The Choline Chronicles: Why It's Important to Get Enough Choline During Pregnancy

What is Choline?

Even some of the most health-savvy, diligent researchers among us might not be in the loop on choline. After all, it was only acknowledged as a nutrient deserving of a Recommended Daily Allowance (RDA) in 1998. 

(I know what you’re thinking. Culturally, 1998 feels like eons ago, but in terms of scientific development - especially in the world of young and rapidly developing nutrition science - that’s relatively recent when it comes to receiving an official, universally recognized stamp of acknowledgment.)  

Since choline is so on the “more-recently-discovered-and-focused-on” side, it wouldn’t surprise me if many had never even heard of it!

But it’s time to change that.

Choline is one of the most important nutrients when it comes to fertility health. And what’s more, it’s crucial to the reproductive vitality of both men and women.

Benefits of Choline

In women, it

• Supports rapid cell division and growth

And in men, it

• Regulates sperm membrane structure and fluidity
• Plays a role in sperm growth and fertilizing capacity

Now, needs differ between the sexes, so we will return to that. Keep reading.

Regarding how we view vital nutrients, think of choline as the new kid in school, just trying to find somewhere to sit in the cafeteria.

Because this organically occurring nutrient functions similarly to several B vitamins, choline is often grouped with B complexes. 

If it had been discovered earlier, at the turn of the nineteenth century, it likely would’ve been labeled and classified as B [insert huge number].

On the surface, that makes sense: both are essential nutrients that affect several vital bodily functions, playing important roles in maintaining healthy brain function and regulating several physical systems that shuttle nutrients throughout the body.* Both are considered essential nutrients.

And for women, when it comes to pregnancy, choline appears to be involved in many of the same metabolic pathways as folate (B9), including methylation, which suggests, and research supports, that choline plays a role in promoting neural tube development (1).*

This is important to note because, reproductive health aside, choline can help promote a healthy liver and facilitate cognitive function (2).

The tricky thing about choline is that it’s neither a vitamin nor a mineral.

Call it an identity crisis. It’s hard to lump the nutrient in with another group because it does have its own unique properties and functions.

(So, while choline might hang out with B vitamins from time to time, it doesn’t consider itself one of them. They don’t align perfectly enough to commit to a seat at the B crowd’s lunch table.)

Choline has difficulty finding a group with which to identify because it is so diverse. The human brain and nervous system utilize choline to regulate memory, mood, and muscle control (talk about all-encompassing talents).* Choline is also handy, playing a big part in helping form the membranes that surround the body's cells.*

Considering its power, both men and women need specific amounts of choline, especially if they are conscious of nurturing reproductive health and fertility.

How Much is the Recommended Choline Intake Amount?

The official adequate choline intake currently sits at (3):

Men | 19+ years = 550 mg/day

Women (not pregnant or lactating) | 19+ years = 425 mg/day

However, since choline is still relatively new, the data used to set that recommendation was pretty weak, based on a depletion-repletion study carried out on adult men and set at a minimum level to support liver function.*

So it’s safe to say that individual needs could vary substantially based not only on case-by-case, individual lifestyle factors that we expect while creating RDAs, but simply based on sex.

Many RDAs are supported by studies conducted explicitly on men. 

Often, RDAs for women are adjusted proportionally/mathematically without further research or evidence that takes anatomical and hormonal differences into account.

Do You Need More Choline During Pregnancy?

When pregnancy and lactation come into play, these figures initially estimated for women are again adjusted upwards based upon conjectures of fetal needs.

Women | Pregnancy = 450 mg/day

Women | Lactation = 550 mg/day

Data from animal models suggest that fetal and infant choline demand is so high that a mother’s stores are significantly depleted during pregnancy and lactation (Nutrition Today, 2018).

In other words, many current RDAs for pregnancy and lactation are scientific guesses.

This includes choline.

My good friend and brilliant colleague, Lily Nichols, RD, author of Real Food for Pregnancy, ​​has joined me in writing and lecturing on why guidelines for nutrition during pregnancy need a drastic makeover. 

This is because new studies suggest the recommended amount of choline for pregnant and lactating women should, in reality, be more than double the current RDA (that’s a whopping 930mg over the present value of 450 mg of choline each day!).

While more research is needed, early observations suggest that this expanded dose has been linked to supporting cognitive function in infants, supporting placental function, and possibly promoting healthy blood pressure levels in moms (FASEB, 2013; FASEB, 2017).*

How Common is Choline Deficiency?

The scary part of that equation is, even with the notion of a double RDA dose of choline aside, around 94% of women already do not meet that daily recommended intake.

Per The Choline Information Council, 90% of the entire US population is choline-deficient, which means men also have difficulty ensuring they are getting enough (4).

Sources of Choline

Foods with Choline: A Dose of Choline from Your Diet

Before trying to conceive, this is so important to know so that you can supplement accordingly and focus on incorporating the most choline-dense foods into your diet, like:

• Liver
• Fatty fish
• Eggs with yolks

For those stuck in the cholesterol-phobic past, rest easy: the current research shows that most of the cholesterol in our body is made by our liver - it doesn't come from the cholesterol we eat (4).

Choline Supplement

Choline supplementation should be considered for vegan and vegetarian men and women alike. 

While choline is naturally found in some plant foods, the quantities available pale compared to the above-listed animal foods.

Incorporate what you can into your diet, but be aware that you will likely need to consider getting more choline from supplemental sources, especially if you are following a vegan or vegetarian diet.

Benefits of Choline

For both men and women, choline can help support normal:

• Cognitive function
• Liver health
• Heart health
• Physical performance (especially in athletes or those who perform regular, rigorous physical activities)

IN MEN

Choline has been studied to support the liver, improving detoxification efforts and reducing oxidative stress.* Additionally, a healthy liver promotes healthy male sexual function overall because the liver is responsible for providing an enormous blood supply to the body.*

Dietary choline intake may be necessary to synthesize specific phospholipids to provide reproductive energy for sperm motility. 

Some studies show that ensuring your choline intake is adequate as little as seven days before beginning to try to conceive may support sperm motility (5).

However, in my private practice, I suggest analyzing intake and considering supplementation anywhere between 1-3 months prior, depending on the individual and their respective diet, since sperm mature over a roughly three-month period.*

IN WOMEN DURING PREGNANCY

Nutrition science is constantly evolving, and though recommendations on newer and understudied nutrients are often made gently, the data on the benefits of maternal choline regarding pregnancy health and brain development is quite strong.

Studies have demonstrated and repeated that higher choline levels in the prenatal and early on in the postnatal period support baby’s brain health and development.

Data from animal studies highlight that adequate levels of choline during pregnancy supports fetal DNA and histone methylation, which suggests that a concerted epigenomic mechanism contributes to positive long-term effects in utero (Clin Chem Lab Med, 2013).

Human studies show similar results and benefits, suggesting that choline also facilitates an energy-efficient transport of nutrients across the placenta (J Nutri, 2017; Metabolism, 2008).*

I trust this science because choline is one of the few nutrients we have numerous randomized controlled trials for, comparing varying degrees of supplementation on pregnancy health and infant outcomes.

As discussed above, many of these studies have compared quantities close to the RDA choline intake of 480 mg per day to a much greater one of 930 mg per day. 

The women receiving 930 mg per day consistently displayed supportive outcomes, as did their babies, and the conclusions keep repeating themselves, heavily pointing to the fact that we need more choline.*

We have even observed some of the longer-term effects of choline. For example, a study of 7-year-old children found that those born to mothers with the highest choline intake during pregnancy had superior visual memory compared to those born to mothers with much lower intakes.*

The Takeaway

As a fertility expert, whenever I educate clients or other healthcare practitioners on optimizing nutrition for conception, I always spend a significant amount of time on choline.

Such a strong consensus of compelling and reinforcing research is uncommon, but there is little debate over choline’s importance, despite its uniqueness and classification-adverse behaviors.

Men and women must be aware of how the nutrient benefits their bodies and how essential it is for the creation of cell membranes, neurotransmission, methyl metabolism, and brain development + tissue expansion for baby.*

Throw in the potential benefits of supporting neural tube development, and deciding to focus more on choline intake is a no-brainer.*