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Choline is one of the most essential nutrients for a healthy pregnancy; unfortunately though, it is often overlooked during the perinatal stage. Its impacts on placental development, baby’s brain health, neural tube formation, healthy lung development, and even transfer of nutrients across the placenta have far reaching and long-term implications for mom and baby. In addition to choline’s support for your baby’s development, it’s also extremely important for a pregnant woman’s healthy metabolism, blood pressure, and mood.
Unfortunately 90-95%+ of pregnant women in the US are not meeting their choline needs.
That’s HUGE.
What’s worse —
The American Medical Association recommends that all prenatal supplements include this vital nutrient, but many supplements still do not contain choline or do not contain adequate amounts of choline.
While eating choline-rich foods like egg yolks, liver, soy and sunflower seeds are a great place to start, the majority of women will also need supplementation to reach the recommended intake to support a healthy pregnancy.
So what exactly is choline, and why is it so essential? Let’s take a look at the unique benefits of choline for pregnancy and how to get more of it in your diet.
Choline is a vitamin-like essential nutrient that plays a key part in several metabolic functions. It is vital for maintaining healthy cell membranes, aiding fat transport, and ensuring proper brain and nervous system function. Additionally, choline is crucial for the development of a healthy brain and spinal cord.
Although your liver can make small amounts of choline, it can’t make enough to meet your needs during pregnancy so it’s important to eat foods rich in choline and take a supplement to get the amount your body requires.
The most abundant phospholipid in our bodies is phosphatidylcholine. Phospholipids, including phosphatidylcholine, are fatty acid molecules that form our cell membranes and the organelles within them, ensuring our many bodily processes operate smoothly.
Cell structure
Choline is needed to make fats that support the structural integrity of cell membranes.
Cell messaging
Choline is involved in the production of compounds that act as cell messengers.
Fat transport and metabolism
Choline is essential for making a substance required for removing cholesterol from your liver. Inadequate choline may result in fat and cholesterol buildup in your liver.
DNA synthesis
Choline and other vitamins, such as B12 and folate, help with a process that’s important for DNA synthesis.
A healthy nervous system
Choline is required to make acetylcholine, an important neurotransmitter. It’s involved in memory, muscle movement, regulating heartbeat, and other basic functions.
Phosphatidylcholine (PC), a natural substance found in every human cell and some foods, includes the critical nutrient choline for brain, gut, and neurotransmitter health, as well as phospholipids, the building blocks of our cell membranes.
Choline contributes to brain health, liver function, lung development and fat metabolism. It also helps produce the neurotransmitter acetylcholine, which is vital for learning and memory. During pregnancy, the choline compound phosphatidylcholine is crucial for a baby’s brain development.
Phosphatidylcholine is found most readily in egg yolks, sunflower seeds, and soybeans. You can also take phosphatidylcholine supplements.
Another type of choline — free choline — is the form of choline that is present in most foods. You find free choline in certain types of meat and fish, broccoli, shiitake mushrooms, almonds, and various legumes.
The body uses free choline by converting it into usable forms that support essential cellular processes, which are especially critical during pregnancy.
Choline is one of the most essential nutrients for a healthy pregnancy. Since phosphatidylcholine is used to maintain and rebuild our cells, it is essential for pregnant women who are literally building a new human being one cell at a time.
There are many studies in both humans and animals that show the benefits of choline during pregnancy and the risks associated with deficiency: protects against neural tube defects, cleft lip, and plate formation; benefits fetal brain and lung development, supports placental function, and supports maternal liver function. Choline is also important for mama’s healthy metabolism, blood pressure, and mood.
Phosphatidylcholine is a major component of the biological membranes that support healthy development of the baby’s lungs and lung surfactants as well as overall healthy fetal growth — especially during the third trimester, when the fetus creates an increased demand for PC, which is transferred from the mother to her developing infant through her nutrient intake of food and supplementation.
Ensuring that you’re meeting your choline needs during pregnancy is also critical for the health of mama’s brain and mood. Many expectant mothers struggle with “pregnancy brain,” finding that they are more forgetful than usual or have difficulty concentrating. Choline has been linked to better cognitive performance, so it can help you feel more like yourself during pregnancy.
Choline is critical from the very earliest weeks of pregnancy. During the first trimester, billions of fetal cells are dividing rapidly, and every single one of those cells requires choline for its membrane structure. This is also when the neural tube forms—the structure that becomes your baby’s brain and spinal cord. Adequate choline during this window significantly reduces the risk of neural tube defects.
This is why I recommend starting choline supplementation during the preconception period. By the time most women discover they’re pregnant (often 4–6 weeks in), the neural tube has already closed. Having sufficient choline stores from the start gives your baby the best possible foundation.
Choline is an important factor in brain development when you’re in the womb, and it influences cognitive function later in life. When you’re choline deficient, it can cause muscle damage and abnormal fat deposits in the liver, which can result in non-alcoholic fatty liver disease. Your body can’t synthesize all the choline it needs, which is why making it a part of your diet is essential.
When a growing baby is deficient in choline, it can cause inadequate brain, spine, or spinal cord development, and even if the baby escapes these serious consequences, they can still have lowered memory capacity and slower cognition as they develop.
During the first few weeks of pregnancy, billions of fetal cells are growing, and all of them contain choline in the cell membrane. During this time period, a large volume of choline transfers from mother to baby. This vital nutrient supports brain and eye development and can protect against neural tube defects, which are severe defects that occur when the neural tube does not close properly during pregnancy.
One of the biggest benefits of choline during pregnancy is its role as a helper nutrient to omega-3. Choline and omega-3 work together to promote healthy brain and eye development. Choline supports the proper uptake of omega-3 DHA, helping to supply omega-3 DHA and other fats to the developing fetus. Choline does this by facilitating the release of omega-3 from the liver into the bloodstream, which helps it reach the fetus more efficiently.
Choline makes DHA more bioavailable, which means more of the nutrient reaches the fetus than just taking Omega-3 on its own.
Additionally, low choline intake may raise the risk of other pregnancy complications. These include preeclampsia, premature birth, and low birth weight.
As noted above, choline is an important part of DNA synthesis and cell membrane structure. The need for prenatal choline is extremely high in the first weeks and months of fetal development, as fetal cells are growing and differentiating.
Choline is important throughout your entire pregnancy, but it’s essential during the third trimester when your baby’s brain is growing rapidly.
Choline is one of the most essential nutrients for a healthy pregnancy. Since phosphatidylcholine is used to maintain and rebuild our cells, it is essential for pregnant women who are literally building a new human being one cell at a time.
There are many studies in both humans and animals that show the benefits of choline during pregnancy and the risks associated with deficiency: protects against neural tube defects, cleft lip, and plate formation; benefits fetal brain and lung development, supports placental function, and supports maternal liver function. Choline is also important for mama’s healthy metabolism, blood pressure, and mood.
Phosphatidylcholine is a major component of the biological membranes that support healthy development of the baby’s lungs and lung surfactants as well as overall healthy fetal growth — especially during the third trimester, when the fetus creates an increased demand for PC, which is transferred from the mother to her developing infant through her nutrient intake of food and supplementation.
Ensuring that you’re meeting your choline needs during pregnancy is also critical for the health of mama’s brain and mood. Many expectant mothers struggle with “pregnancy brain,” finding that they are more forgetful than usual or have difficulty concentrating. Choline has been linked to better cognitive performance, so it can help you feel more like yourself during pregnancy.
Choline is an important factor in brain development when you’re in the womb, and it influences cognitive function later in life. When you’re choline deficient, it can cause muscle damage and abnormal fat deposits in the liver, which can result in non-alcoholic fatty liver disease. Your body can’t synthesize all the choline it needs, which is why making it a part of your diet is essential.
When a growing baby is deficient in choline, it can cause inadequate brain, spine, or spinal cord development, and even if the baby escapes these serious consequences, they can still have lowered memory capacity and slower cognition as they develop.
During the first few weeks of pregnancy, billions of fetal cells are growing, and all of them contain choline in the cell membrane. During this time period, a large volume of choline transfers from mother to baby. This vital nutrient supports brain and eye development and can protect against neural tube defects, which are severe defects that occur when the neural tube does not close properly during pregnancy.
One of the biggest benefits of choline during pregnancy is its role as a helper nutrient to omega-3. Choline and omega-3 work together to promote healthy brain and eye development. Choline supports the proper uptake of omega-3 DHA, helping to supply omega-3 DHA and other fats to the developing fetus. Choline does this by facilitating the release of omega-3 from the liver into the bloodstream, which helps it reach the fetus more efficiently.
Choline makes DHA more bioavailable, which means more of the nutrient reaches the fetus than just taking Omega-3 on its own.
Additionally, low choline intake may raise the risk of other pregnancy complications. These include preeclampsia, premature birth, and low birth weight.
As noted above, choline is an important part of DNA synthesis and cell membrane structure. The need for prenatal choline is extremely high in the first weeks and months of fetal development, as fetal cells are growing and differentiating.
Choline is important throughout your entire pregnancy, but it’s essential during the third trimester when your baby’s brain is growing rapidly.
Choline is a recently discovered nutrient — it was only acknowledged as a required nutrient by the Institute of Medicine in 1998 — and, due to a lack of available evidence, a Reference Daily Intake (RDI) for choline has not been determined. In addition, determining choline intake is difficult because its presence in various foods is relatively unknown.
However, the Institute of Medicine has set a value for adequate intake. This value is intended to be sufficient for most healthy women, helping them avoid negative consequences of deficiency.
Adult women: 425 mg per day
Breastfeeding women: 550 mg per day
Pregnant women: 930 mg per day
The RDA is set at 450 mg per day for pregnancy and 550 mg while nursing, though research suggests that upwards of 900mg in pregnancy supports optimal perinatal and infant health outcomes. Most prenatal vitamins contain 1/10th or less of the RDA.
A recent study found that children at one year of age had significantly increased information processing speeds when their mothers consumed 930 mg/day of choline.
Choline is important throughout your entire pregnancy, but timing matters. Ideally, begin choline supplementation during the preconception period or as soon as you find out you’re pregnant. In the first trimester, choline supports neural tube closure. In the second and third trimesters, demand increases as the baby’s brain undergoes rapid growth.
Choline supplements can be taken at any time of day, with or without food. Many women find it convenient to take their choline supplement alongside their prenatal vitamin in the morning. If you experience any nausea, try taking it with your largest meal.
Yes, choline is safe during pregnancy. The tolerable upper limit for choline is set at 3,500 mg per day, which is well above the recommended 930 mg. Side effects are rare at recommended doses. In very high doses (above the upper limit), some people may experience a fishy body odor, gastrointestinal distress, or low blood pressure. At the doses I recommend for pregnancy (around 890–930 mg from supplements plus food), choline is safe and well-tolerated.
Another randomized controlled feeding study found that children of mothers who received 930 mg/day of choline had improvements in sustained attention when assessed at 7 years follow-up compared to those exposed to 480 mg/day.
Your choline supplement needs may vary by day depending on what you eat and what other supplements you take. However, the tolerable upper limit for choline is set to 3,500mg per day, so taking additional choline is quite safe, and may further benefit the health of you and your baby.
The bottom line is that while some mamas obtain more choline through dietary sources like eggs and liver, most pregnant women can benefit from additional supplementation.
The most concentrated sources of choline are found in beef liver, chicken liver, egg yolks, fresh cod, salmon, soybeans, sunflower seeds, and cruciferous vegetables like cauliflower, broccoli, and legumes.
Here’s a quick reference for choline content in common foods:
Unfortunately, given the level of choline that studies have shown are necessary for optimal health of both mom and baby, even if you’re eating 3-4 eggs a day in pregnancy (which I highly recommend!) you still won’t be getting enough choline, so it’s important to supplement.
If you are currently taking a prenatal — which I recommend starting in the preconception stage (yes, seriously) — have a look to see how much choline it provides. Chances are, it’s under 50 mg … which is nowhere near the recommended 930 mg.
I recommend taking two DFH Phosphatidylcholine softgels which provide 840 mg of choline, plus DFH Prenatals which contain an additional 50 mg of choline for a total of 890 mg of supplemental choline. With the addition of eating choline-rich food sources, such as eggs, on a daily basis you will easily reach the 930 mg of choline needed for an optimal pregnancy.
When choosing a choline supplement, look for phosphatidylcholine rather than choline bitartrate. Phosphatidylcholine is better absorbed and provides the form of choline that is most readily used for brain development and cell membrane formation.
It’s important to note that sufficient choline intake is critical even after you’ve given birth. This is because choline is transferred directly from mother to baby through breast milk. Significant brain development continues to happen after giving birth. Making sure there is enough choline available for your baby’s growing brain and cognitive development is essential. Taking choline supplements and eating choline-rich foods helps ensure you have enough to nourish both you and your baby’s brain.
Additionally, choline plays a key role in your postpartum recovery. Choline is so beneficial for cognitive function that it can be helpful for avoiding the brain fog, memory issues, and mental fatigue that is common during postpartum.
The reality is that 1 in 5 pregnant women don’t get enough choline in her diet during pregnancy.
Choline is an essential nutrient that is required for optimal health — it plays a key role in healthy brain function, heart health, liver function, and fetal development during pregnancy.
It is extremely important to your baby’s brain development and learning capacity throughout life and is important to be supplementing while trying to conceive, during pregnancy and postpartum.
Many pregnant women in Western countries are not meeting the recommended intake. It’s near impossible to get enough choline through food alone, so it’s important to supplement your choline intake … especially during pregnancy and breastfeeding, when most prenatals contain little to no choline.
Food and Nutrition Board, Institute of Medicine. Washington, D.C.: National Academy of Sciences; Dietary Reference Intakes: Thiamin, Riboflavin, Niacin, Vitamin B-6, Vitamin B012, Pantothenic Acid, Biotin, and Choline. 1998:390–422.
Choline: an essential nutrient for public health
Study explores effects of dietary choline deficiency on neurologic, systemwide health
Choline – Health Professional Fact Sheet
Phosphatidylcholine as a precursor of choline for acetylcholine synthesis
Effects of phosphatidylcholine and betaine supplements on women’s serum choline
Choline and Risk of Neural Tube Defects in a Folate-fortified Population
Choline and risk of neural tube defects in a folate-fortified population
Choline makes key nutrient available for baby development
Pre- and postnatal health: evidence of increased choline needs
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Sarah Jane Sandy is a certified nutrition therapist, and a fertility and women’s health expert. She has helped hundreds of women increase their fertility naturally and go on to have healthy full-term pregnancies. She has been working with women and couples trying to get pregnant for over 16 years and over 90% of the women who work with her get pregnant and have healthy babies.
She also works with women trying to fix their hormone imbalances, as well as supporting women through pregnancy and the postpartum period. Learn more about her own fertility and hormone journey here. To send Sarah a message, complete her Contact Form.
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