a beneficial impact for pregnant women and their babies.
folic acid we reduced in rough numbers the risk of an open neural tube
defect from a baseline of 1 in a 1,000 to 1 in 10,000,” Hoffman said.
“So then if you consider mental illnesses, schizophrenia affects about 1
percent of the population, bipolar disorder 1 to 2 percent, autism
spectrum disorders 1 to 2 percent, ADHD even a higher percentage, if
choline is efficacious in remodeling fetal brain development and
preventing or even reducing the prevalence of these conditions, then the
population impact is potentially huge.”
Hoffman’s current study
builds off work conducted by Robert Freedman, MD, former chair of the
Department of Psychiatry, and her former research colleague Randy Ross,
MD, professor of psychiatry, who died in December 2016. (See “Remember
Randy Ross,” page 29)
In that study, researchers recruited 100
pregnant women to review whether giving choline during pregnancy would
enhance brain growth in their developing fetuses. After birth, the
infants were given a placebo or liquid phosphatidylcholine.
five weeks old, the infants were exposed to a series of clicking sounds
and they were monitored for reactions. In normal cases, the infant
brains exhibit inhibition – recognizing the subsequent clicks as
familiar and not significant. However, for some, this inhibition doesn’t
occur, a finding linked with an increased risk for attention problems,
social withdrawal, and perhaps schizophrenia.
concluded that study was not enough to recommend a change in practice,
so the current study aims to broaden the size of the study and to track
children through age four. The study is currently open and Hoffman hopes
to recruit 250 pregnant participants over the next four years.
cautions that the reactions to the clicking sounds or a concerning
assessment when the child is 4 years old is not a diagnosis, just an
“We’re not saying that all withdrawn four-year-olds are
going to develop schizophrenia in young adulthood,” Hoffman said.
“Rather, our thinking is that if you can prevent it or mitigate it with
something this simple, why wouldn’t you?”