Choline – A Critical Nutrient During Pregnancy


Move over DHA, Choline takes the spotlight in pregnancy

For decades, health practitioners have advocated for essential fatty acid (specifically, docosahexaenoic acid (DHA)) supplementation during pregnancy to support neurological development in the fetus and throughout childhood. 

More recently, choline has been added to the list of micronutrients that are highly influential in neurological development and, therefore, should be a prioritized nutrient during pregnancy and lactation.

Why the need for Choline?

Choline is a precursor to various metabolites involved in structural and regulatory roles, including: 

  • betaine (a methyl donor)
  • acetylcholine (a neurotransmitter)
  • phosphatidylcholine (a central component of cell membranes)

 Endogenous choline is insufficient to meet the physiological demands of the body, making it an essential nutrient to consume. Egg yolks are the most concentrated source of choline. Unfortunately, most individuals’ diets provide inadequate choline amounts, leading to widespread deficiency among the population.

Pregnant and lactating women at risk of Choline deficiency

One population, particularly at risk for a deficiency, are pregnant and lactating women. Choline requirements are highest in this population, as evidenced by a noticeable increase in plasma and serum choline concentrations in pregnant women. But not only does a deficiency affect the woman’s structural and biological requirements; it also impacts her unborn child. This is because choline readily passes through the placental barrier. As a result, the concentration of choline in amniotic fluid is 10-fold greater than that present in maternal blood and 6 to7 fold higher in the fetus and newborn compared to their adult years.

Common signs of choline deficiency

Organ and muscle dysfunction appear to be the most prominent sign of choline deficiency among adults. 

In randomized trials, 42 days of a choline-restrictive diet led to organ dysfunction evidenced by either 

  • A five-fold increase of serum creatine phosphokinase (CPK) activity
  • a 1.5-fold increase in serum activity of aspartate transaminase, alanine transaminase, γ-glutamyl transpeptidase, or lactic dehydrogenase
  •  or 28% increase in liver fat content (assessed by magnetic resonance imaging)

Dietary choline resolved all of the issues mentioned above

Estrogens protective role 

In the same report, it was found that female sex hormones play a role in developing a choline deficiency since 80 per cent of postmenopausal women developed signs of choline deficiency compared to only 44 per cent of premenopausal women. 

Further investigation indicated that polymorphisms in the PEMT gene, which carries an estrogen response element that promotes the binding of the estrogen receptor to this gene, may be implicated in the prevalence of choline deficiencies. The role of estrogen in protecting women from a choline deficiency was confirmed in other randomized controlled studies in which women receiving estrogen were less susceptible to the organ damage prompted by a choline deficiency. The PEMT gene encodes for an enzyme that can form a choline moiety de novo. The estrogen surges during pregnancy induce this gene, ensuring choline availability to the fetus.

Dietary choline is necessary to support de novo synthesis. 

Even if the PEMT gene operates at total capacity, dietary choline is necessary to support de novo synthesis. Rat models have shown pregnancy as a state that depletes the liver of choline stores and that maternal dietary choline directly impacts fetal brain development. More specifically, a choline deficiency increased the prevalence of neural tube defects and led to low performance on cognitive tests in children

Other studies have reported that “a woman who consumes a diet low in choline has a 4-fold increased risk of having an infant with a neural tube defect…” Fetal brains had lower numbers of radial glial cells, intermediate progenitor cells, and upper-layer cortical neurons when their mothers lacked choline.

Choline during pregnancy offers protection from memory impairment in ageing. 

Animal studies also suggest that adequate choline provision during pregnancy could protect against memory impairment common with aging. For example, aging rodents exposed to supplemental choline in utero did not show the same decline in memory as their aging counterparts that were not exposed to extra choline. 

Human studies have not yet been conducted to determine whether in utero choline concentrations are associated with dementia and other forms of memory decline in older age; however, studies suggest that exposure to adequate choline during fetal development has a long-lasting impact on learning memory.

The bottom line is choline is vital for pregnant and lactating women.

Since pregnancy and lactation are conditions that draw choline out of the maternal blood to provide for the fetus or infant, supplementation of this vital nutrient is essential for those who may become pregnant. It will not only ensure optimal organ health in the mother, but it will also ensure the developing child has all the appropriate nutrients needed to ensure a robust neurological system both in structure and function.