The Overlooked Prenatal Nutrient

By: Dr. Gregory Ward MBBS FRCOG

October 9, 2017

In recent years there has been a growing importance placed on nutrition and its contribution to a healthy pregnancy. Maintaining good levels of folate vitamin D, iron, B vitamins and DHA is important. A key nutrient, which is often overlooked, is choline and studies have shown that this micronutrient has important effects on fetal neurodevelopment in pregnancy and specifically on the memory function in the brain[1]. Choline is a nutrient that we produce in insufficient amounts, particularly if demand is high. Choline is recognized by the FDA (Food and Drug Administration) as an essential micronutrient to support a healthy pregnancy. Ensuring pregnant and breastfeeding women are eating choline-rich foods or taking a prenatal supplement containing choline is recommended. Women are advised to talk to a doctor about choline intake and incorporate it as part of a healthy and balanced diet.

Where is it Found?

Choline is found in foods such as beef, salmon, eggs, chicken, chickpeas, beans, cauliflower, wheat germ and turkey. Although foods high in choline are mainstream, according to research, choline is consumed at suboptimal levels across the United States[2]. Our ability to absorb choline varies from person to person and depends on the dietary source. The level of absorption of choline varies depending on folate levels, dietary intake and genetics[3]. Deficiency can cause memory loss, nerve damage, reduced cognitive ability and fatigue.

Health Benefits

Choline levels have been linked with supporting healthy growth and development in infants. Choline specifically plays a vital role in the development of brain structure and function,[4] [5]. During early life, the brain is producing billions of cells and forming connecting pathways between different regions of the brain. These pathways are essential for learning and memory[6] and also support proper functioning of the nervous system, and muscle formation. Brain development occurs at a rapid pace in the womb and for the first few months after birth. This period is critical in forming basic neurological function that has a profound influence on brain performance throughout life. During the perinatal period the infant receives choline solely from the mothers supply and from her breast milk. For this reason choline is a required component in infant formula worldwide.

Figure 1 shows the recommended daily intake (RDI) of choline for pregnant women, breastfeeding women, infants and babies. During pregnancy and especially while breastfeeding supplementation of choline is advised to maintain a healthy pregnancy.[7]

During pregnancy, nutrition is the most influential non-genetic factor affecting fetal development[8]. Key nutrients to maintain a healthy pregnancy are widely recognized as folate, B vitamins, iron, DHA and increasingly choline. Folate and choline are synced with one another so that when folate intake is low, choline donates a piece of itself to make up for the deficiency in folate[9]. Research suggests that without supplementation pregnant women would not achieve sufficient levels of these nutrients[10]. A lack of essential vitamins and nutrients can have harmful effects on fetal development that can cause neurological disorders, physiological disorders and impair fetal growth.

Choline levels are linked to the development of DNA and cell structures. During pregnancy the fetus needs choline to ensure healthy stem cell function[11]. Choline also plays a vital role in the normal function of central mechanisms that determine cognitive behavior[12]. Choline plays an essential role in transmembrane signaling throughout the growth and development of nervous tissue[13] and therefore supports healthy nerve function. Not only is it a vital nutrient during pregnancy, but choline deficiency in adult life can lead to fatty liver disease, muscle wastage and cognitive challenges[14]. Due to the positive effect the nutrient can have on brain development, choline has also been researched for its role in supporting brain health as people age[15].

Maintaining choline at the RDA (recommended dietary allowance) level is recommended to support a healthy pregnancy. Insufficient intake of key vitamins and minerals during pregnancy can have detrimental effects on fetal health that can manifest later in the infant’s life so supplementation of nutrients such as choline is recommended. Since choline is under-consumed and our body does not produce enough, supplementation through a prenatal vitamin can increase choline status and ensure that optimum levels are being passed onto the infant. Speaking to a doctor about how to increase choline levels in your diet is advised to help support a healthy pregnancy.


[1] Zeisel, S.H., 2000. Choline: needed for normal development of memory. Journal of the American College of Nutrition19(sup5), pp.528S-531S.

[2] Wallace, T.C. and Fulgoni III, V.L., 2016. Assessment of total choline intakes in the United States. Journal of the American College of Nutrition35(2), pp.108-112.

[3] Jacob, R.A., Jenden, D.J., Allman-Farinelli, M.A. and Swendseid, M.E., 1999. Folate nutriture alters choline status of women and men fed low choline diets. The Journal of nutrition129(3), pp.712-717.

[4] Mudd, A.T., Getty, C.M., Sutton, B.P. and Dilger, R.N., 2016. Perinatal choline deficiency delays brain development and alters metabolite concentrations in the young pig. Nutritional neuroscience19(10), pp.425-433.

[5] Zeisel, S.H., 2004. Nutritional importance of choline for brain development. Journal of the American College of Nutrition23(sup6), pp.621S-626S.

[6] Zeisel, S.H., 2000. Choline: needed for normal development of memory. Journal of the American College of Nutrition19(sup5), pp.528S-531S.

[7] Institute of Medicine. 1998. Dietary Reference Intakes for Thiamine, Riboflavin, Niacin, Vitamin B6, Folate, Vitamin B12, Pantothenic Acid, Biotin and Choline, Washington DC: The National Academies Press.

[8] Phillips, D.I., 2006. External influences on the fetus and their long-term consequences. Lupus15(11), pp.794-800.

[9] Jacob, R.A., Jenden, D.J., Allman-Farinelli, M.A. and Swendseid, M.E., 1999. Folate nutriture alters choline status of women and men fed low choline diets. The Journal of nutrition129(3), pp.712-717.

[10] Masih, S.P., Plumptre, L., Ly, A., Berger, H., Lausman, A.Y., Croxford, R., Kim, Y.I. and O’Connor, D.L., 2015. Pregnant Canadian women achieve recommended intakes of one-carbon nutrients through prenatal supplementation but the supplement composition, including choline, requires reconsideration. The Journal of nutrition145(8), pp.1824-1834.

[11] Zeisel, S.H. and Niculescu, M.D., 2006. Perinatal choline influences brain structure and function. Nutrition reviews64(4), pp.197-203.

[12] Drago, F., Mauceri, F., Nardo, L., Valerio, C., Genazzani, A.A. and Grassi, M., 1993. Effects of cytidine-diphosphocholine on acetylcholine-mediated behaviors in the rat. Brain research bulletin31(5), pp.485-489.

[13] Fuglestad, A.J., Rao, R., Georgieff, M.K. and Code, M.M., 2008. The role of nutrition in cognitive development. Handbook in Developmental Cognitive Neuroscience2, pp.623-641.

[14] Wood, J.L. and Allison, R.G., 1982, December. Effects of consumption of choline and lecithin on neurological and cardiovascular systems. In Federation proceedings (Vol. 41, No. 14, pp. 3015-3021).

[15] J Strupp, B., E Powers, B., Velazquez, R., A Ash, J., M Kelley, C., J Alldred, M., Strawderman, M., A Caudill, M., J Mufson, E. and D Ginsberg, S., 2016. Maternal choline supplementation: A potential prenatal treatment for Down syndrome and Alzheimer’s disease. Current Alzheimer Research13(1), pp.97-106.

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