(OR19-07-26) Maternal Choline Supplementation Reduces Preterm Birth Risk in Women With Gestational Diabetes: A Double-Blind Randomized Controlled Trial

Objectives: The objective of this study was to assess the impact of maternal choline supplementation (MCS) above adequate intake (AI) levels on pregnancy outcomes in women with gestational diabetes mellitus (GDM) in a randomized controlled trial (RCT). Additionally, this study aimed to evaluate placental health and development in response to MCS. It was hypothesized that MCS above the recommended AI would reduce the risk of birth complications through modulation of placental development and angiogenesis.

Methods: Women between 19 and 24 weeks of gestation with GDM were recruited into an 8-week double-blind RCT and were randomly assigned to receive either a placebo (n=19) or a supplement containing 470 mg of choline per day (n=18). Over the course of the intervention, participants’ blood samples were collected at week 0, 4, and 8 along with 24-hour dietary recalls. Upon delivery, cord blood and placental samples were collected. Placental gene expression was measured via RT-qPCR. Incidence of preterm births was analyzed with chi-square testing and RT-qPCR data was analyzed utilizing a generalized linear model.

Results: The incidence of preterm births (PTB) was significantly reduced in the MCS intervention group, compared to the placebo control (OR= 0.11, p=0.043). Placental expression of thioredoxin (TXN), a key redox regulator, as well as the ratio of TXN and its inhibitor thioredoxin interacting protein (TXNIP) (TXN/TXNIP ratio), was significantly increased in the intervention group (both p=0.001) compared to control, suggesting a protective effect to combat placental oxidative stress.

Conclusions: MCS above the recommended AI reduces preterm birth incidence in women with GDM. Reducing oxidative stress in the placenta is a potential mechanism. More studies are warranted to further determine the efficacy of choline as an affordable and widely accessible supplement for the management of GDM.

Funding Sources: Maimonides medical research grant