Choline and pregnancy: needs that rise through to breastfeeding

The adequate intake of choline is 400 mg/day for women and 480 mg/day for pregnant women [2]. In France, women consume an average of 291 mg of choline per day, well below the adequate intake [3]!

The transfer of choline from mother to foetus depletes maternal plasma choline in humans. The body produces little choline, although production increases in the presence of oestrogens. During pregnancy, oestrogen concentrations rise dramatically towards term. However, despite the body’s potentially greater capacity to synthesise choline as oestrogen levels rise, the data suggest that demand from the foetus and infant is so high that maternal stores are depleted during pregnancy and breastfeeding [4].

Furthermore, the latest data suggest that choline needs during pregnancy may be almost twice the current recommendations (930 mg versus 480 mg) [5]! Choline is not a vitamin, but it is found in some vitamins suitable during pregnancy, and it remains essential.

Baby Bump, Bump Essentials and Bump Powder, our range of pregnancy food supplement, contains choline!

Adequate choline intake reduces the risk of neural tube defects

Hyperhomocysteinaemia, or excess homocysteine, is a condition associated with neural tube defects and congenital heart defects, which result from abnormal development of the neural tube or heart [6]. Choline could play a role in reducing neural tube defects by lowering homocysteine levels. It is therefore important to have optimal choline intake even before pregnancy, not just vitamin B9 intake, because neural tube defects develop in the first month of pregnancy.

An observational study compared women who had children with neural tube defects with women whose children did not have them. Researchers found a lower risk of a pregnancy affected by a neural tube defect with higher periconceptional choline intakes, corresponding to adequate intake levels. This applied to neural tube defects overall, as well as spina bifida and anencephaly. At choline intakes equal to or above the recommended level, a 51% reduction in the risk of neural tube defects was observed compared with intakes below 300 mg [7].

High maternal homocysteine concentrations are a risk factor for several adverse pregnancy outcomes, including pre-eclampsia, premature birth and very low birth weight [8]. Choline helps lower homocysteine levels.

An intake 2 times higher than recommended reduces the risk of pre-eclampsia

A study examined the influence of maternal choline intake on the human placenta. Healthy pregnant women were randomly assigned to receive 480 mg of choline/day or 930 mg/day for 12 weeks. A significant 30% reduction in a marker of pre-eclampsia risk was observed in placental tissue from the group receiving 930 mg/day of choline compared with the 480 mg/day group. These results indicate that supplementing the maternal diet with choline could reduce the risk of pre-eclampsia [9].

Choline helps lower levels of the stress hormone

Another study giving the same doses of choline to 2 groups of pregnant women showed that an intake of 930 mg of choline per day reduced cortisol (the stress hormone) levels in umbilical cord plasma by 33%, which could reduce the risk of stress-related diseases later in life [10].

Optimal choline intake improves memory and cognition

During the later stages of pregnancy, the brain’s memory centre develops. Rodents that did not receive enough choline showed a decline in memory as they aged, while offspring exposed to additional choline in utero did not show this age-related change [11].

A human study found similar results! Researchers examined the effects of maternal choline supplementation during pregnancy on infant cognition [5]. Average reaction time, measured at 4, 7, 10 and 13 months of age, was significantly faster in infants whose mothers consumed 930 mg of choline per day, compared with 480 mg. This result indicates that maternal consumption of around twice the recommended amount of choline during the final trimester improves infants’ speed of information processing.

In the group receiving 480 mg of choline per day, infants exposed for longer also had faster reaction times, suggesting that even modest increases in maternal choline intake during pregnancy may offer cognitive benefits for children.

Observational data also showed that maternal choline intake within the adequate intake range during pregnancy was associated with better memory function in children aged 7, compared with children whose mothers consumed around 50% of the recommended intake [12].

After ingestion, choline is converted into various metabolites, including betaine. Betaine is involved in methylated folate (5-mthf)-dependent metabolism. Choline and methylated folate (5-mthf) levels are therefore closely linked, and a deficiency in either compound can worsen the nutritional status of the other [13].

For example, a study in rats showed that a choline-deficient diet reduced methylated folate (5-mthf) content in the liver by 31% compared with rats given a controlled choline intake [14]. Similarly, a study in women showed that insufficient methylated folate (5-mthf) intake led to a 25% decrease in choline levels [15].

In addition, a mutation in the 677T MTHFR gene (which enables methylated folate (5-mthf) to be converted into its active form) can affect choline status [16]. It is estimated that at least 10% of the population has a mutation in this gene [17]!

Choline during pregnancy is therefore just as essential asfolic acid and pregnancy !

To boost your vitamin B9 intake, our pregnancy gummies or our pregnancy snack are ideal.

Study findings highlight potential interactions between the two nutrients and their effects on metabolism. For example, DHA supplementation significantly increases cellular choline uptake compared with cells grown without added DHA, demonstrating that DHA can affect choline status [18].

In a study of choline supplementation, with a DHA supplement or saline solution to pregnant rats, offspring in the groups supplemented with choline or DHA showed a significantly higher number of neurons than offspring in the untreated control groups. Combined choline and DHA supplementation during pregnancy further improved neurodevelopment in the rats compared with the control group, with greater effects than supplementation with either choline or DHA alone [19].

Their combined effect was demonstrated in a study in which DHA supplementation in rats significantly increased DHA levels in plasma and red blood cells compared with the control group. Choline supplementation alone significantly increased free choline in plasma but did not affect DHA levels. However, combined DHA and choline supplementation increased DHA to significantly higher levels than DHA supplementation alone, indicating that the impact of combined choline and DHA supplementation on circulating DHA levels is greater than an additive effect [20].

The duo: our omega-3s during pregnancy Omega Mama + our choline during pregnancy Choline Mama.

Eggs are the best source of choline!

One large hard-boiled egg provides 147 mg of choline [26]. It is found in the yolk: the white contains almost none [32].

You can safely eat cooked eggs; it is best to avoid raw eggs, which carry a higher risk of contamination. You can eat eggs with runny yolks if you choose organic, very fresh eggs and eat them soon after purchase, as close as possible to the laying date.

The main contamination risk from eggs is Salmonella bacteria. In the United States, for example, an estimated 1 egg in 10 000 to 30 000 is contaminated [22]. The risk is 7 times lower for organic free-range eggs [23].

Bonus: Compared with eggs from caged hens, eggs from pasture-raised hens contain 2,5 times more total omega-3 fatty acids [24]! Studies show that more than 50% of people who eat eggs have an adequate choline intake, compared with just 2% of those who do not, and their choline status is almost 2 times as high [25]. It appears difficult to achieve an adequate choline intake without eating eggs.

Other sources of choline

Liver is also a good source of choline, but some types are not recommended during pregnancy because of their retinol content, although poultry liver contains the least retinol.

Choline is found in a variety of foods besides eggs and liver, but in much smaller amounts. For example: 100 g of roast chicken provides 85,3 mg of choline; 100g of sunflower seeds contains 55,1 mg of choline; 100g of almonds contains 52,1 mg of choline; 100g of cauliflower contains 45,2 mg of choline; 100g of shiitake mushrooms contains 36,8 mg of choline; 100g of beans contains 30.5 mg of choline; 100g of Brussels sprouts contains 19,1 mg of choline.

This nutrient is mainly discussed during pregnancy. Yet your needs remain high after birth, and are even higher during breastfeeding: the amount secreted into milk each day adds to the mother’s own needs [2][28]. If you are breastfeeding, our breastfeeding supplements and our selection of postpartum food supplements support you during this period.

Adequate intakes (French dietary reference values [2]):

• Adult woman, not pregnant or breastfeeding: 400 mg per day
• Pregnancy: 480 mg per day
• Breastfeeding: 520 mg per day

If you are not breastfeeding, or once you have weaned, the reference value falls back to 400 mg per day. There is no specific postpartum reference value, in France or elsewhere: values are established for adult women, pregnancy and lactation [2][26]. This 400 mg figure remains above usual intakes: across Europe, average adult intakes range from 291 to 468 mg per day depending on the country, and are lower in women than in men [27].

Choline and breast milk

It is actively transferred into breast milk. Its concentration varies according to the stage of lactation, maternal diet and genetic background [28].

This level is partly linked to intake: in a study of women taking no supplements, dietary intake was correlated with the concentration of phosphatidylcholine in their milk, and two controlled trials showed that supplementation increased several of its forms in milk [29][30]. This effect is limited, however: to keep supplying milk, the mother’s body reduces the amount it uses for its other functions [30]. Maternal stores therefore act as the buffer, and meeting your intake needs postpartum is above all a matter of maternal health.

What about postpartum brain fog?

Many women describe forgetfulness or difficulty juggling several tasks in the months after birth. Documented changes take place in the maternal brain during pregnancy and postpartum, but studies using objective cognitive tests have produced mixed results, and the differences measured remain modest [31]. The factors most consistently identified are disrupted sleep, hormonal changes and mental load. Choline is used to produce acetylcholine, which is involved in memory [26], but its effect on the memory of new mothers has not been studied to date.

Should you take a choline supplement after giving birth?

A varied diet including eggs, meat, fish and pulses can help you approach these reference values. In three situations, the gap remains difficult to close:

• you eat few or no eggs, or your diet does not meet your needs;
• you follow a vegetarian or vegan diet;
• you are breastfeeding, and your needs remain at 520 mg per day over an extended period.

A supplement helps you reach an intake target; it does not replace a varied diet. Choline Mama provides 370 mg in two capsules, as patented VitaCholine® choline bitartrate. The formula contains only this nutrient, so it can be taken alongside a postpartum multivitamin without duplicating ingredients.

Choline is particularly essential during pregnancy, and estimated needs may in fact be twice the recommended amount! After birth, they remain high, reaching 520 mg per day during breastfeeding.

Adequate choline intake is associated with a lower risk of neural tube defects and pre-eclampsia, while a good intake helps maintain methylated folate (5-mthf) and DHA status.

Eggs are the best source of choline. Some vegetables contain it too, but in smaller amounts, which makes it especially important to pay attention to your intake if you follow a vegan diet.