Choline Before Pregnancy: The Nutrient Most Prenatals Miss

Folic acid gets the attention, but choline is a pregnancy nutrient that very few people get enough of. It does not help you conceive; it matters because the baby’s brain and spinal cord start forming in the first weeks of pregnancy. Here is how much you need, why your prenatal probably does not cover it, and what the evidence shows.

What is choline?

Choline is an essential nutrient. The body uses it to make phosphatidylcholine, a main component of cell membranes, and acetylcholine, a neurotransmitter, and it is a major dietary source of methyl groups.² The liver makes small amounts, but most people need to get it from their diet to prevent deficiency.¹

How much choline do you need before and during pregnancy?

The adequate intake (AI) is 425 mg a day for women of reproductive age, 450 mg in pregnancy and 550 mg while breastfeeding.² Human feeding studies suggest that 450 mg may not be enough to meet the demands of pregnancy, according to a 2019 review.²

The tolerable upper intake level for adults is 3,500 mg a day.¹ Food alone will not get you near that, but high supplement intakes have been linked to fishy body odor, vomiting, sweating, low blood pressure and liver toxicity.¹

Most people fall short, and most prenatals do not help

Only about 10% of Americans, and about 8% of pregnant women, meet the AI for choline.¹ The gap is not filled by supplements: choline is absent from most prenatal vitamins on the market.² The American Medical Association has recommended that prenatal vitamins contain evidence-based amounts of choline.¹²

Who may need more?

Genes matter here. A 2019 review describes common variants in folate and choline enzymes, including MTHFR and PEMT, that strain the body’s production of phosphatidylcholine even when people consume the AI.² There is no test-based dosing for this, but it is one reason researchers question whether 450 mg is enough in pregnancy.² The American Medical Association’s 2017 advice that prenatals contain evidence-based amounts of choline reflects the same concern.²

Choline before pregnancy: the evidence at a glance

What does choline do for the baby?

The strongest experimental study is small. Women entering their third trimester were randomized to diets providing 480 mg or 930 mg of choline a day until delivery, with all other nutrients controlled.³ Infants of mothers in the 930 mg group had faster reaction times when tested at 4, 7, 10 and 13 months. In the 480 mg group, infants exposed for longer had faster times too, suggesting even modest increases may help.³

Earlier in pregnancy, a case-control study of 424 pregnancies affected by neural tube defects and 440 controls linked higher maternal choline intake in the three months before conception with lower risk.² A case-control design cannot prove cause, but the timing is relevant to anyone trying to conceive.

Choline and DHA also interact: in a randomized trial of pregnant women already taking DHA, adding 550 mg of choline a day raised some markers of DHA status, such as red blood cell DHA, though not every marker measured.⁴

The best food sources of choline

Animal foods are the richest sources.¹

Eggs drive choline intake in the US diet, followed by meat, poultry and seafood.¹ Two large eggs supply about 294 mg, about two thirds of the pregnancy AI. If you are vegetarian or vegan, a choline supplement may be the practical option.

Should you take a choline supplement?

If your diet is low in eggs, meat and fish, probably yes, and before pregnancy rather than after a positive test. Look for the amount in milligrams and aim for a total, from food plus supplements, near 450 mg. Choline supplements are dietary supplements, which the FDA does not approve before they are sold.⁵

Check the label of any prenatal you consider for choline in milligrams. Every pregnancy nutrient target is in prenatal nutrient doses. Choline works best as part of the basics: folic acid and DHA. More in the Prepare hub.