Associations of choline intake and metabolite status with fetal growth outcomes and placental macronutrient transport in pregnancies with or without gestational diabetes mellitus.

Background & aims: Gestational diabetes mellitus (GDM) is associated with increased risks of fetal overgrowth, possibly due to the increased transport of macronutrients from the placenta to the GDM-exposed fetus. Maternal choline supplementation in obese mice normalizes placental fat and glucose transport and prevents fetal overgrowth. In this study, we aimed to determine the correlation of choline intake and metabolite status with fetal growth outcomes and placental macronutrient metabolism and transport in pregnancies with and without GDM.

Methods: In this prospective study, we recruited women with (n = 40) and without (n = 36) GDM at 25-33 weeks gestation and assessed their choline intake and blood choline metabolite concentrations. We also collected placenta and cord blood samples from a subset of participants (21 GDM and 26 non-GDM) at delivery to examine placental macronutrient metabolism and transport.

Results: Our results demonstrated that a higher maternal choline intake was associated with lower placental mRNA expression of glucose transporter 3 (GLUT3) (β = -0.002, p = 0.012) in non-GDM pregnancies and leptin (LEP) (β = -0.02, p = 0.034) in GDM pregnancies, respectively. Both maternal blood (β = -77.97, p = 0.03) and placental (β = -0.38, p = 0.049) glycerophosphorylcholine (GPC) concentrations were negatively associated with infant birthweight regardless of GDM status. Maternal GPC concentrations were also negatively associated with placental triglyceride concentrations (β = -0.18, p = 0.017) and cord blood triglyceride (β = -11.1, p = 0.014) and free fatty acid (β = -39.6, p = 0.034) contents, while placental GPC concentrations were negatively associated with fatty acid transporter 1 (FATP1) mRNA expression (β = -1.38E-4, p = 0.036) in all participants. Lipidomics profiling demonstrated that maternal choline intake was negatively associated with concentrations of triglyceride species in the placenta regardless of GDM status.

Conclusions: In conclusion, maternal choline intakes demonstrated negative associations with placental macronutrient transporters and triglyceride contents. GPC concentrations seem to be a consistent indicator of reduced placental-fetal fat transport and eventually lower birth weight. These observations suggest the potential of using choline to alleviate GDM-related excess in transplacental fat transport and fetal overgrowth.