Claus Muss
International Scientific Group of Applied Preventive Medicine (I-GAP), Research Center and Laboratory, Vienna, Austria

Korespondenční autor: Claus Muss (

ISSN 1804-7181 (On-line)

Full verze:
Full version

Submitted:11. 10. 2011
Published online: 15. 12. 2011


It is well documented that malnutrition in pregnancy is of increasing concern in both the developing and developed world, resulting in poor health of children. Various serious diseases in childhood have been attributed to malnutrition in maternity. Latest research links maternal malnutrition with dysfunction of the higher brain in children. It has been hypothesised from animal trials, that prenatal nutrition has a strong impact on the neurological development of the infant. Especially the content of unsaturated fats and certain phospholipids seem to be essential for the cerebral function of the foetus. There is a strong body of evidence pointing especially to omega 3 fatty acids and choline as one very necessary nutritional component in pregnancy. The consumption of omega 3 in fish has been under controversial discussion because of methyl mercury which can induce food poisonings also affecting the unbo0rn child. Evidently mother’s nutrition is effecting the development of the child even after parturition. However little is only known about the definite supply with choline in different stages of human pregnancy. Considering factors socioeconomically, it can be assumed that choline supply in pregnant woman presently does not meet the required amount for a development of higher brain structures in children. This certainly applies to developing countries with a higher proportion of poverty and malnutrition in low-income households. Epidemiological data has shown, that in so called developed countries such as in Europe or United States the content of choline in prenatal diets is not balanced enough to reach the requirements of the unborn child fully.

From this point of view the prevention of prenatal malnutrition is a main subject for public health concern. We recommend revising the rationale for recommending certain dietary supplements in pregnancy and breastfeeding wo­men.

Keywords: nutrition in pregnancy; impact of malnutrition on intelligence in children; stimulating components in food for the development of intelligence; omega 3 and choline and cerebral development


1. Adebami OJ, Owa JA, Oyedeji GA, Oyelami OA (2007). Prevalence and problems of foetal malnutrition in term babies at Wesley Guild Hospital, South Western Nigeria. West Afr J Med. 26(4): 278–282.

2. Block SA, Kiess L, Webb P, Kosen S, Moench-Pfanner R, Bloem MW, Timmer CP (2004). Macro shocks and micro outcomes: child nutrition during Indonesia’s crisis. Econ Hum Biol. 2(1): 21–44.

3. Böhm U, Muss C (2011). Rationelle Therapie in der Mikronährstof­fmedizin. UNI-MED Science, p. 384.

4. Böhm U, Muss C, Pfisterer M (2003). Rationelle Diagnostik in der Orthomolekularen Medizin. Hippokrates Verlag Stuttgart.

5. Calderon F, Kim HY (2004). Docosahexaenoic acid promotes neurite growth in hippocampal neurons. J Neurochem. 90: 1540.

6. Cheng R-K, MacDonald ChJ, Williams ChL, Meck WH (2008a). Prenatal choline supplementation alters the timing, emotion, and memory performance (TEMP) of adult male and female rats as indexed by differential reinforcement of low-rate schedule behavior. Learn Mem Mar. 15(3): 153–162.

7. Cheng R-K, Scott AC, Penney TB, Williams CL, Meck WH (2008b). Prenatal-choline supplementation differentially modulates timing of auditory and visual stimuli in aged rats. Brain Res. 1237: 167–175.

8. Choi DW, Koh JY (1998). Zinc and brain injury.Annual Review of Neuroscience. 21: 347–375.

9. Colter AL, Cutler C, Meckling KA (2008). Fatty acid status and behavioural symptoms of attention deficit hyperactivity disorder in adolescents: a case-control study. Nutr J. 7: 8.

10. Da Costa K-A, Niculescu MD, Craciunescu CN, Fischer LM, Zeisel SH (2006). Choline deficiency increases lymphocyte apoptosis and DNA damage in humans. Am J Clin Nutr Jul. 84(1): 88–94.

11. Daniels JL, Longnecker MP, Rowland AS, Golding J (2004). Fish intake during pregnancy and early cognitive development of off spring. Epidemiology. 15: 394–402.

12. Davison JM, Mellott TJ, Kovacheva VP, Blusztajn J (2009). Gestational choline supply regulates methylation of histone H3, expression of histone methyltransferases G9a (Kmt1c) and Suv39h1 (Kmt1a), and DNA methylation of their genes in rat fetal liver and brain. J Biol Chem. 284(4): 1982– 1989.

13. Delisle H (2002). Foetal programming of nutrition-related chronic diseases Sante. 12(1): 56–63.

14. Department of Environment Food and Rural Affairs (2006). University of Bristol Survey. Mercury in imported fish and shellfish and UK farmed fish and their products and FSIS 151.

15. Detopoulou P, Demosthenes B, Antonopoulou S, Pitsavos C, Stefanadis C (2008). Dietary choline and betaine intakes in relation to concentrations of inflammatory markers in healthy adults: the ATTICA study. Am J Clin Nutr. 87(2): 424–430.

16. Fischer LM, da Costa KA, Kwock L, Stewart PW, Lu T-S, Stabler SP, Allen RH, Zeisel SH (2007). Sex and menopausal status influence human dietary requirements for the nutrient choline.Am J Clin Nutr. 85(5): 1275–1285.

17. Food and Agriculture Organization of the United Nations (FAO) (1996), The Sixth World Food Survey (FAO, Rome), 5–6.

18. Friis H (2006). International nutrition and health. Ugeskr Laeger Sep. 168(36): 3020–3023.

19. Gautam VP, Taneja DK, Sharma N, Gupta VK, Ingle GK (2008). Dietary aspects of pregnant women in rural areas of Northern India: Matern Child Nutr Apr. 4(2): 86–94.

20. Georgieff MK (2007). Nutrition and the developing brain: nutrient priorities and measurement. Am J Clin Nutr. 85(2): 614–620.

21. Gossell-Williams M, Benjamin J (2006). Choline: are our university students eating enough? West Indian Med J. 55(3): 197–199.

22. Hambidge KM, Casey CE, Krebs NF (1986). Zinc. In: Mertz W (ed.). Trace Elements in Human and Animal Nutrition. 5th ed. Orlando, Fla: Academic Press Inc. 2: 1–137.

23. Helland IB, Smith L, Saarem K, Saugstad OD, Drevon CA (2003). Maternal supplementation with very-long-chain n-3 fatty acids during pregnancy and lactation augments children’s IQ at 4 years of age. Pediatrics. 111: 39–44.

24. Hibbeln JR, Davis JM, Steer C, Emmett P, Rogers I, Williams C, Golding J (2007). Maternal seafood consumption in pregnancy and neurodevelopmental outcome in childhood (ALSPAC study): an observational cohort study. Lancet. 369: 578–585.

25. Holm PI, Ueland PM, Vollset SE (2005) Betaine and folate status as cooperative determinants of plasma homocysteine in humans. Arterioscler Thromb Vasc Biol. 25: 379–385.

26. Hung J, Abratte ChM, Wang W, Li Rui M, David J, Caudill MA (2008). Ethnicity and folate influence choline status in young women consuming controlled nutrient intakes. J Am Coll Nutr Apr. 27(2): 253–259.

27. Hunter SR, Williams JK, Thomas JD (2008). Choline supplementation attenuates learning deficits associated with neonatal alcohol exposure in the rat: effects of varying the timing of choline administration. Brain Res. 1237: 91–100.

28. Hurley LS, Swenerton H (1966). Congenital malformations resulting from zinc deficiency in rats. Proc Soc Exp Biol Med. 123: 692–696.

29. Hytten FE (1980). Nutrition. In: Clinical Physiology in Obstetrics. Edited by F. Hytten and G. Chamberlain. Oxford: Blackwell Scientific Publications.

30. Joint FAO/WHO Ad Hoc Expert Committee (1973). Energy and Protein Requirements. Geneva: World Health Org. techn. Rep. Ser. No. 522.

31. King J (1981). University of California Berkeley: Energy and protein requirements during pregnancy. Joint FAO/WHO/UNU Expert Consultation on Energy and Protein Requirements Rome.

32. Kodas E, Galineau L, Bodard S (2004). Serotoninergic neurotransmission is affected by n-3 polyunsaturated fatty acids in the rat. J Neurochem. 89: 695–702.

33. Krebs NF (2000). Overview of Zinc Absorption and Excretion in the Human Gastrointestinal Tract. Journal of Nutrition. 130: 1374–1377.

34. Lamoureux J, Meck A, Williams WH (2008). Prenatal choline availability alters the context sensitivity of Pavlovian conditioning in adult rats. Learn Mem. 15(12): 866–875.

35. Lapardin MP, Kiku PF (2008). Hygienic assessment of nutrition in different urban groups of the Primorye Territory runova. Gig Sanit. (5): 51–54.

36. Mehmet B, Yakup A, Gedik Y, Deer O, Mocan H, Erduran E, Karahan C (2006). Journal of Child Psychology and Psychiatry: Relationships Between Serum Free Fatty Acids and Zinc, and Attention Deficit Hyperactivity Disorder: A Research Note. 37(2): 225–227.

37. Muss C, Stejskal V, Titel E (2009). The Effectiveness of Cholin Citrate Infusions monitored by Lymphocyte Transfromation Test (LTT) in Multiple Sclerosis. A new approach to the diagnosis and treatment of the disease. Neuro Endocrinol Lett. 30(3): 331–334.

38. Myers GJ, Davidson PW (2007). Maternal fish consumption benefits children’s de­velopment. Lancet; 369: 537–539.

39. Myers GJ, Davidson PW, Strain JJ (2007). Nutrient and methyl mercury exposure from consuming fish. J Nutr. 137(12): 2805–2808.

40. Napoli I, Blusztajn JK, Mellott TJ (2008). Prenatal choline supplementation in rats increases the expression of IGF2 and its receptor IGF2R and enhances IGF2-induced acetylcholine release in hippocampus and frontal cortex. Brain Res. 1237: 124–135.

41. National Institute for Health and Clinical Excellence (NICE) (2008). Improving the nutrition of pregnant and breastfeeding mothers and children in low-income households. London (UK): 105 (Public health guidance; no. 11).

42. Nupur M, Tiffany J, Berger-Sweeney JE (2008). Effects of postnatal dietary choline supplementation on motor regional brain volume and growth factor expression in a mouse model of Rett syndrome. Brain Res. 1237: 101–109.

43. Oldham H, Sheft BB (1951). Effect of caloric intake on nitrogen utilization during pregnancy. J. Am. Dietet. Assoc. 27: 847.

44. Ozarda Ilcol Y, Uncu G, Ulus IH (2002). Free and phospholipid-bound choline concentrations in serum during pregnancy, after delivery and in newborns. Arch Physiol Biochem. 110: 393–399.

45. Ramakrishnan U, Imhoff-Kunsch B, DiGirolamo AM (2009). Role of docosahexaenoic acid in maternal and child mental health. Am J Clin Nutr Mar. 89(3): 958–962.

46. Resseguie M, Song J, Niculescu MD, da Costa K-A, Randall TA, Zeisel SH (2007). Phosphatidylet­hanolamine N-methyltransferase (PEMT) gene expression is induced by estrogen in human and mouse primary hepatocytes. FASEB J. 21(10): 2622–2632.

47. Roeytenberg A, Cohen T, Freund HR, Hanani M (2007). Cholinergic properties of soy. Nutrition Sep. 23(9): 681–686.

48. Roseboom TJ, van der Meulen JH, Ravelli AC, Osmond C, Barker DJ, Bleker OP (2001). Effects of prenatal exposure to the Dutch famine on adult disease in later life: an overview. Mol Cell Endocrinol. 185(1–2): 93–98.

49. Salem N, Jr., Litman B, Kim HY, Gawrisch K (2001). Mechanisms of action of docosahexaenoic acid in the nervous system. Lipids. 36: 945–959.

50. Scientific Advisory Committee on Nutrition. Food Standards Agency. Advice on seafood consumption: benefits and risks (2004). London: The Food Standards Agency.

51. Selhub J (1999). Homocysteine metabolism. Annu Rev Nutr. 19: 217–246.

52. Semczuk M, Semczuk-Sikora A (2001). New data on toxic metal intoxication (Cd, Pb, and Hg in particular) and Mg status during pregnancy. Med Sci Monit. 7(2): 332–340.

53. Shannon K, Mahmud Z, Asfia A, Ali M (2008). The social and environmental factors underlying maternal malnutrition in rural Bangladesh: implications for reproductive health and nutrition programs. Health Care Women Int. 29(8): 826–840.

54. Shaw GM, Carmichael SL, Yang W, Selvin S, Schaffer DM (2004) Periconceptional dietary intake of choline and betaine and neural tube defects in offspring. Am J Epidemiol. 160: 102–109.

55. Shrimpton R, Shrimpton R, Schultink W (2002). Can supplements help meet the micronutrient needs of the developing world? Proc Nutr Soc. 61(2): 223–229.

56. State of the World’s Children (2007). Women and Children – The double dividend of gender UNICEF.

57. Stein Z, Susser M (1975). The Dutch famine, 1944–1945, and the reproductive process. Effects or six indices at birth. Pediatr Res. 9(2): 70–76.

58. Szalay F, Zsarnovszky A, Fekete S, Hullár I, Jancsik V, Hajós F (2001). Retarded myelination in the lumbar spinal cord of piglets born with spread-leg syndrome Anat Embryol (Berl). 203(1): 53–59.

59. Tam O, Innis SM (2006). Dietary polyunsaturated fatty acids in gestation alter fetal cortical phospholipids, fatty acids and phosphatidylserine synthesis. Dev Neurosci. 28(3): 222–229.

60. The US Department of Health and Human Services, US Environmental Protection Agency: What you need to know about mercury in fish and shellfish 2004 EPA and FDA advice for: women who might become pregnant women who are pregnant nursing mothers young children (2004). Washington, DC.

61. The World Health Report (1997). Conquering Suffering, Enriching Humanity 51 World Health Organization (WHO).

62. Tomkins A, Watson F (1989). Malnutrition and Infection: A Review (United Nations Administrative Committee on Coordination/Sub­committee on Nutrition, WHO, Geneva, 5–6.

63. Vallee BL, Falchuk KH (1993). The biochemical basis of zinc physiology. Physiol Rev. 73: 79–118.

64. Van de Poel E, Hosseinpoor AR, Speybroeck N, Van Ourti T, Vega J (2008). Socioeconomic inequality in malnutrition in developing countries. Bull World Health Organ. 86(4): 282–291.

65. Veenema K, Solis C, Li RW, Wei M, Charles VA, Christian M, Caudill MA (2008). Adequate Intake levels of choline are sufficient for preventing elevations in serum markers of liver dysfunction in Mexican American men but are not optimal for minimizing plasma total homocysteine increases after a methionine load. Am J Clin Nutr Sep. 88(3): 685–692.

66. Victora CG, Adair L, Fall C, Hallal PC, Martorell R, Richter L, Sachdev HS (2008). Maternal and child undernutrition: consequences for adult health and human capital. Lancet. 371(9609): 340–357.

67. Zeisel SH (2008). Genetic polymorphisms in methyl-group metabolism and epigenetics: lessons from humans and mouse models. Brain Res. 1237: 5–11.

68. Zeisel SH (2009a). Importance of methyl donors during reproduction. Am J Clin Nutr. 89(2): 673– 677.

69. Zeisel SH (2009b). Is maternal diet supplementation beneficial? Optimal development of infant depends on mother’s diet. Am J Clin Nutr Feb. 89(2): 685–687.

70. Zeisel SH, Mar MH, Howe JC, Holden J (2003). Concentrations of choline-containing compounds and betaine in common foods. J. Nutr. 133: 1302–1307.