Choline in Pregnancy:
Does it Matter if it’s not in Your Prenatal Vitamin?

Written by: Katie Dewhurst

Edited by: Ashley Eskew, MD, MSCI

Last updated: December 16th, 2022

Choline and Pregnancy

Did you know adding choline to your prenatal diet can improve your child’s lifelong brain health and function? 

It’s true, choline is an essential nutrient for pregnancy, but sadly less than 10% of women get enough choline during pregnancy as it is absent from most prenatal vitamins (1).

In this article, you will learn why prenatal choline supplementation and getting adequate levels of choline in if you’re trying to become pregnant or already are pregnant is important for fetal development.

And while we’re on the topic of the importance of optimal nutrition in pregnancy, we’ll also cover one of the most common questions we get – how to gain weight healthily during pregnancy.

Here’s a quick overview of what you’ll discover:

Does choline matter if you’re pregnant?

The short answer is YES! 

Maternal choline intake absolutely matters if you’re pregnant.

If you’re pregnant or trying to conceive, you’ve probably heard of the importance of folate (or folic acid supplementation) for pregnancy but less about choline supplementation. Well, recent research has shown that taking choline supplements is just as essential to a healthy pregnancy as folate or folic acid, yet it doesn’t get nearly as much attention from healthcare professionals.

Both obstetricians and midwives are not widely aware of choline supplementation or data surrounding it, which is why I thought it would be helpful news to discuss it further here. In fact, choline was only established as an essential nutrient in 1998, and many of the studies on choline needs for pregnant women are quite recent. 

Don’t worry – I’ll fill you in on all the details! 

First, you should know that choline supplementation is vitally important in pretty much every stage of your journey to motherhood, including preconception, pregnancy, breastfeeding, and when you introduce solids to your infant during those early weeks.

Choline is involved in so many important biologic processes throughout the fertility and pregnancy journey, including:

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    Egg health & fertility

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    Healthy genetic expression for your baby (i.e., genetic predispositions for adult diseases)

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    Neural tube development of the fetus (the brain and spinal cord)

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    Formation of brain cells and neurotransmitters (important messengers in the brain)

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    Development of fetal tissues

One study found that adequate choline supplementation in combination with folic acid further prevents the risk for neural tube defects, compared to taking folic acid alone (2). This is especially important in the preconception period to obtain enough folic acid and choline because the neural tube begins to form within the first few weeks of pregnancy when many women don’t even know they’re pregnant! So getting enough of these two essential nutrients before and during pregnancy is key.

Choline supplementation also improves healthy genetic expression, which you might be surprised to hear actually starts within the egg months before you conceive or get pregnant! 

What if my prenatal vitamin doesn’t have choline?

Even with the mounting evidence of the importance of maternal choline supplementation, many prenatal vitamins still skimp on or don’t include choline at all

If your prenatal vitamin doesn’t have choline, consider upgrading to a prenatal that provides at least 300-500 mg  of choline. Alternatively, add a separate choline supplement on top of your current prenatal vitamin as getting adequate maternal choline from a prenatal vitamin can be challenging.

Choline Supplement

Also, keep in mind while supplements are often treated as an insurance policy to help avoid nutrient deficiencies when trying to become pregnant or during pregnancy, the best place to obtain nutrients is through real food

Why is that? (It’s so much easier to take a pill sometimes…)

Nature has a way of packaging nutrients together so your body can best utilize them (higher bioavailability). For example, docosahexaenoic acid (DHA, an omega-3 fatty acid) and choline work synergistically to support brain development (3). So eating foods naturally rich in both DHA and choline, like salmon, have synergistic effects that supplements alone may not provide. That’s why I always recommend focusing first on a nutrient-dense diet and then adding supplements to help fill any gaps and provide some extra coverage. 

The richest food source of choline is eggs with the yolk and beef liver. There are some great regenerative grass-fed meat companies that are blending small amounts of organ meats into ground muscle meat so you can reap the added nutrient benefits without having to eat straight-up organ meat. These ancestral meat blends have been a game changer for me and my prenatal clients. 

The reality is, research is lacking on organ meat intake while trying to become pregnant, and during pregnancy. So if you’re looking for other ways to boost your choline intake through diet and keep your levels high during pregnancy – here are some other food sources of choline which you may find a little more palatable: 

2 whole eggs (with yolk) = 294 mg choline

3 oz beef liver = 260 mg choline

3 oz chicken liver = 192 mg choline

5 oz salmon = 130 mg choline

5 oz chicken or turkey = 120 mg choline

1 cup cooked shiitake mushrooms = 116 mg choline

5 oz ground beef = 116 mg choline

1 cup chopped cauliflower = 47 mg choline

As an added bonus, many of these foods are rich sources of iron which we also know is important during pregnancy!

The importance of choline supplementation in pregnancy

The recommended daily allowance (RDA) for maternal choline during pregnancy is currently 450 mg, but recent research has found fetal cognitive benefits at much higher levels of choline intake. 

In 2018, researchers at Cornell University noted that supplementing with 930 mg of choline per day vs. 480 mg per day (more than doubling the choline RDA) during the third trimester improved memory, speed of processing, attention, and problem-solving in children (4). Although this was a small study of 26 women, it was prospective and randomized and suggests some promising results to lay the groundwork for larger studies in the future looking at maternal choline levels and choline supplementation.

It’s probably a good idea, in general, to think of most micronutrient RDAs more as a bare minimum, not an optimal target for overall health. Along with other nutrients, like vitamin B12 and DHA, for example, scientific literature suggests that the RDAs may be too low to achieve the best possible health outcomes (5,6). 

Suppose you are an egg or meat eater. In that case, I’d suggest getting anywhere from 300-500mg (aiming towards the higher end in the third trimester) every day before, during, and postpartum while breastfeeding and prioritizing choline-rich foods like eggs, salmon, and meat into your diet.

If you are vegetarian or do not consume eggs or beef liver, consider taking 500 mg of choline by mouth daily in supplement form, as it is tough to meet your needs through plant-based foods alone. It is estimated that vegetarians get less than 200 mg per day of choline through diet on average, and for expectant mothers, that’s simply not enough (6)! 

To date, none of the randomized controlled trials looking at 500-900 mg of choline supplementation per day in pregnancy have reported any negative side effects (7). The tolerable upper limit of choline is 3,500 mg, so even 930 mg is well under a level that might start to cause issues.

As with most nutrients, both too little and too much choline can likely be problematic. Based on current research, supplementing with 500-930 mg per day seems safe and provides the most potential benefit to a baby’s brain health and development.

The importance of healthy weight gain in pregnancy

The conversation of healthy weight gain in pregnancy can be a sensitive topic as culture has emphasized women’s weight and appearance. As women, we’re exposed to diet culture from a young age, and our physical appearance can quickly become tied to our self-worth and identity. It’s important to acknowledge that this history can make the weight gain part of pregnancy a little jarring for some women. If you’re struggling with this, definitely reach out for help because you’re certainly not alone.

With that said, it is helpful to know how to support healthy weight gain for expectant mothers. Here are some important points to consider when it comes to gaining a healthy amount of weight during pregnancy:

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    The scientific literature clearly shows that the optimal amount of weight gain for pregnancy varies depending on your starting weight and body mass index (BMI). If you’re underweight, you will need to gain more weight during pregnancy than if you’re overweight or obese. Here are some reference ranges provided by the Institute of Medicine. Remember that BMI isn’t a perfect measurement, meaning optimal weight gain could vary slightly depending on your muscle mass to body fat ratio. 

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    Gaining too much weight during pregnancy can result in pregnancy complications like gestational diabetes, unfavorable changes to the baby’s metabolism, and larger babies, which can lead to complications with delivery.

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    Not gaining enough weight due to malnourishment can result in developmental deficits for the baby. Consuming enough calories in the form of high-quality protein, healthy fats, and complex carbohydrates such as whole grains, vegetables, and fruits is important for healthy fetal development. 

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    Focusing on eating whole grains instead of refined grains can help support healthy weight gain. Women who eat more refined carbohydrates throughout pregnancy tend to gain an average of 18 extra pounds compared to those who eat mostly whole, natural carbohydrate sources like vegetables, fruits, legumes, nuts, seeds, and whole grains (8).

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    Although it can be uncomfortable to see our bodies change so quickly, remember that only a small portion of healthy weight gain during pregnancy is actual body fat. Most weight gained can be attributed to a significant increase in blood volume and fluids, increased breast size, growing baby, placenta, and uterus. The small amount of fat our bodies hold onto is considered “emergency” energy in case calories become scarce. In my experience, most of my clients lose a few extra pounds of body fat without too much effort within the first year postpartum, so there’s no need to stress! Your body is accomplishing a MAJOR achievement carrying a pregnancy- so be sure to give yourself extra love and grace during this time!

At the end of the day, weight gain is just a data point, and isn’t a tell-all of a healthy pregnancy. Nourishing your growing baby as an expectant mother with the nutrients they need is more important than any number on the scale.

Final Thoughts

Building a baby from scratch is clearly not a walk in the park! It requires significantly more nutrients than pre-pregnancy, which means eating more nutrient-dense foods and appropriate use of supplements is crucial. 

After reading this article, I hope you understand the important role of choline  in your baby’s mental and cognitive development, how to obtain choline through food, and how to supplement with choline to meet your choline needs during pregnancy. 

Keep in mind choline is just one of the many essential nutrients you need more of during pregnancy. If you’ve been confused about what to eat for pregnancy and are looking for more support, I would love to hear from you! You can reach me at @hellobabynutrition on instagram, or email me at hello@hellobalance.co to learn more about how I can help you optimize your nutrition for pregnancy.

Katie Dewhurst

Katie Dewhurst is a certified functional medicine health coach and founder of the health and wellness company Hello Balance. She’s passionate about teaching women how they can optimize their health for fertility and pregnancy through food and lifestyle.

With Love & Empowerment,
Katie Dewhurst & Ashley Eskew, MD, MSCI

Resources:

  1. Wallace TC, Fulgoni VL. Usual choline intakes are associated with egg ad protein food consumption in the United States. Nutrients. 2017, 5:9(8):839. PMID: 28783055

  2. Shaw GM, Carmichael SL, Yang W, Selvin S, Schaffer DM. Periconceptional dietary intake of choline and betaine nd neural tube defects in offspring. Am J Epidemiol. 2004, 15;160(2):102-9. PMID: 15234930

  3. Cheatham CL, Sheppard KW. Synergistic effects of human milk nutrients in the support of infant recognition memory: an observational study. Nutrients. 2015, 3;7(1):9079-95. PMID: 26540073

  4. Caudill MA, Strupp BJ, Muscalu L, Nevins JEH, Canfield RL. Maternal choline supplementation during the third trimester of pregnancy improves infant information processing speed: a randomized, double-blind, controlled feeding study. FASEB J. 2018, 32(4)2172-2180. PMID: 29217669

  5. Bae S, West AA, Yan J, Jiang X, Perry CA, Malysheva O., et al. Vitamin B-12 status differs among pregnant, lactating and control women with equivalent nutrient intakes. J Nutr. 2015, 145(7):1507-14.PMID: 25995278

  6. Wallace TC, Blusztajn JK, Caudill MA, Klatt KC, Natker E, Zeisel SH, Zelman KM. Choline: the underconsumed and underappreciated essential nutrient. Nutr Today. 2018, 53(6):240-253. PMID: 30853718.

  7. Korsmo HW, Jiang X, Caudill MA. Choline: exploring the growing science of its benefits for moms and babies. Nutrients 2019.11(8)1823. PMID: 31394787.

  8. Clapp JF. Maternal carbohydrate intake and pregnancy outcome. Proc Nutr Soc. 2002. 61(1):45-50. PMID 1200864. DOI: 10.1079/pns2001129.

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