Choline During Pregnancy (Everything You Need to Know)

Choline; ever heard of it?

Did you know that it is a part of every single cell in your ENTIRE body, and that without it, we could not survive?

Choline, also called Vitamin B4, is responsible for healthy brain development, liver function, the entire nervous system, a healthy placenta for your baby, and can help to prevent certain diseases.

Most people do not get enough choline, and pregnant women are at the highest risk for deficiency.

Now that we have your attention, read on to learn more about this amazing nutrient, how it can help you and your baby, and in which foods it’s found.

Choline and Pregnancy: What It Is, and What It Does

Choline is a super important nutrient, especially during pregnancy.

This is because:

  • In 2018, the American Academy of Pediatrics recognized choline as an important nutrient for the development of your baby’s brain.
  • Choline is an essential nutrient, meaning that our body can’t make it, and we have to consume it through food or supplements (food is ideal, as it’s more effectively absorbed and metabolized).
  • Choline is important because it’s needed to grow and form healthy cell structures throughout the entire body, and is part of every cell membrane.
  • Choline helps to regulate gene expression, promoting the healthy growth of DNA throughout the body.
  • Choline helps to promote healthy placental growth, which provides oxygen and nutrients for your baby; without a healthy placenta, the risk for preeclampsia and restricted growth is much higher.
  • Adequate choline intake helps to promote a healthy liver, and not consuming enough can lead to the development of fatty liver disease, which can cause a myriad of other health problems.
  • A neurotransmitter called acetylcholine (made from choline) is active in both the central and peripheral nervous system, which control and regulate the entire body.

(Source: Nutrients Journal)

pregnant woman eating a salad

Research shows that most people don’t get enough Choline. The liver can synthesize small amounts of choline, but not enough to survive.

Choline deficiency can cause muscle damage, liver damage, and even fatty liver disease.

Genetics and pregnancy can also influence deficiency, as well as specific medical conditions that require nutrition through IV feeding.

Some people can’t synthesize it as well as others, and people who require complete nutrition through IV feeding also often become deficient.

Pregnant moms with hyperemesis (a severe form of prolonged vomiting that can lead to hospitalization) would fit in this category because most women with hyperemesis require IV feeding to prevent dehydration, malnutrition, and electrolyte imbalance.

The Benefits of Choline during Pregnancy

By now you probably realize that choline is a vital nutrient for you and your baby.

Research is still being done, but the benefits are undeniable.

Here are some interesting studies and discoveries about choline supplementation during pregnancy:

One study showed that when moms consumed a targeted daily dose of 930mg of choline (between food and supplementation) from the second trimester to the third month postpartum, infants had improved brain health.

The study showed that the infants were able to better control the brain, showed increased cognition and response time to stimuli, and inhibit responses that are typical characteristics of schizophrenia and attention-deficit disorders (Source: FASEB Journal)

Another long-term study showed that modestly higher maternal intake of Choline (average of ~350mg/day from food only, no supplementation) during pregnancy benefitted children from birth until school-age.

The children had an enhanced ability to problem solve, a better memory, and improved attention from 4 months of age until 7 years of age.

This study helps to show that a healthy diet can provide adequate amounts of Choline during pregnancy, and that food should be the first source whenever possible. (Nutrition Today)

A recent study was conducted of mothers who supplemented with Choline, who had also contracted serious respiratory illnesses.

The infants born to mothers who had higher serum Choline levels were significantly more able to maintain attention and bond with their mothers than those born to mothers with lower serum Choline levels (Source: Journal of Psychiatric Research).

This is more proof that Choline can protect the delicate fetal brain even if mom gets sick during pregnancy.

young mother breastfeeding her baby

Another interesting aspect that continues to develop is the link between Choline intake and autism prevention.

The theory is that adequate levels of Choline consumed during pregnancy can promote healthy brain development and reduce anxiety and social deficits, which are apparent in autism spectrum disorders.

More specific research shows that Choline intake can help to form ample white and gray matter in the brain along with the development of the hippocampus (Source: Boston University School of Medicine).

The hippocampus is responsible for emotional and memory regulation. In children with autism disorders, the hippocampus is abnormal or underdeveloped.

Finally, other research shows that women who consume less choline, folic acid, methionine, and protein are at higher risk of birthing a baby with neural tube defects and/or cleft palates (source: Journal of Epidemiology).

One important note about this study is that it was based on food frequency questionnaires and not direct intervention with supplementation.

Should I Take a Choline Supplement During Pregnancy?

Nearly 95% of pregnant women do not consume enough Choline.

Most prenatal supplements contain little to no Choline, and Choline metabolism and absorption is also dependent on nutrients like Vitamin B12 or folate intake.

Currently, Choline recommendations are based around an “Adequate Intake”; this is the amount of a nutrient that is deemed sufficient to ensure nutritional adequacy.

There is not enough research on Choline to establish a Recommended Dietary Allowance just yet.

The Adequate Intake for Choline is based on the amount needed to prevent liver damage, which can be measured through blood levels of enzymes released by the liver (Source: National Institutes of Health)

Choline needs change dramatically throughout your lifespan, and increase during pregnancy and lactation.

The needs are also dependent on other nutrients like amino acids and folate.

According to the National Institute of Health, needs are as follows:

  • Birth-6 months; males and females; 125 milligrams per day
  • 7-12 months; males and females; 150 milligrams per day
  • 1-3 years; males and females; 200 milligrams per day
  • 4-8 years; males and females; 250 milligrams per day
  • 9-13 years; males and females; 375 milligrams per day
  • 14-18 years; males; 550 milligrams per day, females; 400 milligrams per day
  • 19 years and over; males; 550 milligrams per day, females; 425 milligrams per day
  • Pregnancy; 450 milligrams per day
  • Lactation; 550 milligrams per day

(Source: NIH)

Choline blood testing is not common, so consuming a diet rich in choline, especially during pregnancy, is very important.

Choline supplements are available, but be mindful that supplements are not regulated by the FDA.

Therefore, choosing a high quality supplement would be top priority, and discussing this with your medical professional is best before starting a choline regimen.

Unfortunately, prenatal supplements do not contain choline, and because it’s important to also consume adequate amounts of folic acid and other nutrients, eating a wide variety of foods is key for meeting daily choline requirements.

an African American pregnant woman smiling and holding her bump

Which Foods Contain Choline?

Choline is easy to consume through a diet rich in animal proteins, including meat, eggs, and dairy.

Following a plant-based diet? Not to worry! Choline is also found in soy, nuts, seeds, and some cruciferous vegetables.

Here is an easy to follow list of the foods that contain the most choline per serving:

  • Liver (beef, chicken, etc); 245-317 milligrams per 75 grams
  • Eggs (chicken); 294 milligrams per two large eggs
  • Tofu; 107 milligrams per 100 gram serving
  • Soybeans; 107 milligrams per ½ cup cooked
  • Beef/lamb/pork/chicken/turkey; 60-100 milligrams per 75 grams
  • Salmon; 85 milligrams per 75 gram serving
  • Cod; 71 milligrams per 75 gram serving
  • Kidney beans/Navy beans; 57 milligrams per ¾ cup
  • Wheat germ; 54 milligrams per 30 grams
  • Shiitake mushrooms; 58 milligrams per ½ cup raw
  • Lentils; 45 milligrams per ¾ cup
  • Milk (cow’s); 40-45 milligrams per 1 cup serving
  • Breastmilk (human); 42 milligrams per 1 cup
  • Ricotta/Cottage cheese; 42 milligrams per 1 cup
  • Pumpkin Seeds; 36 milligrams per ¼ cup
  • Broccoli/Cauliflower/Collard greens/Brussels Sprouts; average 35 milligrams per ½ cup serving
  • Avocado; 28 milligrams per whole, pitted fruit
  • Yogurt; 27 milligrams per ¾ cup
  • Nuts (tree nuts; almonds, pistachios, cashews, also peanuts); 20-25 milligrams per ¼ cup
  • Quinoa;  23 milligrams per ½ cup

(Source: Canadian Nutrient File)

hard boiled egg

Is Too Much Choline During Pregnancy Harmful?

We’ve talked in depth about the benefits of choline and what happens if you don’t consume enough during pregnancy.

But is there too much of a good thing?

There is a tolerable upper limit (UL) established for Choline of 3500mg. This is the amount of a nutrient that can be consumed before any health risks become apparent.

Research shows that maternal supplementation of amounts as large as 900mg per day can safely be taken without harmful side effects.

Animal studies do show that excessive levels of intake of nutrients including choline could cause asthma-like symptoms or increased risk for colitis.

Excess Choline can also convert to TMAO, an organic compound that may be an indication for metabolic disease; however, the mechanism of action is not yet known, so more research is likely needed (Source: MDPI / Nutrients Journal).

Long story short, as long as you aren’t taking excessive amounts of Choline, you are likely safe.

It’s always important to talk to your medical professional if you feed that Choline supplementation would be beneficial for you.

Overall, choline is a nutrient that plays an important role in the development of every cell in the body, and is dependent on several other nutrients for adequate absorption and metabolism.

During pregnancy, women are at a very high risk of becoming deficient, and deficiency can lead to increased risk of harm for your baby.

A well-rounded diet rich in animal protein, whole grains, tofu, and cruciferous vegetables is likely to provide adequate amounts of Choline, but under certain circumstances, supplementation may be needed.


For more on essential pregnancy nutrients, you might also like:

This article has been reviewed and approved for publication in line with our editorial policy.

Stephanie Searor, MS RD LDN

Stephanie Searor MS, RD, LDN is a Registered Dietitian and Registered Yoga Teacher. After completing her dietetic internship at the University of North Carolina at Greensboro, she received her Master's Degree in Nutrition & Dietetics from Central Michigan University. She is experienced in all nutrition-related needs throughout pregnancy and postpartum.

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