Choline concentrations are lower in postnatal plasma of preterm infants than in cord plasma
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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.
KeywordsCholine deficiency Neonate Neurological development Nutrition Preterm infant
Betaine homocysteine methyltransferase
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
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.
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