Choline - An Essential Nutrient to Support Baby's Brain Development in Utero and Beyond

Choline is one of the MOST important, yet most under-appreciated and underutilized nutrients for fetal brain support. In fact, extra choline is the most common nutrient I recommend on top of a woman's prenatal in order to support optimal fetal brain development. 

While choline has been well recognized as a key nutrient for fetal brain development and protection, less than 15% of pregnant women in the United States are attaining enough choline from their diet and only one prenatal on the market currently meets the recommended dietary allowance (RDA) for choline requirements in pregnancy.

Choline requirements in pregnancy and lactation increase, as large amounts of choline are transported across the placenta and via breast milk during pregnancy and breastfeeding, respectively. Choline transport to the fetus is so important, that the concentration of choline in the amniotic fluid is 10x greater than in maternal blood! 

Importance of Maternal Choline Intake for Fetal Brain Development: 

Choline is an important nutrient in neural tube closure: 

When thinking about neural tube defects, folate often comes to mind- but it turns out adequate choline is also necessary! The importance of choline in early pregnancy has also been well established but not popularized. Women with choline levels in the lower quartile during their first trimester have a 4x greater risk of developing a neural tube defect than women in the highest quartile. Though, even moderate choline deficiency can increase the risk.  Data derived from births in California between 1989 and 1991 found an increased incidence of neural tube defects in women consuming less than 300 mg choline per day during pregnancy compared with women consuming more than 500 mg/d.

Choline supports the baby’s memory and learning:

Choline has been shown to dramatically impact the development of the hippocampus, the brain’s memory center.  Another area of the brain that requires choline for proper development is the frontal cortex, which is the region of the brain responsible for high-level thinking. 

In addition to impacting the development of key areas of the brain, choline is an essential precursor for the neurotransmitter required for creating memories- acetylcholine. Acetylcholine acts as a messenger between nerves and also supports learning, attention, and alertness.

In rodent models, the impacts of choline supplementation and choline deficiency in pregnancy are shown to result in permanent alterations in the structure of the hippocampus, resulting in long term effects on memory. Animals supplemented with choline exhibited significantly higher memory capacity into adulthood, while deficient animals were found to have offspring with impaired memory. 

Higher prenatal choline levels protect against damage from infections: 

Various types of infections have been shown to pose a potential threat to fetal brain development. Common bacterial and viral infections have been shown to increase the risk of ADHD, autism spectrum disorder, and schizophrenia in the offspring due to a heightened maternal inflammatory response. However, higher maternal choline levels have been shown to protect the fetal brain from the dangers of maternal infections, including SARS-COV-2.

Higher maternal choline levels have been shown to mitigate damage from recreational drug use in pregnancy: 

Within animal models, choline supplementation during pregnancy and early childhood has been shown to attenuate the behavioral effects associated with alcohol exposure in utero.

Higher maternal choline has also been shown to mitigate some of the deleterious impacts of marijuana use in pregnancy, which is known to adversely affect fetal brain development and subsequent behavioral self-regulation.  

Other Benefits of Choline in Pregnancy and Lactation: 

Choline is required for maintaining normal levels of homocysteine: 

Elevated homocysteine levels during pregnancy have been associated with complications, such as preeclampsia, early pregnancy loss, placental abruption, intrauterine growth restrictions, venous thrombosis, and other cardiovascular related complications.  

B6, B12, and Folate status are believed to be primarily responsible for homocysteine levels; however, choline also plays an important role! 

PEMT rs7946  gene polymorphism (a gene known to regulate endogenous production of choline) has been associated with increased concentrations of homocysteine and subsequent increased risk of preterm birth. A study out of China showed that higher maternal choline levels appear to mitigate the risk of preterm birth in this population. 

Phosphatidylcholine supplementation may decrease the risk of abnormal liver function tests and  cholestasis: 

Phosphatidylcholine is an important component of bile, which keeps it flowing freely. Bile is responsible for transporting fats and toxins out of the liver, as well as, necessary for proper fat absorption in the digestive tract. Choline deficiency has been shown to increase the risk of cholestasis and  non-alcoholic fatty liver disease, which are believed to be responsible for abnormal liver function tests in pregnancy. More research is needed to fully understand the role of choline in mitigating these affects in pregnancy. 

Lecithin supplementation  decreases risk of clogged ducts and mastitis: 

Lecithin is a mixture of choline, choline esters, fatty acids, glycerol, glycolipids, triglycerides, phosphoric acid, and phospholipids, such as phosphatidylcholine that are normal components of human milk. Supplemental lecithin has been recommended as a treatment for plugged milk ducts, and as an additive to human milk that is given to preterm infants via pumping through plastic tubing in order to prevent fat loss.

When using choline supplementation for this purpose, lecithin appears to be the preferred form, followed by phosphatidylcholine. 

Genes that Influence the Need for Choline: 

By far, PEMT, is the gene that most highly influences potential variation in prenatal requirements and susceptibility for deficiency. The role of your PEMT gene is to produce phosphatidylcholine. Phosphatidylcholine is a major component of your cell membranes and a major component of bile. Common symptoms and disorders associated with a PEMT mutation include: fatty liver disease, gallbladder issues due to sluggish bile with subsequent intestinal bacterial overgrowth due to poor fat breakdown, breastfeeding issues like mastitis, elevated triglyceride levels, and generalized muscle weakness. 

In order to test genetic susceptibility for choline deficiency (as well as many other important genes for pregnancy and general health), I often use MaxGen Labs “Max Function” panel or “The Work”panel.

RDA in Pregnancy and Lactation: 

The RDA for choline in pregnancy is 450 mg and 550 mg in breastfeeding. However, those with genetic polymorphisms may need substantially more choline than this. 

Dietary Sources: 

Choline is a naturally occurring amino acid found in egg yolks, liver, animal meat, beans, milk, some vegetables, as well as in human breast milk. 

Amount of Choline Per Serving of Food: 

• Beef Liver (3 oz): 356 mg 

• Egg, hard boiled: 147 mg 

• Beef top round (3 oz) : 117 mg 

• Soybeans, roasted (½ cup): 107 mg 

• Chicken breasts (3 oz)  72 mg

• Beef, ground (3 oz): 72 mg 

• Fish, cod and salmon (3 oz): 71 mg 

• Broccoli (1 cup): 63 mg 

• Green Peas (1 cup): 47.5 mg 

• Navy Beans (½ cup): 41 mg

• Milk (8 oz): 40 mg

Suggested Supplements 

Please enjoy 15% off physician grade supplements via my online dispensary through Fullscript™.

Preferred Prenatal: 

Needed Prenatal Capsules: 

Suggested Dosing: 8 capsules daily 

Needed Prenatal Powder: 

Suggested Dosing: 1 scoop daily 

Preferred Phosphatidylcholine/Choline Add-On Supplements:

Optimal PC (Seeking Health)

Suggested Dosing: 2 tsp daily

BodyBio PC Liquid

Suggested Dosing: 2 tsp daily

Choline 550 mg (Vital Nutrients)

Suggested Dosing: 2 capsules daily

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