Choline Intake During Pregnancy and Genetic Polymorphisms Influence Choline Metabolism in Chinese Preterms Receiving Total Parenteral Nutrition Therapy
Authors: Zhu Jie 
Published: November 2023

BackgroundCholine is an essential nutrient for fetal and neonatal development. Common single nucleotide polymorphisms (SNPs) may change requirements of choline supply in total parenteral nutrition (TPN) for preterms.ObjectivesThis study was aimed to investigate whether total choline intake during pregnancy and/or SNPs influence choline metabolism and the growth in preterms receiving TPN therapy.MethodsA total of 90‐paired Chinese parturients with premature delivery and their preterm infants were enrolled at Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine. The inclusion criteria for preterms were Asian singleton fetus with no other diseases, gestational age < 37 weeks, 1600g ≤ birth weight ≤ 2100g and administration of TPN for ≥7 days. 90‐paired healthy Chinese parturients and their full‐term newborns were also enrolled as controls. Dietary choline intake during pregnancy was assessed by food frequency questionnaires and 24 h dietary recalls. Plasma choline levels in peripheral venous blood from all parturients and preterms before or after TPN were measured with SNPs of PEMT rs12325817(G‐744C) and CHDH rs12676 (G432T) genotyped in all parturients and neonates. X2 test, a linear regression model and a multivariable logistic regression were performed for statistical analysis.ResultsDietary choline intakes of women with preterm delivery were lower than those in controls during pregnancy (P < 0.05); Plasma choline levels in peripheral vein from preterm parturients were also lower than those in control parturients (P < 0.05); Among the parturients with choline intake within lowest quartile level during pregnancy, PEMT ‐774 C > G was found to be related to preterm risk (OR 2.51, 95% CI 1.56 – 3.79, P < 0.05). Plasma choline levels in peripheral vein of preterms after TPN for 7 days were decreased relative to those before TPN (P < 0.05); Compared with PEMT‐744GG and GC genotypes, the maternal variant CC genotype enhanced the risk of lower plasma choline concentrations in peripheral vein of their preterms after TPN for 7 days (P < 0.05). Moreover, the CHDH 432T allele was associated with a higher risk of reduced plasma choline levels in preterms after TPN for 7 days (OR 2.63, 95% CI 1.32–5.29, P < 0.05), more days to regain the birth weight (OR 1.43, 95% CI, 1.28–2.69, P < 0.05), and lower weight gain during hospital stay (OR 1.78, 95% CI, 1.16–3.39, P < 0.05), compared to the G allele.ConclusionsInadequate intake of choline during pregnancy and PEMT‐744CC genotype in gestational Chinese Asian women could enhance the risk of premature births. TPN may promote the decrement of choline in the Chinese preterms. The PEMT‐744CC genotype in the parturients with premature delivery and the CHDH 432T allele may further increase susceptibility of choline decline and inhibit the growth in preterms on TPN feeding. These preterms may need more choline for growth and development after birth.Support or Funding InformationSupported by the Young Investigator Research Projects of Shanghai Municipal Bureau of Health (20134196).