Why choline is important during pregnancy

Choline is an important nutrient for general health. Your body needs more of it than normal during pregnancy and breastfeeding, but many prenatal supplements do not contain choline. A recent study concluded that most pregnant women are not consuming enough choline, especially those who eat a vegetarian or vegan diet.

Here we answer some of your questions about the benefits of choline in pregnancy and how to ensure you are getting enough of this important nutrient.

What is choline?

You may not have heard of choline before. It’s only relatively recently that choline has been recognised as an essential nutrient. This means it’s a nutrient our body needs, but we cannot make enough of it ourselves, so we must get it from the food we eat.   

Choline is not a vitamin or a mineral, although it used to be grouped with the B vitamins because it shares some similarities.

Choline plays a vital role in many body systems, including your liver, brain, muscles, nervous system and metabolism. It’s crucial in a baby’s early brain development.

Choline is naturally present in some foods and can also be taken as a dietary supplement.

How much choline do I need?

Our liver makes a small amount of choline, but this isn’t enough for all the roles it plays in our bodies. We therefore need to consume choline through the food we eat or by taking a supplement.

During pregnancy and breastfeeding, the need for choline increases significantly. Choline is needed in every living cell, and during pregnancy your baby’s cells are rapidly dividing and multiplying. Large amounts of choline are delivered to your baby via the placenta. After birth, choline is also passed to your baby through your breastmilk.

The European Food Safety Authority has defined a daily adequate intake (AI) of 400mg of choline per day for adults, rising to 480mg for pregnant women and 520mg for women who are breastfeeding. The AI is the minimum amount required to prevent deficiency.

There’s not enough research data on choline intake to establish a recommended dietary allowance (RDA). The RDA is the optimal amount of a nutrient for health.

Experts believe that many people do not consume enough choline in their diets. It’s estimated that up to 95% of pregnant women are consuming less than the daily adequate intake of this important nutrient.

The shortfall in choline intake for pregnant and breastfeeding women is thought to be around 70–100mg per day.

How can choline deficiency affect pregnancy?

Some evidence suggests that low levels of choline during pregnancy are linked to a greater risk of neural tube defects (problems with the developing brain, spine or spinal cord) although this hasn’t been shown consistently in all studies.

Choline is one of six key nutrients identified as being important for brain development. A lack of choline during pregnancy can therefore affect foetal brain development, depending on the timing and severity of the deficiency. Research suggests that this impact on the brain cannot be reversed by increasing choline intake later on.

What are the best foods to get choline from?

Lots of foods contain choline. Animal-based products such as meat, eggs, poultry, fish and dairy products contain more choline than plant-based foods. Egg yolks are the most concentrated source of choline.

Cruciferous vegetables such as broccoli, cabbage and cauliflower are also good sources of choline.

Choline-rich foods include:

• Liver
• Eggs
• Beef
• Chicken
• Fish
• Milk and yoghurt
• Shiitake mushrooms
• Red potatoes
• Soybeans
• Cruciferous vegetables
• Sunflower seeds
  

Can I take choline supplements?

Choline is available in dietary supplements containing choline only or in combination with other vitamins/minerals. It’s often combined with the B vitamins. If you choose a multivitamin containing choline, be sure that it’s suitable for use during pregnancy.

Typical amounts in supplements range from 10mg to 250mg.

There are different forms of choline available in supplements, including choline bitartrate, choline chloride, phosphatidylcholine and lecithin (lecithin contains choline and is also a common food additive). It’s not known whether one form is better than another.

Many of the prenatal and pregnancy multi-nutrient brands do not contain choline, so it’s worth checking the label and considering an additional choline supplement if it’s not included, particularly if you don’t eat many choline-rich foods.

Should I still take choline after my baby is born?

Your body’s demands for choline remain high if you are breastfeeding, as your body transfers choline to your baby through your breastmilk, so it’s a good idea to keep taking a supplement while you are breastfeeding – and beyond if you want to.

How do I ensure my baby is getting enough choline?

Breastmilk is rich in choline. Research shows that a newborn’s choline levels are around three times higher than their mother’s.

Infant formula also contains choline, so you don’t need to worry about your baby getting enough.  

What happens if I take too much choline?

The health risks from taking too much choline include a fishy body odour, vomiting, excessive sweating, low blood pressure and liver problems. The upper limit for choline during pregnancy is 3,500mg, so it’s very unlikely you’ll take too much if you follow the advice on the label.