Does supplementation of choline during or after pregnancies exposed to alcohol improve neurocognitive development of children? A meta-analysis

BACKGROUND: Alcohol impairs early cognitive development, especially in utero exposures. Nutrient supplementation may avert some of its consequences. OBJECTIVE: We reviewed whether prenatal and postnatal choline supplementation could improve neurocognitive development in children of alcohol-exposed pregnancies. METHODS: A systematic literature search was conducted in Medline, Embase, and Cochrane Library databases to identify randomized controlled trials published up to May 01, 2024. Data were analyzed using Standardized Mean Difference (SMD) with 95 % Confidence Intervals (CI) and a random-effects model. Sensitivity analyses and the posterior probability of benefit (Pr) were calculated using a Bayesian Markov chain Monte Carlo model. RESULTS: Five trials were included in this review. Prenatal supplementation likely benefits memory (SMD 0.61, 95 % CI 0.19 to 1.02; Pr_(SMD>0) = 96.29 %; I2 = 0 %; 2 trials; 94 participants; moderate-certainty evidence). Postnatal supplementation may improve global cognition (SMD 0.78, 95 % CI 0.21 to 1.34; Pr_(SMD>0) = 96.94 %; I2 = 13 %; 2 trials; 62 participants; low-certainty evidence) and a small benefit to attention was only demonstrated in the Bayesian analysis (postnatal: SMD 0.44, 95 % CI -0.73 to 1.61; Pr_(SMD>0) = 91.80 %; I2 = 84 %; 2 trials; 83 participants; low-certainty evidence). CONCLUSION: Supplementation of choline in either period could benefit neurocognitive development in children of heavy-drinking mothers. REGISTRATION: CRD42024537733 (PROSPERO).