Matthew Messer

Matthew Messer


Adequate nutrition is always worth paying attention to but never quite as significantly as during pregnancy and breastfeeding. If an important nutrient is insufficient at these critical times, it can affect not only the parent but the development and subsequent life of the unborn child. Choline is one of the micronutrients without which our bodies cannot function properly. Unfortunately, its importance is not stressed sufficiently, despite the fact that hardly 10% of people reach a sufficient intake according to surveys. This figure is worrisome, since we need more choline during pregnancy, and an insufficient intake can increase the risk of pregnancy complications as well as hinder the development of the fetus. (1) Furthermore, many studies have found a higher choline intake in general, and the supplementation of choline during pregnancy, in particular, to be beneficial.  

Why is choline so important when expecting? 

Choline’s exceptional importance is illustrated by the choline concentration in amniotic fluid, which is ten times that of the mother's blood, and the choline concentrations of the fetus and the newborn baby, which are six to seven times as high as in the mother’s blood. (2) The placenta also holds a high level of choline, so our bodies do everything within their power to provide sufficient choline for the fetus. Mother’s milk does not contain a particularly large amount of choline, 125-166 mg / L, but even so, proportionally to body weight, a newborn’s choline intake is much higher than that of an adult. (3) Accordingly, the unborn baby’s supply of choline is determined by the choline intake of the mother; if she consumes more choline, the fetus, too will have more, and after birth, the mother’s milk will contain more of it. (3) 

How can a higher choline intake positively affect the development of the fetus?  

A 2018 randomized clinical trial investigated the effects of different levels of choline intake. The participating women were separated into two groups, which were supplied with 480 and 930 mg of choline respectively, beginning in the third trimester.  (5) 

The infants’ speed of information processing and visual-spatial memory was tested, aged four, seven, ten, and thirteen months. Reaction times were significantly faster in infants whose mothers had consumed 930 mg of choline. Researchers were thus able to determine that twice the amount of the current recommended dose improved children’s speed of information processing significantly. Even with the children of those consuming 480 mg of choline linear improvements were observed, showing that even a small increase in choline intake can lead to a positive effect on the child's cognitive abilities.  

In a similar clinical study, once more, participating women consumed 930 and 480 mg of choline. Seven years later, the effects of higher choline intake on the children's cognitive abilities were studied. (6) Those, whose mothers had consumed 930 mg of choline during pregnancy were able to concentrate on one problem for much longer and completed it with fewer mistakes than those, whose mothers consumed only 480 mg. This is remarkable, considering that even 480 mg a day is well over the average choline consumption of pregnant women. 

A further interesting difference between the two groups in the study was found. Those mothers who consumed 930 mg of choline a day showed cortisol levels 33% lower in the umbilical cord, which researchers deduced to mean that a higher choline intake produced positive epigenetic changes, likely influencing the newborns’ ability to cope with stress as well as the development of their nervous system. (7)  

Choline mitigated negative effects 

The negative effects of consuming alcohol during pregnancy are well known: it is recommended that women refrain from alcohol altogether during their pregnancy since it can damage the fetus' nervous system and development. Unfortunately, some continue to consume alcohol during pregnancy because of addiction. This can lead to so-called fetal alcohol syndrome. In 2018, choline supplementation was researched on alcoholic women in a randomized study. Higher choline intake proved to mitigate the harmful effects of alcohol, improving both the nervous system and the development of newborns. (8)  

In another clinical study, choline supplementation was found helpful for children suffering from fetal alcohol syndrome, who developed higher non-verbal intelligence, visual-spatial ability, and better verbal memory, and showed less hyperactivity and attention deficit disorders than the placebo group. (9) 

  1. Shaw GM, Carmichael SL, Yang W, Selvin S, Schaffer DM. Periconceptional dietary intake of choline and betaine and neural tube defects in offspring. Am J Epidemiol. 2004 Jul 15;160(2):102-9. doi: 10.1093/aje/kwh187. PMID: 15234930. 

  2. Zeisel SH. Choline: critical role during fetal development and dietary requirements in adults. Annu Rev Nutr. 2006;26:229-250. doi:10.1146/annurev.nutr.26.061505.111156 

  3.  Wiedeman AM, Barr SI, Green TJ, Xu Z, Innis SM, Kitts DD. Dietary Choline Intake: Current State of Knowledge Across the Life Cycle. Nutrients. 2018 Oct 16;10(10):1513. doi: 10.3390/nu10101513. PMID: 30332744; PMCID: PMC6213596.

  4. Taesuwan S, McDougall MQ, Malysheva OV, Bender E, Nevins JEH, Devapatla S, Vidavalur R, Caudill MA, Klatt KC. Choline metabolome response to prenatal choline supplementation across pregnancy: A randomized controlled trial. FASEB J. 2021 Dec;35(12):e22063. doi: 10.1096/fj.202101401RR. PMID: 34820909. 

  5. 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 Apr;32(4):2172-2180. doi: 10.1096/fj.201700692RR. Epub 2018 Jan 5. PMID: 29217669; PMCID: PMC6988845. 

  6. Bahnfleth CL, Strupp BJ, Caudill MA, Canfield RL. Prenatal choline supplementation improves child sustained attention: A 7-year follow-up of a randomized controlled feeding trial. FASEB J. 2022 Jan;36(1):e22054. doi: 10.1096/fj.202101217R. PMID: 34962672. 

  7. Jiang X, Yan J, West AA, Perry CA, Malysheva OV, Devapatla S, Pressman E, Vermeylen F, Caudill MA. Maternal choline intake alters the epigenetic state of fetal cortisol-regulating genes in humans. FASEB J. 2012 Aug;26(8):3563-74. doi: 10.1096/fj.12-207894. Epub 2012 May 1. PMID: 22549509. 

  8. Jacobson SW, Carter RC, Molteno CD, Stanton ME, Herbert JS, Lindinger NM, Lewis CE, Dodge NC, Hoyme HE, Zeisel SH, Meintjes EM, Duggan CP, Jacobson JL. Efficacy of Maternal Choline Supplementation During Pregnancy in Mitigating Adverse Effects of Prenatal Alcohol Exposure on Growth and Cognitive Function: A Randomized, Double-Blind, Placebo-Controlled Clinical Trial. Alcohol Clin Exp Res. 2018 Jul;42(7):1327-1341. doi: 10.1111/acer.13769. Epub 2018 Jun 15. PMID: 29750367; PMCID: PMC6028282. 

  9. Wozniak JR, Fink BA, Fuglestad AJ, Eckerle JK, Boys CJ, Sandness KE, Radke JP, Miller NC, Lindgren C, Brearley AM, Zeisel SH, Georgieff MK. Four-year follow-up of a randomized controlled trial of choline for neurodevelopment in fetal alcohol spectrum disorder. J Neurodev Disord. 2020 Mar 12;12(1):9. doi: 10.1186/s11689-020-09312-7. PMID: 32164522; PMCID: PMC7066854. 

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