Choline in Pregnancy: Most Women Fall Short, and Most Prenatal Vitamins Barely Help

The pregnancy choline gap

The AI for choline is 450 mg/day in pregnancy and 550 mg/day while breastfeeding ^[1]. Approximately 90% to 95% of pregnant women consume less than that, and prenatal supplements typically contain little if any choline ^[1].

Choline needs overlap with other methyl donors. ODS notes the risk of low choline status might be greater in pregnant and breastfeeding women who do not take folic acid, those with low vitamin B12 status, and those with a common variant in a folate-related enzyme ^[1]. For the folate side of that picture, see methylfolate vs folic acid.

The trial that found a benefit

A 2018 controlled feeding study randomized women entering the third trimester to 480 mg/day or 930 mg/day of choline until delivery, with 13 women per group ^[2]. Infants were tested at 4, 7, 10 and 13 months, and mean reaction time was faster in the 930 mg group ^[2].

A follow-up of 20 of the children at age 7 found better sustained attention in the 930 mg group on the main test ^[4]. Both arms got choline, so this compares two intakes, not choline against none, and the groups were very small; we grade the infant finding D.

The trial that did not

A 2012 double-blind trial randomized 140 pregnant women to 750 mg/day of phosphatidylcholine or a corn-oil placebo, from 18 weeks of pregnancy through 90 days after birth ^[3]. The women already ate about 360 mg/day of choline from food ^[3].

At 10 and 12 months, the 99 infants tested did not differ in global development, language, short-term visuospatial memory or long-term episodic memory, and the supplements were well tolerated ^[3]. The authors noted that a longer follow-up might reveal later effects ^[3].

Getting there with food

Meat, poultry, fish, dairy and eggs are the richest sources, with cruciferous vegetables and certain beans also contributing ^[1]. A few servings from the ODS food table:

• Beef liver, pan fried, 3 ounces: 356 mg ^[1]
• Egg, hard boiled, 1 large: 147 mg ^[1]
• Soybeans, roasted, ½ cup: 107 mg ^[1]
• Chicken breast, roasted, 3 ounces: 72 mg ^[1]
• Fish, cod, cooked, 3 ounces: 71 mg ^[1]

Supplement amounts and safety

Choline supplements typically contain 10 mg to 250 mg, as choline bitartrate, phosphatidylcholine or lecithin ^[1]. The adult upper limit is 3,500 mg/day; very high intakes are associated with fishy body odor, vomiting, heavy sweating, low blood pressure and liver toxicity ^[1].

Forms differ in how they are handled, which we cover in alpha-GPC vs choline bitartrate. Talk to your prenatal clinician before adding any supplement in pregnancy.