Is Extra Choline Safe Before Pregnancy?
Yes, taking extra choline before pregnancy is safe and beneficial—aim for 550 mg daily, which is the recommended adequate intake for pregnancy and remains approximately 6-fold below any safety threshold. 1
Safety Profile
- The tolerable upper intake level for choline is 3,500 mg/day, meaning a 550 mg daily dose provides a substantial safety margin 1
- At recommended doses, choline supplementation appears safe with minimal risk of adverse effects 2
- High-dose choline (well above 550 mg) may theoretically cause hypotension or fishy body odor, but these effects are rare at recommended intake levels 1, 2
Why Start Before Pregnancy
- Neural tube defect prevention: Emerging evidence from the International Federation of Gynecology and Obstetrics suggests choline may help prevent neural tube defects, particularly in folate-fortified populations and potentially in folate-resistant cases 2
- In populations with adequate folate intake, lower choline levels were associated with higher NTD risk, suggesting choline provides additional protection beyond folic acid alone 2
- The American College of Medical Genetics acknowledges that choline has been investigated for a preventive role in fetal NTDs, though more research is needed before formal recommendations 3
Current Intake Gap
- The majority of pregnant women fail to achieve target choline intake levels—most consume only 233-383 mg/day, well below the 550 mg adequate intake 4
- In Germany, only 7% of pregnant women achieved adequate choline intake, with median intake of just 260 mg/day 5
- Choline is not found in most prenatal vitamins, creating a widespread nutritional gap 6, 7
Recommended Approach
- Target 550 mg/day starting before conception to build maternal stores and support early fetal development 1
- This can be achieved through choline-rich foods (eggs, meat, milk) or supplementation 7
- Women following vegetarian or vegan diets have significantly lower choline intake (205 mg/day vs. 269 mg/day in omnivores) and should particularly consider supplementation 5
Important Caveats
- Certain genetic variants may increase choline requirements beyond current recommendations, though routine genetic testing is not standard 6
- While choline shows promise for neural tube defect prevention, the American College of Medical Genetics notes that replication studies should be done before proceeding with widespread fortification recommendations 3
- There is a theoretical concern about choline conversion to TMAO by gut bacteria at very high doses, but this is not relevant at the 550 mg recommended dose 1