Alcohol Use in a Study of Phosphatidylcholine Supplementation in Pregnancy: Response to Bell and Ajula

To the Editor: The inquiry from Dr. Bell and Jessie Ajula prompted our additional examination of the Ross et al. study (1), published in the May 2016 issue of the Journal. In that study, 49 women in a randomized, placebo-controlled, double-blind trial of phosphatidylcholine supplementation during pregnancy rated their children on the Child Behavior Checklist at 40 months of age (2). Aggression is the parameter on this checklist most relevant to the development of disruptive behavior, as conceptualized by Wakschlag et al. Eight of the 49 women had significant ongoing alcohol and drug abuse at the time of conception (alcohol, N=4; cannabis, N=2; cocaine, N=1; alcohol, cannabis, and hallucinogens, N=1). Their children had higher ratings of aggression (9.8, SD=5.6) compared with the other children (6.9, SD=3.7). Aggression ratings were lower by a mean of 1.5 points (SD=6.2) in children whose mothers had phosphatidylcholine supplementation compared with placebo, but there was no similar effect of phosphatidylcholine supplementation compared with placebo for children whose mothers were abusing drugs and alcohol (−0.4, SD=5.7). These differences are not significant, and the number of children studied limits the certainty of any conclusions. As Wakschlag et al. note in their reply to Bell and Ajula, other risk factors may also affect these children. However, it would seem that public health efforts should encourage both prenatal drug and alcohol abstinence and phosphatidylcholine supplementation, now recommend by the American Medical Association (3), along with other elements of good maternal care, at the time of conception or as early in gestation as possible.