Early choline in FASD tied to IQ, memory gains 5 years later

Nine months of choline supplementation in early childhood was associated with better nonverbal IQ and working memory among children with fetal alcohol spectrum disorder (FASD) about 5 years after treatment ended. The findings come from a long-term follow-up of 3 randomized controlled trials (RCTs) published in Alcohol: Clinical & Experimental Research.¹ They add to a small evidence base for interventions targeting the core cognitive deficits of FASD, which is estimated to affect 1% to 5% of the population.²

Choline RCT follow-up design in children with FASD

Investigators at the University of Minnesota previously ran 3 double-blind RCTs in which children aged 2.5 to 5.9 years with FASD received choline (n = 53) or placebo (n = 51) for 9 months.¹ Two trials compared a fixed daily dose of 500 mg with placebo, and the third tested a weight-adjusted dose.¹ A cumulative analysis of those trials reported memory benefits on an elicited imitation task,³ with higher doses linked to greater gains.²

For the current analysis, 58 children (28 choline, 30 placebo) were reassessed at a mean age of 9.1 years.¹ Of these, 9% had fetal alcohol syndrome, 43% partial fetal alcohol syndrome, and 48% alcohol-related neurodevelopmental disorder.¹ Parents completed a diagnostic interview and behavior checklists. Children completed assessments of general cognitive ability, executive functioning, and memory.¹

Nonverbal IQ and working memory outcomes with early choline

Children originally randomized to choline performed better than the placebo group on 2 measures, both with a medium effect size: 9.1% better on nonverbal IQ and 11.3% better on working memory.¹ Age at enrollment did not explain significant variance in outcomes. Choline dose, however, was significantly associated with both nonverbal IQ and working memory, and higher doses were linked to better performance at follow-up.¹ Inhibition, a component of executive function, showed a medium effect size benefit that was not statistically significant.²

Anxiety disorders and impulse-control disorders were common across the cohort.¹ The groups did not differ significantly in mental health diagnoses, although some comparisons approached significance.¹

Choline as a neurodevelopmental intervention for FASD

Choline is an essential nutrient involved in brain development. Preclinical models of prenatal alcohol exposure provided the rationale for testing it as a postnatal treatment.⁴ The new results are consistent with the group's earlier 4-year follow-up of a single trial. In that study, choline recipients had higher nonverbal intelligence, visual-spatial skill, working memory, and verbal memory, and fewer attention-deficit/hyperactivity disorder symptoms, than placebo recipients.⁴ The press release describes choline as the only biologically based FASD treatment that has been evaluated systematically in RCTs.²

The benefits persisted years after supplementation stopped. This suggests choline may shape the course of brain development during a sensitive early window rather than producing a short-term effect. The mechanism in humans, however, remains unconfirmed.¹,⁴

References

1. Wozniak JR, Eckerle JK, Gimbel BA, et al. Long-term neurodevelopmental outcome following three randomized controlled trials of choline in fetal alcohol spectrum disorder (FASD). Alcohol Clin Exp Res (Hoboken). 2026;50(10):e70394. doi:10.1111/acer.70394

2. Choline supplementation in young children with fetal alcohol spectrum disorder has durable developmental benefits, with gains evident five years later, study suggests. News release. Newswise. October 2026. Accessed October 12, 2026. https://www.newswise.com/articles/choline-supplementation-in-young-children-with-fetal-alcohol-spectrum-disorder-has-durable-developmental-benefits-with-gains-evident-five-years-later-study-suggests

3. Wozniak JR, Eckerle JK, Gimbel BA, et al. Choline enhances elicited imitation memory performance in preschool children with prenatal alcohol exposure: a cumulative report of 3 randomized controlled trials. Am J Clin Nutr. 2025;121(4):921-931. doi:10.1016/j.ajcnut.2025.02.009

4. Wozniak JR, Fink BA, Fuglestad AJ, et al. Four-year follow-up of a randomized controlled trial of choline for neurodevelopment in fetal alcohol spectrum disorder. J Neurodev Disord. 2020;12(1):9.