Choline’s crucial role in pregnancy and beyond: Your top questions answered


This post on choline was sponsored by Balchem, a nutritional ingredient supplier.

Choline, an essential nutrient, has been getting a lot of attention lately–and for good reason. In June, the American Medical Association suggested that all prenatal vitamins include evidence-based amounts of choline to support fetal nervous system development. Prenatal vitamins only contain 0-55 mg of choline, which means the majority of pregnant and lactating women do not consume enough to protect the health and development of their babies.

It’s estimated that less than 10% of pregnant women in America are meeting the Adequate Intake (AI) levels of choline, which are 450 mg during pregnancy and 550 mg while breastfeeding. This critical recommendation has left those trying to conceive or expecting a new baby with many questions regarding what is needed for optimal brain and spinal cord development. The potential benefits of choline don’t stop there. Emerging research on this powerful essential nutrient may expand far beyond early development. We’ve got the answers to parents’ top questions about choline and why getting enough of it is so important.

The benefits of choline sound similar to the B vitamin, folate. How are the two nutrients different?

For decades folate has been a priority nutrient for women of childbearing age. It’s known as the vitamin that helps prevent neural tube defects such as spina bifida and anenceophaly. Because of folate’s role in DNA synthesis, it is crucial during early fetal development when cell growth rates are high. There are many food sources of folate including dark leafy greens, fruits, nuts, and most meats.

Choline, however, isn’t quite as easy to incorporate into some diets, particularly since it is most abundant in animal-based products. While it’s also present in other foods, many aren’t exactly favorites of the American palate (think: liver). As an essential nutrient, choline plays a role in gene expression, cell membrane signaling and construction, and brain development. Higher amounts of choline are needed during pregnancy to support rapid cell division and tissue expansion. While folate and choline have distinct and separate roles in the body, they also work synergistically. If folate becomes low during pregnancy, the need for choline becomes even greater.

Does choline have benefits for baby and mom beyond fetal development?

Emerging research suggests that getting adequate levels of choline may have protective benefits for mom during pregnancy and lifelong benefits for baby. In addition to helping reduce the risk of neural tube defects, a 2012 study in the Journal of the Federation of American Societies for Experimental Biology (FASEB J) suggests that choline supplementation during pregnancy results in babies with lower levels of the stress hormone cortisol. It is speculated that lower levels of cortisol early in life may reduce the risk of stress-related diseases such as depression, high blood pressure, and diabetes.

Research conducted by Marie Caudill, published in 2010 in the Journal of the American Dietetic Association, suggests that extra maternal choline may lead to benefits including improved memory, learning, and attention. Newer research by Caudill, recently published in FASEB J, found that infants whose mothers supplemented with choline during pregnancy (930mg) had higher processing speeds than infants whose mothers ingested typical doses (480mg) of choline. Even the low-dose group saw improvements in processing speeds over time, indicating this dose was effective too. These results indicate that the recommended amount over time can have cognitive benefits for infants.

Another study published in FASEB J (2013) reported on supplementing mothers with 480 mg of choline during their third trimester of pregnancy. The results show that women who supplemented with choline had lower circulating levels of proteins related to kidney dysfunction and hypertension, which may lower the risk for preeclampsia during pregnancy. Altogether, this research suggests that both mom and baby benefit from higher choline intake during pregnancy.

Is supplementing with choline necessary, or can the recommendation be met with food alone?

The foods most abundant in choline include egg yolks, liver, beef, poultry, salmon, pork, milk, legumes, broccoli, lima beans, and Brussels sprouts. However, pregnant women may not consume these foods in amounts that meet daily needs for choline.

While a carefully planned diet may provide the AI level for pregnant women of 450 mg of choline, it’s unlikely that intake would be met daily during pregnancy. Furthermore, if a mother is experiencing nausea or food aversions, there’s an even greater chance she’ll be unable to consume enough choline through food alone. Those following a vegetarian or vegan diet typically have a very difficult time meeting choline needs through food sources alone, as the highest amounts of choline tend to be found in animal-based foods.

Currently, none of the top 25 prenatal vitamins contain the recommended amount of choline. In the future, prenatal supplements will contain greater amounts of choline. Until then it may be necessary to supplement choline in addition to planning a diet rich in foods that provide this essential nutrient. If you are curious about meeting your needs and/or supplementing with choline, be sure to first discuss it with your physician or qualified health professional.

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