Choline in early childhood FASD: gains still visible five years on

Design

Five-year follow-up of three randomised placebo-controlled trials

Population

58 children with FASD (28 choline, 30 placebo), mean age 9.1 at follow-up

Primary outcome

Cognitive and executive function, memory, and psychiatric diagnoses

Effect

Non-verbal IQ 9.1% and working memory 11.3% better with choline; no significant difference in psychiatric diagnoses

Three small randomised trials gave choline or placebo to children aged 2.5 to 5.9 years with fetal alcohol spectrum disorder (FASD). This follow-up reassessed 58 of the original 104 children about five years later, at an average age of nine.

Children who had received choline scored about 9% better on non-verbal IQ and 11% better on working memory than those given placebo, both medium effect sizes. Higher doses were linked to better scores. Rates of anxiety and impulse-control disorders were high in both groups, with no significant difference in mental health diagnoses.

FASD has very few interventions, so a durable cognitive signal from a cheap supplement is notable. But only just over half the children were followed up, and those who returned may differ from those who did not.

This is not yet a basis for routine prescribing. It is a reason to keep FASD in mind, identify affected children early, and watch for a larger confirmatory trial.

• Ask about alcohol exposure in pregnancy when assessing a child with attention, memory or behaviour problems
• Screen children with FASD for anxiety and impulse-control disorders, which were common in this cohort
• Choline supplementation for FASD is research-stage and not established treatment
• Refer suspected FASD early for developmental assessment and school support

Why it matters

It is one of very few interventions in FASD with any lasting cognitive signal.

Don't overread it

Fewer than 60 children were followed up, so the gain may not hold in a larger trial.

The statistics, in plain English

A 'medium effect size' means the average choline-treated child scored noticeably above the average placebo child, but there was much overlap. With 58 children and 44% lost to follow-up, the estimate is fragile.

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