Pregnancy The Science of Nutrition

What Is Choline? (Hint: It's Up There With Folate)

Steph Greunke

What Is Choline? (Hint: It's Up There With Folate)

Table of contents

  • Intro
  • What Is Choline and What Role Does It Play in the Body?
  • Why Is Choline Considered a “Helper Nutrient” to Omega-3?
  • Why Do I Need Choline Before Pregnancy?
  • Why Do I Need Choline During Pregnancy?
  • Why Do I Need Choline After Pregnancy?
  • Why Are Most Women So Deficient in Choline?
  • Your Omega-3 Offers Just 55mg of Choline, Should I Take More?Where to Go From Here

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If you haven’t yet heard of Choline, you’re not alone. Although it’s recommended to be included in all prenatal vitamins, most prenatals don’t include a meaningful amount of Choline--if they contain any at all. While Choline is naturally present in foods like beef liver and whole eggs, as many as 95% of pregnant women do not consume enough prenatal Choline to meet their dietary needs.

Sound familiar? Like Omega-3 (our other favorite nutritional underdog), the benefits of Choline for before, during, and after pregnancy are clinically-validated, and yet most women of childbearing age do not consume nearly enough from food and their prenatal vitamins. 

We hope this article inspires you to look for ways to increase your choline consumption before, during, and after pregnancy. 

What is choline and what role does it play in the body? 

Choline is a “vitamin-like” essential nutrient, meaning that while it’s not a vitamin, it acts like one. Choline is required for normal functioning of the body, and is especially important around pregnancy in supporting proper uptake of Omega-3 DHA, overall development of the baby, and mama’s own health and wellbeing. Choline cannot be synthesized by the body, and therefore must be obtained from diet, through food or supplementation.

Choline is required for many bodily processes including for lipid (fat) transport throughout the body, methyl donation (a process by which methyl group molecules are added to DNA to help to control gene expression), neurotransmitter synthesis, cell to cell signaling, and the synthesis of certain phospholipids that are essential structural components of cell membranes.

Why is Choline considered a “helper nutrient” to Omega-3?

Choline delivers Omega-3 DHA to the developing fetus through its role in lipid transport. It also works synergistically with DHA, increasing the amount of DHA that gets incorporated into baby’s cells, including for fostering normal brain and eye development. More Choline means more usable DHA for baby!

We designed our Omega-3 to be delivered in the most nourishing formulation, including 100mg of Choline per 2 capsules. This helps to ensure that you and your baby get the optimal amount of Omega-3 DHA and EPA. 

Why do I need Choline before pregnancy? 

Research indicates that Choline is involved with all stages of early reproduction, from basic fertility and egg health, to specifically supporting fertilization and implantation. 

In addition, a woman’s Choline stores may become depleted during pregnancy and breastfeeding, as baby's requirements for Choline often exceed mama’s intake. Maintaining optimal Choline levels before pregnancy can help to ensure adequate amounts of this critical nutrient are available for both mama and baby.

Why do I need Choline during pregnancy? 

Choline is an important part of cell membrane structure. The need for prenatal Choline is extremely high in the first weeks and months of fetal development, as billions of fetal cells are growing and differentiating. 

Choline guards against birth defects. Research shows that the lowest rates of neural tube defects are directly correlated with the mother’s Choline status in pregnancy.

Choline works against factors that cause gestational issues. High levels of the amino acid homocysteine (produced from protein breaking down) during pregnancy are associated with multiple gestational issues including low birth weight, pre-eclampsia, placental abruption, and recurrent pregnancy loss. Choline, along with Vitamins B12 and Folate, supports the proper metabolism of homocysteine into methionine, another amino acid, decreasing homocysteine levels.

In addition, Choline reduces baby’s response to stress, can improve childhood visual memory, and improve motor performance in tasks requiring accuracy

Why do I need Choline after pregnancy? 

Large volumes of Choline are often transferred to baby in pregnancy and through breastfeeding while the infant is still rapidly growing. Replenishing mama’s levels postpartum continues to be important for a woman and her growing baby. 

Choline levels in breastmilk are directly linked to a mama’s current levels of Choline. Many practitioners in our community consider choline to be helpful in easing the occurrence of a mama’s decreased focus and memory, sometimes known as “mommy brain.”

Why are most women so deficient in Choline?

Women are deficient in choline for two main reasons: historically low awareness of its importance, and availability of quality dietary sources (including through prenatal supplements). 

Choline did not garner much attention until the last two decades. The Institute of Medicine did not establish Dietary Reference Intakes (DRIs), the reference values for assessing dietary intake, for choline until 1998. Most common nutrients had reference values established in 1941 with the advent of Recommended Dietary Allowances (RDAs), the predecessor to DRIs. 

The American Medical Association has since recommended the inclusion of Choline in all prenatal vitamins, however adoption has been slow. As of April 2019, of the top 25 prenatal vitamins, only 8 contain Choline. And, of those 8, only 2 contain Choline at 55mg, or 10% of the DRI value, that qualifies it as a “Good Source” of Choline (source: Balchem). Our Prenatal Multi contains a supportive 400mg recommended dose of Choline during pregnancy and breastfeeding. In addition, our Omega-3 powder contains an additional 100mg of Choline per 2 capsule dose. 

Food sources of Choline are limited. Eggs and liver are the two best food sources. A pregnant woman can get almost half the minimum daily dose of Choline she needs from two eggs, 250 milligrams. And, it is naturally occurring in salmon, the best food source of Omega-3 (~190 milligrams of Choline per 6oz fillet). Meat (chicken, beef, and pork chops), peanuts, navy beans, and broccoli also offer some Choline. However, it can be hard to get enough from diet without supplementation, especially in the First Trimester of pregnancy (a time of heightened Choline needs) when food aversions and nausea have many women steering way clear of foods like liver and other types of meat.

Your Omega-3 offers just 55mg of Choline, should I take more? 

Yes, ideally. The current DRIs suggests 450 milligrams of choline per day for pregnant women and 550 milligrams per day for breastfeeding mothers. We would advocate for even exceeding the DRIs, as these values are based on minimum levels needed to avoid malnutrition--not the levels you need to be optimally nourished! The body seems to use as much Choline as you can give it, and there is no upper limit to what is safe to consume. Furthermore, recent research has shown that more Choline (up to 930mg) can further benefit baby’s cognitive development. 

Some women have heightened Choline requirements due to common genetic predispositions, such as mutations in the MTHFR or PEMT genes, that have been shown in research to affect Choline metabolism and therefore increase the need for Choline. 

Our Omega-3 offers a good source of Choline at 100mg, particularly when added onto our Prenatal Multi. In addition to contributing to your daily Choline intake, the Choline in our product ensures optimal Omega-3 nutrient delivery. 

Where to go from here

It’s likely that the more Choline you consume, the better you and your baby will feel. Whether you are trying to conceive, currently pregnant, or a new mama focused on breastfeeding and recovery, we recommend paying close attention to your Choline intake. This might mean upping your Choline intake through foods like liver, eggs, and salmon, and it may also mean supplementing with a Choline-rich prenatal vitamin, a Choline-rich Omega-3, and additional Choline in a well-absorbed form to fill in the gaps where needed to achieve optimal Choline intake of 930mg per day before, during, and after pregnancy. 

Feeling empowered after reading? Please share this post with a fellow mama or health practitioner in your life. 

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Steph Greunke, MS, RD, CPT, PMH-C

Stephanie Greunke is a registered dietitian that specializes in prenatal/postnatal nutrition, behavioral psychology, and holds additional certifications in perinatal mental health and fitness. She's a key contributor and advisor to Needed as well as Needed’s Head of Practitioner Relationships. Steph is the owner of Postpartum Reset, an online postpartum nutrition course, and the co-host of "Doctor Mom" podcast.