Effects of Genomic and Metabolomic Variations of Choline on Risk of Preterm Birth and Clinical Outcomes in Preterms

Genomic and Metabolomic Differences of Choline on the Risk of Preterm Delivery and Their Effects on Clinical Outcomes in Preterms Receiving Total Parenteral Nutrition Therapy

The incidence of preterm birth increases annually. Premature delivery has become the leading cause of neonatal illness and death. For the survived premature babies, the incidence of sequelae is also higher than the full-term babies, which brings a heavy burden to a family and society. Preterm birth has become the important factor affecting the quality of births. The occurrence of premature birth is the outcome of combined action of genetic and environmental factors. However, its etiology is not clear. Recent studies have shown that the risk of preterm birth is associated with dietary factors. Choline is an essential nutrient for human health and it plays an important role in the growth and development of fetuses and neonates. The investigators previously found that serum levels of free choline in preterm mothers were lower than those in normal mothers with full-term birth. Serum levels of free choline also reduced in preterms after receiving parenteral nutrition (PN). However, the relationships between choline and preterm birth is not clear. Therefore, this study is aimed to explore the effect of choline intake during pregnancy and genetic polymorphisms on the risk of preterm birth and on the clinical outcomes in preterms receiving total PN therapy. Healthy Chinese pregnant women with their healthy term infants will be recruited as the control group, while Chinese women with preterm delivery and their preterm infants will be recruited as the preterm group. Dietary choline intake during pregnancy will be evaluated by semi-quantitative food frequency questionnaire and 24-h dietary recall questionnaire. Gene polymorphisms in the key enzymes of choline metabolism will be identified among the participated women and neonates through Real-time polymerase chain reaction. Choline and its related metabolites will be assayed using high performance liquid chromatography combined with mass spectrometry among all mothers and preterms before and after 7-days PN treatment. The influence of genetic risk factors and metabolic changes of choline on the physical and mental development of preterms will be evaluated. The results of this study will contribute to a comprehensive understanding of the role of choline and the relative gene polymorphisms on the risk of preterm birth, which will be helpful for estimating the high risk in advance. The results will also provide the scientific evidences to establish the personalized amount of choline intake among women and infants, optimize nutrition support for pregnant women and preterms, and promote better prenatal and postnatal care.

Study Overview

• Status: Unknown
• Conditions: Preterm Birth; Total Parenteral Nutrition; Genomic and Metabolomic Variations
• Intervention / Treatment: Other: No intervention

• Study Type: Observational
• Enrollment (Anticipated): 400

Contacts and Locations

• Study Contact: Name: Jie Zhu, MD,PhD; Phone Number: 648 86-021-2507-8999; Email: jacky284868@163.com

Study Locations

• China
  • Shanghai
    • Shanghai, Shanghai, China, 200092
      • Recruiting
      • Xinhua Hospital, Shanghai Jiao Tong University School of Medicine
      • Contact: Jie Zhu, MD, PhD; Phone Number: 6418 86-021-2507-8999; Email: jacky284868@163.com

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Child; Adult; Older Adult
• Accepts Healthy Volunteers: Yes
• Genders Eligible for Study: All

• Sampling Method: Probability Sample

Study Population

Healthy Chinese women with their healthy term infants were recruited as the control group, while Chinese women with preterm delivery and their preterm infants (gestational age < 37w) were recruited as the preterm group.

Description

Inclusion Criteria:

1. Preterm group: preterm infants (gestational age < 37 w) and their mothers (125 pairs );
2. Control group: healthy full-term infants and their mothers (125 pairs );_
3. Admission to Xin Hua Hospital, Shanghai;_ 4.1600g ≤ birth weight ≤ 2100g for preterms;

5.Administration of total parenteral nutrition (TPN) ≥ 7d; 6.No contraindication of TPN therapy.

Exclusion Criteria:

1. Administration of TPN before enrollment;
2. Receive blood infusion during TPN treatment;
3. Liver or renal markers present at 2 times higher than the normal level;
4. Suspected or identified chromosome diseases, congenital metabolic disease, congenital digestive tract diseases and necrotizing enterocolitis;
5. Cytomegalovirus infection, viral hepatitis, and congenital or acquired immune deficiency.

Study Plan

How is the study designed?

Number of groups / cohorts

4

Cohorts and Interventions

Group / Cohort	Intervention / Treatment
The normal mothers group; No intervention	Other: No intervention; No intervention
The normal full-term infants group; No intervention	Other: No intervention; No intervention
The preterm mothers group; No intervention	Other: No intervention; No intervention
The preterms group; No intervention	Other: No intervention; No intervention

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Time Frame
Distribution of single nucleotide polymorphisms of the targeted genes	June 2016 - December,2019
Plasma concentrations of choline	3 years
Plasma concentrations of betaine	3 years
Plasma concentrations of phosphocholine	3 years

Secondary Outcome Measures

Outcome Measure	Time Frame
Dietary questionnaire of choline intake during pregnancy	through study completion, an average of 3 years
Serum alanine aminotransferase	through study completion, an average of 3 years
Serum aspartate aminotransferase	through study completion, an average of 3 years
Serum total bilirubin	through study completion, an average of 3 years
Serum direct bilirubin	through study completion, an average of 3 years
Serum bile acid	through study completion, an average of 3 years
Serum gamma glutamyl transferase	through study completion, an average of 3 years
Serum triglyceride	through study completion, an average of 3 years
Mental developmental index	through study completion, an average of 3 years
Psychomotor developmental index	through study completion, an average of 3 years

Collaborators and Investigators

• Sponsor: Xinhua Hospital, Shanghai Jiao Tong University School of Medicine
• Investigators: Principal Investigator: Jie Zhu, MD,PhD, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine

Study record dates

Study Major Dates

• Study Start: March 1, 2016
• Primary Completion (Anticipated): December 1, 2019
• Study Completion (Anticipated): December 1, 2019

Study Registration Dates

• First Submitted: July 12, 2016
• First Submitted That Met QC Criteria: July 19, 2016
• First Posted (Estimate): July 22, 2016

Study Record Updates

• Last Update Posted (Estimate): July 27, 2016
• Last Update Submitted That Met QC Criteria: July 26, 2016
• Last Verified: July 1, 2016

More Information

Terms related to this study

• Additional Relevant MeSH Terms: Pregnancy Complications; Obstetric Labor Complications; Obstetric Labor, Premature; Premature Birth
• Other Study ID Numbers: XH-16-005