Importance Of Choline In Prenatal Supplements

  • Ayah Alshami BSc in Biomedical Sciences, Manchester Metropolitan University

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Importance of choline in prenatal supplements

Pregnancy can be an amazing experience. With a baby (or babies) growing inside the womb, suddenly you have another life (or lives) to think about, and one way of giving them the best start in life is by taking prenatal supplements.

Such supplements aren’t merely a contemporary trend; science has shown that some are recommended for all pregnant people such as folic acid.  In this article we will be talking about choline, a vital nutrient that was originally considered essential for humans only in 1998.

We’ll explore what Cholineis, its role in neural tube development, cognitive function, and the prevention of developmental issues and how you should take it during your pregnancy.

Understanding choline

Choline is an essential nutrient, meaning that it is something that we need but can’t produce in sufficient quantities.  It is closely related to the B vitamins that is present in meat, milk and eggs and although we can produce a small amount of it in the liver, this is not enough to meet demand.It is an important nutrient for the membrane that surrounds cells, and is needed by the brain and nervous system to regulate mood, memory and muscle control.  It also helps protect against fatty liver disease.

Choline is processed in different ways in the body, and isimportant for the development of the baby's brain and overall health, especially in the later stages of pregnancy.

In the later stages of pregnancy, certain pathways of how Cholineis processed become more active. More of one type of product ends up in the baby's bloodstream. This is because this product is rich in DHA, a type of omega-3 fatty acid important for the baby's brain development.3

Sources of choline

There are various dietary sources of choline.  It can be found in plant and animal sources, however sources from animals typically contain more per gram.  These include:

·       Eggs (specifically egg yolk)

·       Beef

·       Chicken breast

·       Seafood (such as salmon)

·       Dairy products (milk, yoghurt, cheese)

·       Nuts and Seeds: Some nuts and seeds, including sunflower seeds, are good sources of choline

·       Leafy greens like broccoli and spinach, though these contain lower amounts

Choline in pregnancy

Choline requirements increase when you are pregnant, as the demand for essential nutrients rises.  In the USA, women’s intake of choline is often below the recommended amounts.Choline is required for the baby’s optimal brain development, and supplementation may improve cognitive function and response to stress.5  

Neural tube defects

Inadequate intake has been associated with neural tube defects, which is when there is a problem with the tube that will eventually become the baby’s brain and spinal cord.4  The most well-known of these is spina bifida, where the spinal cord is left exposed or covered by skin.  However, other research has found no relationship between choline levels in pregnancy and neural tube defects.

Other benefits

The beneficial effects from supplementation don’t end there, with a study finding that children born to mothers on choline supplements taken from the second trimester performed better on a test of visual memory at 7 years of age.5

Choline may also affect congenital defects and developmental disorders.  One study looked at supplementing pregnant women with choline and its effect on an infant’s cerebral inhibition – something that is involved in the causes of schizophrenia, with more infants having a normal cerebral inhibition compared to the placebo group.5  Cerebral inhibition develops during the vital foetal and early postnatal life, and can be studied in animals as well as humans.Other experiments on rodents found that if given while they were pregnant it protected the offspring from cognitive impairments.2

In a mouse model of Down syndrome, many positive effects were found in mice given choline during pregnancy and in a rat model of induced breast cancer there was a reduced risk in daughters born to choline supplemented rats.5

In a study with pregnant women in their third trimester, researchers looked at the effects of giving some women higher doses of choline (930 mg per day) compared to others who received lower doses (480 mg per day). They found that the women who got more choline had 30% less of a substance called sFLT1 in their placentas. This sFLT1 can cause problems in pregnancy, particularly a condition called preeclampsia. When there's too much sFLT1 in the blood, it grabs onto a protein called VEGF that's needed for healthy blood vessels. This can lead to issues like high blood pressure and kidney problems.5

There have been studies that have demonstrated an interaction between choline and how nutrients are processed during pregnancy. In a mouse model of gestational diabetes mellitus (GDM), it was found that maternal choline supplementation prevented the foetus from overgrowing in the middle of the gestation periods – which is the most common complication of GDM.3

Researchers have also evaluated the effects of higher maternal plasma choline on attention and social problems in children. Attention problems and withdrawn syndrome scales on a specific checklist were investigated, and higher maternal blood levels of choline was associated with fewer attention problems in children, and in males it led to less social withdrawal.

In one randomised controlled trial phosphatidylcholine supplements (which is what choline can be processed into) were given to pregnant people with another group receiving placebo.  Compared to the placebo group, phosphatidylcholine supplementation improved the inhibition of something that is associated with the development of schizophrenia (76% versus 43% of newborns).  A gene affecting the inhibition negatively was also found to influence it only in the placebo group, suggesting the supplements had a positive effect.6

How much choline should I take? 

An adequate intake amount of choline, defined as the level that is assumed to ensure nutritional adequacy for a pregnant person is 450mg per day.

It is available in supplements, with some containing only choline while others are in combination with other vitamins/minerals.  The typical amount of choline in these supplements is from 10 to 250mg.The importance of choline during pregnancy is increasingly being recognised but prenatal dietary supplements, however, either contain little or no choline, so with this in mind it is essential to carefully read the labels to ensure they contain choline.

It’s also important to check with your healthcare professional when starting or changing supplements so guidance can be tailored to your pregnancy.

Risks of choline deficiency

The risk of not having an adequate amount of choline may be greater in pregnant people who aren’t taking folic acid supplements and people with low vitamin B12 amounts.7

Deficiency can cause muscle damage, liver damage and fatty liver disease.  As choline is needed so much by the growing baby, the mother can have reduced amounts in their blood; it is also found in large amounts in the placenta and amniotic fluid.

Maximum doses of choline

Very high amounts of choline (over 3500mg per day) are associated with a fishy body odour, vomiting, excessive sweating, increased salivation, and liver damage.2

Summary

Animal and human studies have shown the importance of adequate choline intake during pregnancy – something that most pregnant people are not meeting.  Benefits include improved cognition performance, neurodevelopment and placental functioning among others. Currently there are only a few randomised control trials on prenatal choline and pregnancy outcomes, and the appropriate dose required to see benefits.

Hopefully there will be further, larger clinical tests with different dosages that measure different outcomes that will inform future choline intake recommendations for pregnant people.

For the moment, you should aim to at least meet the adequate intake (450mg) as the current science shows this can help improve your baby’s growth and pregnancy outcomes.

References

  • PubMed [Internet]. 1998 [cited 2023 Oct 9]. Dietary reference intakes for thiamin, riboflavin, niacin, vitamin b6, folate, vitamin b12, pantothenic acid, biotin, and choline. Available from: https://pubmed.ncbi.nlm.nih.gov/23193625/
  • Spoelstra SK, Eijsink JJH, Hoenders HJR, Knegtering H. Maternal choline supplementation during pregnancy to promote mental health in offspring. Early Interv Psychiatry. 2023 Jul;17(7):643–51.
  • Korsmo HW, Jiang X, Caudill MA. Choline: exploring the growing science on its benefits for moms and babies. Nutrients. 2019 Aug 7;11(8):1823.
  • Adams JB, Kirby JK, Sorensen JC, Pollard EL, Audhya T. Evidence based recommendations for an optimal prenatal supplement for women in the US: vitamins and related nutrients. Matern Health Neonatol Perinatol. 2022 Jul 11;8(1):4.
  • Jiang X, West AA, Caudill MA. Maternal choline supplementation: a nutritional approach for improving offspring health? Trends Endocrinol Metab. 2014 May;25(5):263–73.
  • Freedman R, Hunter SK, Law AJ, Clark AM, Roberts A, Hoffman MC. Choline, folic acid, Vitamin D, and fetal brain development in the psychosis spectrum. Schizophr Res. 2022 Sep;247:16–25.
  • Office of dietary supplements - choline [Internet]. [cited 2023 Oct 10]. Available from: https://ods.od.nih.gov/factsheets/Choline-HealthProfessional/

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Christopher Burke

MBBS, GKT School of Medical Education, King's College London

Chris is a tutor who holds a degree in medicine from King's College London. He enjoys writing informative yet easy to read articles relating to health and disease with the aim of educating people about various conditions. During his time at university, he continually worked on his writing and presentation skills, and was awarded the highest mark of his cohort for a literature review. He has helped many students from primary school to university level achieve their goals and is particularly interested in immunology research.

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