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Choline is an important nutrient for women during pregnancy and breastfeeding, contributing to cognitive function and growth of the brain, nervous system and other organs. However, most women aren’t getting the recommended amount from their diets alone. SmartBrief spoke with Pharmavite VP of Science and Technology, Susan Hazels Mitmesser, Ph.D., about this problem and how health care providers can help.
Why is choline so important for infant development in the womb, particularly cognitive function?
Choline is a vitamin-like essential nutrient that is involved in many processes in the body but is particularly important during pregnancy. It is a structural component of every cell membrane in the body, and as such is needed in even higher concentration for moms during both pregnancy and lactation.1 Moms transfer large amounts of choline to their babies across the placenta and through breast milk. There is increased demand on choline stores during pregnancy and lactation because of the significant period of brain and nervous system growth and development that occurs in the last trimester of pregnancy and up through age three — roughly the first 1,000 days of a child’s life. The American Academy of Pediatrics indicates choline as one of the key nutrients that supports early brain development.2
What are some of the most significant clinical findings related to choline and prenatal development?
Low levels of choline in the blood may increase the risk of having a baby with neural tube defect (NTD), underscoring the importance of ensuring that choline is consumed regularly by pregnant women. If it is not consumed via food, then the nutrient gap should be met through supplementation. The demand for choline increases as pregnancy progresses, with choline needed for placental development and to support fetal organ growth, including the brain and nervous system, where it is found in high concentration.
Several clinical studies have assessed the relationship between dietary choline intake or blood choline concentration and the risk of NTD and cognitive development issues. In one study, mothers with diets rich in choline and betaine experienced a 51% decreased risk of having an NTD-affected pregnancy.3 Another study found higher NTD risks associated with lower levels of blood choline and reduced risks with higher levels of choline.4 In an ongoing prospective study (Project Viva), the highest level of choline intake (392 mg/day) during the second trimester was significantly associated with higher visual memory scores in children at 7 years of age.5
Are most women getting enough choline?
According to national survey data (NHANES 2007-2008), the average choline intake was about 260 mg/day for women, which is well below the recommended intake of 450 mg/day during pregnancy. Choline intake should continue to increase during lactation to 550 mg, as the demand on the nervous system growth and development increases as well. While choline synthesis can occur in the body to a degree, it is not enough to meet metabolic needs. Therefore, choline should also be obtained through increased intake in foods such as eggs, milk, peanuts, and beef or dietary supplements.
How are current dietary trends contributing to this shortfall?
Pregnant moms who are vegetarian or vegan may be at risk for inadequate choline intake because many of the primary food sources of choline are animal-based, such as beef, eggs, fish and milk. It is especially important to consider dietary supplements in this population to ensure the nutrient gap is being met.
How can health care providers ensure their patients get enough choline during pregnancy?
Health care providers are encouraged to discuss dietary intake and habits with pregnant patients to determine if there are shortfalls of key nutrients during pregnancy, including choline. They should talk to their patients about taking a daily prenatal multivitamin formulated with choline, and other important nutrients like DHA, which are also often deficient in pregnant women, especially those with dietary restrictions or who avoid animal food sources.
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Zeisel SH. Nutrition in pregnancy: the argument for including a source of choline. Int J Women’s Health. 2013;5:193-199.
Schwarzenberg SJ, Georgieff MK, AAP Committee on Nutrition. Advocacy for Improving Nutrition in the First 1000 Days to Support Childhood Development and Adult Health. Pediatrics. 2018;141(2):e20173716.
Shaw GM, Carmichael SL, Yang W, Selvin S, Schaffer DM. Periconceptional dietary intake of choline and betaine and neural tube defects in offspring. Am J Epidemiol. 2004;160(2):102-109.
Shaw GM, Finnell RH, Blom HJ, et al. Choline and risk of neural tube defects in a folate-fortified population. Epidemiology. 2009;20(5):714-719.
Boeke CE, Gillman MW, Hughes MD, Rifas-Shiman SL, Villamor E, Oken E. Choline intake during pregnancy and child cognition at age 7 years. Am J Epidemiol. 2013;177(12):1338-1347.