Why You Need Choline During Pregnancy

Most pregnant women know about folate (or folic acid), a B vitamin that’s crucial for healthy fetal brain development. But there’s another important brain-building nutrient you may not have heard of: choline. Although less well known, choline is becoming increasingly recognized for its importance in prenatal health and fetal brain development.1 

Because choline is still somewhat under the radar, most of us fall short of the daily recommended amount. This is especially a problem for pregnant women -- in fact, it’s estimated that 90-95% of pregnant women don’t get as much choline as they should.2 Here’s what you need to know about choline, and how to make sure that you and your baby are getting enough.

What is Choline & Why Is It Important?

Choline is an essential vitamin-like nutrient that’s often grouped with the B vitamin family because it has similar functions in the body. It’s important for healthy brain and nerve function, muscle control, and metabolism. Like folate and B12, it also plays a role in DNA synthesis, cell structure maintenance, and early brain and nervous system development, making it crucial for prenatal health.2,3

Choline is a precursor for acetylcholine, a neurotransmitter that plays an important role in memory, mood regulation, thinking, and learning. It’s also critical for neurodevelopment, and has an early influence on the structure and function of the brain. Low choline levels in the womb and early life have been shown to impact memory functions later in adult life.4,5

In fact, there’s growing evidence that choline may be just as important as folate for early fetal brain development. High amounts of choline are delivered from the mother to the fetus during pregnancy, depleting the mother’s stores and increasing her choline demands. Low choline intake in the mother’s diet is linked with an increased risk of neural tube birth defects in the fetus, as well as other pregnancy complications.4,6  

For this reason, both the American Medical Association and the American Academy of Pediatrics have recently called attention to the importance of choline for prenatal and postnatal nutrition.1 But since these recommendations only came out in 2017 and 2018, many women are still unaware of them, and many prenatal multivitamins still don’t include choline.

Getting Enough Choline

Choline was first recognized as an essential nutrient by the Institute of Medicine as recently as 1998. It doesn’t yet have a recommended dietary allowance (RDA) like other vitamins. But the IOM recommends a daily adequate intake (AI) of 550 mg for adult men and 425 mg for adult women. Pregnant women need 450 mg and breastfeeding moms need 550 mg to reach nutritional adequacy.2

Although we get some choline from our food, most of us aren’t meeting this target. Research suggests that only about two thirds of women get the recommended amount of choline on a normal day. During pregnancy, when our choline needs increase, less than 10% of women are meeting the AI. This means that pregnant women have an increased risk of choline deficiency.2

You may also be at risk of choline deficiency if you carry the MTHFR gene variant, a common genetic variation which makes it more difficult to metabolize certain B vitamins in your diet, including folate. Both folate and choline are methyl donors, meaning that the body can use them for methylation, a biochemical process that’s required for making DNA, producing neurotransmitters, and other important functions. When your folate levels are low, your body will use choline as a methyl donor in its place. This will increase your need for choline.7

Choline is found in many common foods, so most of us do get some in our diets. But most of us could also use more, especially if we’re pregnant or breastfeeding. 450-550 mg of choline a day is not an easy target to meet through diet alone. You’re also unlikely to find a multivitamin that includes that much. But you can easily meet your choline needs through a combination of diet and supplements. 

Some of the foods that include choline are:2

  • 1 hard-boiled egg: 147 mg
  • 1/2 cup soybeans: 107 mg
  • 3 oz chicken breast: 72 mg
  • 3 oz ground beef: 72 mg
  • 3 oz Atlantic cod: 71 mg
  • 1 large baked red potato: 57 mg
  • ½ cup kidney beans: 45 mg
  • 1 cup cooked quinoa: 43 mg
  • 1 cup 1% milk: 43 mg
  • 1 cup nonfat yogurt: 38 mg
  • ½ cup brussels sprouts: 32 mg
  • ½ cup broccoli: 31 mg
  • ½ cup shiitake mushrooms: 27 mg

You’ll also find 100 mg choline per serving in our Prenatal Multivitamin and 55 mg choline per serving in our Postnatal Multivitamin. Learn more about What to Look for in a Prenatal Multivitamin.

References:

1. Korsmo, Hunter W et al. “Choline: Exploring the Growing Science on Its Benefits for Moms and Babies.Nutrients vol. 11,8 1823. 7 Aug. 2019, doi:10.3390/nu11081823

2. “Choline. Fact Sheet for Health Professionals.” National Institutes of Health.

3. “What is Choline? An Essential Nutrient with Many Benefits.” Healthline, 2018.

4. Zeisel, Steven H. “Choline: critical role during fetal development and dietary requirements in adults.Annual review of nutrition vol. 26 (2006): 229-50. doi:10.1146/annurev.nutr.26.061505.111156

5. Bekdash RA. “Choline and the Brain: An Epigenetic Perspective.” Adv Neurobiol. 2016;12:381-99. doi: 10.1007/978-3-319-28383-8_21. PMID: 27651265.

6. Zeisel, Steven H. “Choline: critical role during fetal development and dietary requirements in adults.Annual review of nutrition vol. 26 (2006): 229-50. doi:10.1146/annurev.nutr.26.061505.111156

7.  Robert A. Jacob, Donald J. Jenden, Margaret A. Allman-Farinelli, Marian E. Swendseid, Folate Nutriture Alters Choline Status of Women and Men Fed Low Choline Diets, The Journal of Nutrition, Volume 129, Issue 3, March 1999, Pages 712–717, https://doi.org/10.1093/jn/129.3.712