Choline Supplementation for Fetal Alcohol Syndrome in School Children

Running head: HEALTHCARE DISSERTATION
HEALTHCARE DISSERTATION
Name of the Student:
Name of the University:
Author Note:

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Table of Contents
Chapter 1: Introduction....................................................................................................................5
1.0: Background:..........................................................................................................................5
1.1: Problem Statement:...............................................................................................................5
1.2: Research Rationale:..............................................................................................................6
1.3: Research Question:...............................................................................................................6
1.4: Research Aim:......................................................................................................................7
1.5: Research Objectives:............................................................................................................7
1.6: Literature Review:................................................................................................................8
1.7: Results and Discussion:........................................................................................................8
Chapter 2: Literature Review...........................................................................................................9
2.0: Introduction:.........................................................................................................................9
2.1: Literature Review:................................................................................................................9
Literature Gap:...........................................................................................................................20
Chapter 3: Methodology................................................................................................................22
3:0: Methodology:.....................................................................................................................22
3.1: Summary of the Literature Findings:..................................................................................22
3.2: Search Strategy:..................................................................................................................23
3.3: Exclusion Criteria:..............................................................................................................25
3.4: Inclusion Criteria:...............................................................................................................25
3.5: Key Terms:.........................................................................................................................25
3.6: PICO Questions:.................................................................................................................26
Research Study Design and Justification:..................................................................................27
Chapter 4: Results and Discussion................................................................................................28
4.0: Literature Findings:............................................................................................................28
4.1: Thematic Analysis:.............................................................................................................28
4.2: Critical Analysis:................................................................................................................33
4.3: Discussion:..........................................................................................................................33
4.4: Summary:............................................................................................................................34
4.5: Limitations:.........................................................................................................................35
4.6: Level of evidence:..............................................................................................................36

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Chapter 5: Conclusion and Recommendations..............................................................................38
5.0: Conclusion:.........................................................................................................................38
5.1: Recommendation:...............................................................................................................38

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Abstract:
Background: According to a report published by the Institute of Alcohol Studies (2019), it has
been mentioned that UK ranks among the top five nations with the highest prevalence of Fetal
Alcohol Syndrome. The research report further suggested that Britain has the highest prevalence
percentage of FASD on a global context. The estimated cases diagnosed within Britain
comprises of 61.3 cases out of 10,000 live births. In addition to this, the disease burden
associated with FASD results in problems such as learning difficulties, hearing and vision
impairment, poor growth and development and behavioral difficulties which diminish the quality
of life of the child as well as the parents who are responsible for bringing up the child. The
rationale for conducting the research can be explained as evaluating the evidence base to
determine if choline supplementation could help in improving cognitive functioning in school
children so as to support them through the developmental process and improve their coping
skills.
Research Study Design: A systematic review research design was adapted to address the
research. Relevant literatures were scanned on the electronic databases of CINAHL and Google
Scholar. Appropriate key terms were used and papers that qualified inclusion criteria were
included in the research study.
Results and Discussion: Choline supplementation intervention can help in improving cognitive
functions and memory in FASD children. In addition to this a combination of pharamacological
interventions and support systems such as special education and occupational therapy can help in
supporting the child through developmental stages

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Conclusion and Recommendation: More research is required in order to validate the genetic
precision pharamacological interventions and validate the positive effect of choline
supplementation on the children suffering from FASD.

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Chapter 1: Introduction
1.0: Background:
Fetal Alcohol Syndrome abbreviated as FAS can be defined as a condition that manifests
when the mother is exposed to alcohol during the pregnancy term. Fetal alcohol syndrome results
in brain damage and significant growth and developmental problems (Rasmussen et al. 2013). It
is important to note here that the defect caused by fetal alcohol syndrome is irreversible but the
intensity of the effect varies from one child to other. Consumption of alcohol during pregnancy is
unsafe and increases the risk of developing Fetal Alcohol Syndrome in babies. Research studies
suggest that early diagnosis could help in implementing effective interventions to treat learning
difficulties and behavioral problems (Fuglestad et al. 2013; Tsang et al. 2016). Research studies
further state that the sign and symptoms of FAS span across a combination of physical, cognitive
and intellectual defects (Fuglestad et al. 2015). It is crucial to note here that there is no specific
recommended treatment routine that can treat FASD in infants and children. However, the
associated symptoms of the disorder can be controlled so as to improve the coping skills of the
child. A number of research studies suggest that nutritional intervention with the inclusion of
Choline-supplementation could help in improving cognitive functioning in FASD children
(Tsang et al. 2016; Murawski et al. 2015).
1.1: Problem Statement:
According to a report published by the Institute of Alcohol Studies (2019), it has been
mentioned that UK ranks among the top five nations with the highest prevalence of Fetal
Alcohol Syndrome. The research report further suggested that Britain has the highest prevalence

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percentage of FASD on a global context. The estimated cases diagnosed within Britain
comprises of 61.3 cases out of 10,000 live births. In addition to this, the disease burden
associated with FASD results in problems such as learning difficulties, hearing and vision
impairment, poor growth and development and behavioral difficulties which diminish the quality
of life of the child as well as the parents who are responsible for bringing up the child.
1.2: Research Rationale:
It is important to note that there is no specific treatment available for the cure of FASD,
however, the evidence base reveals about a number of interventions which could help in
symptom management. Particularly, in this regard, administering nutritional intervention in the
form of Choline supplementation has been studied to improve cognitive functioning in children.
Choline is an important nutrient that is responsible for the development of brain and behavior
(Coriale et al. 2013). A number of animal trials have been successfully conducted that reveal
prenatal and post natal choline supplementation was responsible for enhancing cognitive
functions. Also, research studies have suggested that choline supplementation improved
cognitive outcomes in rats that were exposed to alcohol during the development process
(Murawski et al. 2015). Therefore, the rationale for conducting the research can be explained as
evaluating the evidence base to determine if choline supplementation could help in improving
cognitive functioning in school children so as to support them through the developmental process
and improve their coping skills.
1.3: Research Question:

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Thus, based on the available background information about fetal alcohol syndrome and
its impact on the quality of life of the affected children and their care providers, the following
research questions can be formulated:
RQ1: What does the evidence base suggest about the use of choline supplementation as a
potential nutritional intervention for treating FASD symptoms in school age children?
RQ2: What are the positive effects of using choline supplementation in school age children
suffering from FASD?
RQ3: What are the evidence-based interventions that can be used for treating FASD in school
age children?
1.4: Research Aim:
The aim of the research is to conduct a thorough search on the electronic databases so as
to evaluate the effectiveness of using choline supplementation as a nutritional intervention for
treating the symptoms of FASD in relation to intellectual and cognitive impairment in school
children. The research also intends to evaluate the evidence based intervention strategies that
could be used to treat FASD in school age children.
1.5: Research Objectives:
The research objectives for the research study include the following:
 To determine whether choline supplementation could be used as an effective intervention
to treat the symptoms of FASD in school children
 To determine the impact of using choline supplementation in school children