European Journal of Nutrition

, Volume 54, Issue 5, pp 733–741 | Cite as

Choline concentrations are lower in postnatal plasma of preterm infants than in cord plasma

  • Wolfgang Bernhard
  • Marco Raith
  • Rebecca Kunze
  • Vera Koch
  • Martin Heni
  • Christoph Maas
  • Harald Abele
  • Christian F. Poets
  • Axel R. Franz
Original Contribution



Choline is essential to human development, particularly of the brain in the form of phosphatidylcholine, sphingomyelin and acetylcholine, for bile and lipoprotein formation, and as a methyl group donator. Choline is actively transported into the fetus, and maternal supply correlates with cognitive outcome. Interruption of placental supply may therefore impair choline homeostasis in preterm infants.


Determination of postnatal plasma concentrations of choline and its derivatives betaine and dimethylglycine (DMG) in preterm infants compared to cord and maternal blood matched for postmenstrual age (PMA).


We collected plasma of very low-birth-weight infants undergoing neonatal intensive care (n = 162), cord plasma of term and preterm infants (n = 176, 24–42-week PMA), serum of parturients (n = 36), and plasma of healthy premenopausal women (n = 40). Target metabolites were analyzed with tandem mass spectrometry and reported as median (25th/75th percentiles).


Cord plasma choline concentration was 41.4 (31.8–51.2) µmol/L and inversely correlated with PMA. In term but not in preterm infants, cord plasma choline was lower in girls than in boys. Prenatal glucocorticoid treatment did not affect choline levels in cord plasma, whereas betaine was decreased and DMG increased. In parturients and non-pregnant women, choline concentrations were 14.1 (10.3–16.9) and 8.8 (5.7–11.2) µmol/L, respectively, whereas betaine was lowest in parturients. After delivery, preterm infant plasma choline decreased to 20.8 (16.0–27.6) µmol/L within 48 h. Betaine and DMG correlated with plasma choline in all groups.


In preterm infants, plasma choline decreases to 50 % of cord plasma concentrations, reflecting choline undernourishment and postnatal metabolic adaptation, and potentially contributing to impaired outcome.


Choline deficiency Neonate Neurological development Nutrition Preterm infant 



Adequate intake


Betaine homocysteine methyltransferase




Docosahexaenoic acid




Ethylene diamine tetraacetate


Heated electrospray ionization interface


High performance liquid chromatography


Liquid chromatography–electrospray ionization interface tandem mass spectrometry


Long-chain poly-unsaturated fatty acid


Neonatal intensive care unit








Postmenstrual age






Specific reaction monitoring


Total ion count


Very low-density lipoproteins





This study was supported by an institutional grant (Project No. E.1100008) of the ZEM—Zentrum Ernährungsmedizin of the Medical Faculty of the University of Tuebingen and the University of Hohenheim. The authors have no financial relationships relevant to this article to disclose. This study was funded by an internal grant of the Eberhard-Karls-University, Tübingen, and the University of Hohenheim, Stuttgart, Germany (ZEM 4A II-08).

Conflict of interest

The authors have no conflict of interests to disclose.

Supplementary material

394_2014_751_MOESM1_ESM.doc (79 kb)
Supplementary material 1 (DOC 79 kb)


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Copyright information

© Springer-Verlag Berlin Heidelberg 2014

Authors and Affiliations

  • Wolfgang Bernhard
    • 1
  • Marco Raith
    • 1
  • Rebecca Kunze
    • 1
  • Vera Koch
    • 1
  • Martin Heni
    • 2
  • Christoph Maas
    • 1
  • Harald Abele
    • 3
  • Christian F. Poets
    • 1
  • Axel R. Franz
    • 1
    • 4
  1. 1.Department of Neonatology, Faculty of MedicineEberhard-Karls-UniversityTūbingenGermany
  2. 2.Department of Internal Medicine IV, Faculty of MedicineEberhard-Karls-UniversityTūbingenGermany
  3. 3.Department of Gynecology, Faculty of MedicineEberhard-Karls-UniversityTūbingenGermany
  4. 4.Center for Pediatric Clinical Studies, Faculty of MedicineEberhard-Karls-UniversityTūbingenGermany

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