Written by Jennifer Walpole, BANT Registered Nutritionist. Reviewed by Dr Phoebe Howells. 

Jennifer Walpole is a BANT Registered Nutritionist specialising in fertility and pregnancy nutrition, supporting individuals and couples who are looking to optimise their fertility for conception, whether spontaneously or via IVF. Jen also works alongside Consultant Obstetricians and accredited specialists in Foetal and Maternal Medicine at Bliss - the Chelsea Clinic for Women & Children, consulting with parents for nutrition support throughout pregnancy.

Trigger warning: sensitive content relating to pregnancy. 

This blog discusses choline during pregnancy and breastfeeding. We recognise that this may feel sensitive or emotionally challenging while you are trying to conceive. Please take care if you decide to read this, and please stop reading if at any point you feel you need to. 

Your well-being matters, and that is the biggest priority. OVUM is here to create a community that is safe and accessible to all, so we recognise that we need boundaries in place to ensure everyone is comfortable when we share information and education. 

Support is available for you, and some resources include: 

• Tommy’s Charity: a charity supporting those through pregnancy and baby loss

• Mind UK: a mental health service available to adults in the UK

• Fertility Network UK Support Groups: available to those who wish to share experiences with others. 

Why Choline Deserves More Attention

During pregnancy, key nutrients like folic acid and vitamin D are widely recognised as important, with recommendations to supplement from preconception onwards (for good reason). Yet, there are other key nutrients that should be considered, particularly during pregnancy, that receive less attention, such as choline. 

What is Choline, and How Much Do I Need?

Considered a member of the B vitamin family, choline has gained traction in the last 25+ years, since the first recommended intakes were established. Adequate intake levels for choline were first set in the United States in 1998, and the EFSA established European adequate intake values in 2016. There was limited data on pregnancy until more recently, when human studies linked choline to foetal brain development, neural tube support, and methylation pathways. Since then, we have gained a better understanding of the role it plays not just in pregnancy and foetal development, but also in neurotransmitter production, methylation, lipid metabolism, and liver function.

Although the recommended intake of choline in pregnancy is 480 mg per day (set by the EFSA’s established Adequate Intake (AI) levels), some women may have increased needs, and research indicates that higher intakes of choline in the third trimester of pregnancy may provide further cognitive benefits for children. Yet many women don’t meet the AI levels of choline due to several factors, including low dietary intake during pregnancy, and some people also carry common genetic variants that can affect choline metabolism. For example, variants in the PEMT gene may reduce the body’s ability to synthesise choline, increasing reliance on dietary intake.

Although this vitamin-like nutrient is present in a wide variety of foods, including meat, fish, dairy, eggs, beans, cruciferous veg, nuts and seeds, during pregnancy, women may be at risk of low intake due to symptoms such as food aversions or dietary restrictions (such as vegetarians or vegans). Furthermore, whilst choline must be predominantly sourced from the diet, many pregnancy supplements contain little or no choline, or amounts unlikely to make a meaningful contribution to daily intake.

The Role of Choline During Pregnancy and Breastfeeding 

Brain Development

Choline is critical for embryonic development and one of the most important nutrients for foetal brain development. During pregnancy, rapid brain growth involves the formation of billions of new cells, and choline is required for these processes, which include cell membrane formation, neuronal growth, and normal brain signalling. It’s important to mention that during breastfeeding, needs increase to around 520mg/day (as recommended by the EFSA). The period of rapid brain development continues during early infancy, whether a baby is breastfed, formula-fed, or combination-fed. Therefore, I advise supplementation beyond birth and during lactation as well. 

The benefits of choline extend well beyond early infancy, too. In fact, studies have shown that higher choline intake during the first and second trimesters is associated with significantly better visual memory and improved attention spans in 7-year-old children, suggesting that dietary intake and supplementation during pregnancy can have lasting effects on brain function even years later. 

Methylation and Neural Tube Defects

Aside from its role in brain function and cognition, choline is also required for neural tube development, playing a complementary role alongside folate. Methylation, which is involved in almost every process in the body and is particularly high during pregnancy, requires choline for the conversion of homocysteine to methionine. 

What’s more, emerging evidence suggests choline may also play a complementary role alongside folate in neural tube development. Some observational studies have linked lower maternal choline intake with a higher risk of neural tube defects, independent of folate intake, although folate remains the primary established nutrient in this area. This highlights the importance of adequately supplementing during pregnancy. 

When considering the role of methylation, choline should be supplemented alongside other key nutrients involved in this process. For example, it works alongside an array of B vitamins, including folate (B9) and B12, so a well-rounded pregnancy supplement should be considered. 

Cell division and placental function

In addition to methylation, choline’s role in cell membrane synthesis is one of the reasons why needs increase during pregnancy. Pregnancy is a time of rapid cell division and growth, which is important for the development of placental and foetal tissues. 

Choline is a precursor to phosphatidylcholine, a major structural component of cell membranes. During pregnancy, there is rapid cell division and growth as the foetus develops and the placenta forms and expands. This makes adequate choline availability essential for the healthy development of cells in both maternal and foetal tissues. 

This process is closely linked to placental function. The placenta is a highly metabolically active organ responsible for nutrient transfer, waste removal, hormone production and immune signalling. Choline supports the integrity and fluidity of placental cell membranes, helping to optimise these processes and ensure efficient communication between mother and baby.

Maternal Liver Function

Finally, choline’s role in maternal liver function supports liver health during increased metabolic demand. Pregnancy places significant strain on the liver due to changes in hormone levels, increased lipid metabolism, and the need to process nutrients for both the mother and the baby. Choline is essential for the transport and metabolism of fats in the liver, and without sufficient intake, fat may accumulate in the liver.

This is particularly relevant as optimal liver function underpins multiple aspects of maternal health, including hormone metabolism, detoxification pathways and nutrient processing. In this way, choline doesn’t just support the developing baby; it also helps ensure that the mother’s body can adapt to and sustain the complex metabolic demands of pregnancy.

OVUM’s Time to Carry® Prenatal

OVUM has included a dose of 400mg of choline in Time to Carry®, which addresses the increased demands of pregnancy and aligns with evidence-based intake recommendations. Supplementing during pregnancy ensures that mother and baby obtain what they need to support brain function, rapid cell division, methylation and liver function, during a time when dietary intake may be low. 

Why Choline Supplementation Can Be Needed

Dietary intake is often low during the crucial early weeks of pregnancy, as many women experience food aversions, particularly toward foods considered the richest sources of choline, such as eggs and meat. Therefore, supplementing with an optimal dose is advisable from the first trimester onwards, since we understand that as pregnancy progresses, dietary intake remains important, especially given emerging evidence that higher intakes later in pregnancy may be relevant to foetal brain development. 

Rich food sources of choline include eggs (especially the yolks), red meat, fish, poultry and dairy. Choline may also be obtained from plant-based sources (albeit in lower amounts), such as soybeans, lentils and cruciferous vegetables. It is important to note that it is harder to meet choline requirements in pregnancy without animal products; therefore, vegans and vegetarians are at risk of low choline status, as well as those avoiding eggs or low-fat or restrictive diets. Women relying on standard prenatal supplementation without choline may also be at risk of low choline status. 

Key Takeaways: 

•  Choline is a key nutrient to consider supplementing during pregnancy; the EFSA established recommended intakes in 2016. Choline, considered a B-vitamin, may be obtained through food sources including meat, fish, dairy, eggs, beans, cruciferous vegetables, nuts and seeds. However, supplementation of up to 480mg should be considered during pregnancy, especially in women at risk of low intake due to dietary restrictions or food aversions. 

• Choline plays a critical role in foetal brain development during pregnancy. During pregnancy, the baby produces billions of new brain cells, and choline is required for these processes, which include cell membrane formation, neuronal growth, and normal brain signalling.

• Beyond brain development, choline also plays a role in neural tube development, alongside folate. Choline also supports maternal liver function and placental function, making it a key nutrient during pregnancy.