From the Guidelines
Choline supplementation during pregnancy is recommended at a dose of 400-550 mg daily, as suggested by the most recent and highest quality study 1. Pregnant women should aim to consume adequate choline through diet (eggs, meat, fish, dairy, and some vegetables) and consider supplementation if dietary intake is insufficient. Common supplement forms include choline bitartrate and phosphatidylcholine, available as standalone supplements or in prenatal vitamins. For implementation, women can take supplements with food to minimize gastrointestinal discomfort, dividing larger doses throughout the day if needed. Choline is essential during pregnancy because it supports fetal brain development, particularly neural tube formation and memory center development. It also helps prevent neural tube defects and may improve cognitive outcomes in children. The body's demand for choline increases significantly during pregnancy as it's transferred to the developing fetus, making adequate intake particularly important during this period. While most prenatal vitamins contain some choline, many don't provide the full recommended amount, so checking labels and possibly adding a separate choline supplement may be necessary. Other micronutrients such as folic acid, thiamine, betaine, riboflavin, vitamin B6, vitamin C, vitamin E, niacin, iron, retinol, vitamin A have been investigated for their role in preventing fetal neural tube defects, but choline supplementation is specifically recommended based on the strongest and most recent evidence 1. It's worth noting that the recommendation for choline supplementation is based on a strong consensus, with a grade of recommendation of 0, indicating a strong consensus of 100% 1. In contrast, other studies, such as those on folic acid supplementation 1, provide important information on preventing neural tube defects, but do not directly inform the recommendation for choline supplementation during pregnancy.
From the Research
Importance of Choline Supplementation in Pregnancy
- Choline supplementation during pregnancy has been shown to be a non-pharmacological treatment capable of improving both physical and mental qualities of the new individual 2.
- The existence of recent publications that deal with its application in humans makes it necessary to carry out a systematic review to determine the effects that a nutritional intervention through choline supplementation in pregnant mothers can have on children's cognition 2.
Prevalence of Adequate Choline Intake in Pregnant Women
- A meta-analysis of 12 prevalence studies revealed a concerning 11.24% prevalence of pregnant women with adequate choline intake recommendations 3.
- Approximately 88.76% of pregnant women do not achieve the optimal choline intake, highlighting the need for specific policies and actions to improve choline intake in pregnant women's care 3.
Role of Choline in Fetal Development and Maternal Health
- Choline is critical during fetal development, influencing stem cell proliferation and apoptosis, and altering brain and spinal cord structure and function 4.
- Adequate intake of dietary choline may be important for optimal fetal outcome and for maternal liver and placental function 5.
- A high maternal choline level was likely to be associated with a lower risk of adverse pregnancy outcomes, with an odds ratio of 0.51 (95% confidence interval, 0.40-0.65) 3.
Current Evidence and Limitations
- Current evidence is insufficient to support or refute the hypothesis that increasing choline intake in pregnancy improves the neurodevelopmental outcomes of the child 6.
- Critical limitations were present across clinical trials and observational studies, preventing confidence in the results and evidence base 6.
- More research is needed to fully understand the effects of choline supplementation during pregnancy on children's cognition and neurodevelopmental outcomes 2, 6.