Elsevier

Clinical Nutrition ESPEN

Volume 43, June 2021, Pages 1-8
Clinical Nutrition ESPEN

Narrative Review
Maternal nutrients and effects of gestational COVID-19 infection on fetal brain development

https://doi.org/10.1016/j.clnesp.2021.04.019Get rights and content

Summary

Background & aims

Maternal gestational infection is a well-characterized risk factor for offsprings’ development of mental disorders including schizophrenia, autism, and attention deficit disorder. The inflammatory response elicited by the infection is partly directed against the placenta and fetus and is the putative pathogenic mechanism for fetal brain developmental abnormalities. Fetal brain abnormalities are generally irreversible after birth and increase risk for later mental disorders. Maternal immune activation in animals models this pathophysiology. SARS-CoV-2 produces maternal inflammatory responses during pregnancy similar to previously studied common respiratory viruses.

Method

Choline, folic acid, Vitamin D, and n-3 polyunsaturated fatty acids are among the nutrients that have been studied as possible mitigating factors for effects of maternal infection and inflammation on fetal development. Clinical and animal studies relevant to their use in pregnant women who have been infected are reviewed.

Results

Higher maternal choline levels have positive effects on the development of brain function for infants of mothers who experienced viral infections in early pregnancy. No other nutrient has been studied in the context of viral inflammation. Vitamin D reduces pro-inflammatory cytokines in some, but not all, studies. Active folic acid metabolites decrease anti-inflammatory cytokines. N-3 polyunsaturated fatty acids have no effect.

Conclusions

Vitamin D and folic acid are already supplemented in food additives and in prenatal vitamins. Despite recommendations by several public health agencies and medical societies, choline intake is often inadequate in early gestation when the brain is forming. A public health initiative for choline supplements during the pandemic could be helpful for women planning or already pregnant who also become exposed or infected with SARS-CoV-2.

Keywords

Coronavirus
Choline
Pregnancy
Fetal development
Vaccine
COVID-19

Cited by (0)

Submitted in response to the European Society for Clinical Nutrition and Metabolism (ESPEN) and World Health Organization Regional Office for Europe (WHO/Europe) call for papers on nutritional status and nutritional care in COVID-19.

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