Choline: The Essential Nutrient Most Prenatals Overlook
If you’re not thinking about choline during pregnancy, you’re not alone.
Despite being recognized as an essential nutrient since 1998, choline remains among the most consistently underconsumed nutrients among pregnant women.
That oversight matters. Choline plays a foundational role in fetal brain and nervous system development, cell membrane formation, methylation, and liver fat metabolism. Yet most standard prenatal vitamins provide little or none of it.
Pregnancy dramatically increases choline demand due to placental transfer, fetal organ development, and maternal metabolic adaptation. When intake is insufficient, both maternal and fetal systems may be affected quietly, without obvious early symptoms.
A growing body of human clinical research now makes clear that adequate choline intake during pregnancy supports healthier neurodevelopment, liver function, and pregnancy outcomes, yet habitual intake remains strikingly low worldwide.
Short on time? Here’s the takeaway
If you are pregnant, planning a pregnancy, or breastfeeding, choline is one of the most commonly missed yet biologically essential nutrients for fetal brain development, liver health, and methylation. Most prenatal vitamins do not provide enough.
→ Explore my physician-designed Prenatal Support Plan
→ Take the 2-minute quiz to see if it’s right for you
What Choline Does in the Body
Choline is not a single-function nutrient. Like TMG, it sits at the intersection of several critical biochemical pathways—many of which become especially important during pregnancy.
Choline:
Serves as a precursor to acetylcholine, a neurotransmitter essential for memory, attention, and autonomic nervous system function
It is required for the synthesis of phosphatidylcholine, a major structural component of cell membranes and lipoproteins
Acts as a methyl donor, supporting one-carbon metabolism alongside folate and vitamin B12
Enables hepatic lipid export, protecting the liver from fat accumulation
During pregnancy, choline is actively transported from the mother to the placenta, fetus, and later into breast milk. This maternal-to-fetal gradient increases the risk of maternal depletion when intake is insufficient.
In simple terms, choline supports:
Fetal brain and nervous system development
Healthy cell division and membrane integrity
Liver fat metabolism in both the mother and the fetus
Methylation pathways that regulate gene expression
What the Research Shows
Choline Intake During Pregnancy Is Inadequate for Most Women
Multiple extensive reviews and population studies consistently demonstrate that most pregnant women fail to meet the recommended choline intake.
A 2024 systematic review and meta-analysis found that only about 11% of pregnant women achieve adequate choline intake, meaning nearly 9 out of 10 fall short. This gap persists even in high-income countries and is more pronounced among women following plant-based diets.
Across childbearing years, average intakes typically range from 230–380 mg/day, well below pregnancy targets—even when supplements are included.
Reduced Risk of Adverse Pregnancy Outcomes
Higher maternal choline intake has been associated with improved pregnancy outcomes.
A pooled meta-analysis of human studies demonstrated that women with higher choline intake or circulating choline levels had approximately 50% lower odds of adverse pregnancy outcomes compared with those with lower intake.
These findings suggest choline plays a meaningful role in placental function and fetal development—not merely as a supportive nutrient, but as a protective one.
Neural Tube Defects and Brain Development
Folate remains essential, but choline provides independent and complementary protection.
A systematic review and meta-analysis examining neural tube defects found that low maternal choline intake was associated with a significantly higher risk of NTDs, with some populations showing up to a 2.3-fold increase in risk.
Importantly, this association persisted even in folate-replete populations, suggesting choline addresses developmental pathways that folate alone does not fully cover.
Long-Term Neurocognitive Outcomes
Choline’s influence extends well beyond birth.
Human intervention trials and observational studies indicate that higher maternal choline intake during pregnancy is associated with improved child neurocognition, including memory, attention, and visuospatial processing.
One randomized controlled feeding trial followed children to age 7 and found that offspring of mothers who consumed approximately 930 mg/day of choline during the third trimester demonstrated significantly better sustained attention than children whose mothers consumed an intake closer to current recommendations.
This supports the concept of developmental programming, where prenatal nutrition shapes long-term brain function.
Fetal and Infant Liver Health
Choline deficiency is one of the few nutrient deficiencies reliably known to induce fatty liver in humans.
During pregnancy, maternal choline intake directly influences fetal and infant liver fat metabolism. Both animal and human data show that inadequate choline intake leads to hepatic fat accumulation, while repletion reverses this effect.
This is mediated by choline’s role in phosphatidylcholine synthesis, which is required for exporting triglycerides from the liver.
Who May Benefit From Paying Closer Attention to Choline
You may want to be especially mindful of choline intake during pregnancy if you:
Avoid eggs or animal proteins
Follow a vegetarian or vegan diet
Have a history of fatty liver or metabolic stress
Carry MTHFR or other methylation-related variants
Are you pregnant, planning a pregnancy, or breastfeeding
Rely solely on standard prenatal vitamins for nutrition
Most prenatal vitamins contain little or no choline—largely due to formulation challenges, not lack of biological importance.
If several of these apply to you, I typically recommend starting with a structured Prenatal Support plan rather than relying on standard prenatal vitamins alone.
→ View the Prenatal Support Plan
How Much Choline Is Needed During Pregnancy?
Current adequate intake (AI) recommendations are:
Pregnancy: ~450–480 mg/day
Lactation: ~550 mg/day
Notably, many intervention trials demonstrating benefit used intakes above the AI, often ranging from 550–1,000 mg/day, combining dietary intake with supplementation.
Eggs, liver, meat, and seafood are the richest dietary sources, while most plant foods contain relatively small amounts.
Safety and Practical Considerations
Choline is generally well-tolerated when used within the ranges studied. Very high intakes—well above typical clinical use—may cause gastrointestinal discomfort or a fishy body odor.
As with any supplement during pregnancy:
Avoid megadosing without guidance
Consider total intake from diet plus supplements
Discuss supplementation with your clinician
How Choline Fits Into a Functional Pregnancy Plan
I think of choline as a foundational pregnancy nutrient, similar to folate—not optional, not fringe, and not interchangeable with other vitamins.
In practice, choline works best when paired with:
Adequate folate (preferably as 5-MTHF)
Vitamin B12
DHA
Sufficient protein intake
Together, these nutrients support methylation, membrane integrity, neurodevelopment, and metabolic resilience during pregnancy.
Where to Find Quality Choline
Rather than trying to piece together choline, DHA, and methylation support separately, I typically recommend starting with a structured Prenatal Support plan and adjusting based on diet and individual needs.
For patients who prefer targeted supplementation, the following clinician-grade options meet my quality and pregnancy-safety standards:
I recommend:
Prenatal Pro: Provides a comprehensive prenatal foundation with bioavailable vitamins and minerals to support maternal nutrient sufficiency, healthy methylation, and fetal growth and development.
Prenatal Choline+: Supports fetal brain and nervous system development by providing concentrated, bioavailable choline to support neural tube formation, cell membrane integrity, and methylation demands during pregnancy.
OmegAvail Hi-Po Fish Oil: Supports fetal brain, eye, and nervous system development by providing concentrated omega-3 fatty acids to promote healthy cell membrane function and modulate inflammation during pregnancy.
You can find all of these professional-grade options in my Fullscript store — where I’ve curated prenatal support products I trust for my patients: https://www.tayloredmedical.com/prenatal.
Support Tools for Pre- and Postnatal Health
These simple tools can support hydration, comfort, and physical stability during pregnancy and the postpartum period, thereby reducing daily physiological strain and supporting recovery, sleep, and overall resilience.
Daily Hydration Support
Adequate hydration is essential during pregnancy and lactation as blood volume, kidney workload, and nutrient transport increase. Using a large, easy-to-carry water bottle with a straw makes consistent hydration far more automatic throughout the day. The STANLEY Quencher H2.0 Tumbler (40 oz) is durable, convenient, and encourages steady fluid intake without effort.
Full-Body Pregnancy Pillow
As pregnancy progresses, sleep quality often declines due to back, hip, and pelvic strain. A full-body pregnancy pillow helps support side sleeping by stabilizing the spine, hips, legs, and abdomen, which can significantly improve sleep comfort and overnight recovery. The Momcozy U-Shaped Pregnancy Pillow provides all-around support and remains helpful postpartum for rest and nursing.
Maternity Belly Band & Abdominal Support
As the abdomen grows, added mechanical support can reduce strain on the lower back, hips, and pelvic floor. A maternity support belt helps redistribute weight, improve posture, and reduce discomfort during standing, walking, and other daily activities. A pregnancy belly band like this one provides adjustable abdominal and back support and may be particularly helpful later in pregnancy or during periods of increased activity.
Final Thoughts
Choline is no longer a “nice-to-have” during pregnancy. It is a biologically essential nutrient for fetal brain development, liver health, and long-term neurocognition, and intake remains consistently inadequate worldwide.
If you are pregnant, planning a pregnancy, or breastfeeding, choline deserves deliberate attention alongside folate, DHA, and protein intake.
If you want a clear, physician-guided way to meet these needs — without relying on incomplete prenatals — explore my Prenatal Support Plan or take the quiz to find the right starting point.
→ Explore the Prenatal Support Plan
→ Take the quiz
When you purchase through my website, you’ll receive:
20% off all products
Free shipping on orders over $50
10% off your first order when you sign up through my Fullscript store: https://us.fullscript.com/welcome/tayloredmedical
(As always, consult your clinician before starting any new supplement, especially during pregnancy or breastfeeding.)
References
Derbyshire EJ. Choline in pregnancy and lactation: Essential knowledge for clinical practice. Nutrients. 2025;17(9):1558. doi:10.3390/nu17091558
Nguyen HT, Oktayani PPI, Lee SD, Huang LC. Choline in pregnant women: A systematic review and meta-analysis. Nutr Rev. 2024;82(9):e26. doi:10.1093/nutrit/nuae026
Obeid R, Derbyshire E, Schön C. Association between maternal choline, fetal brain development, and child neurocognition: Systematic review and meta-analysis of human studies. Adv Nutr. 2022;13(6):1848–1867. doi:10.1093/advances/nmac082
Bahnfleth CL, Strupp BJ, Caudill MA, Canfield RL. Prenatal choline supplementation improves child sustained attention: A 7-year follow-up of a randomized controlled feeding trial. FASEB J. 2022;36(3):e22113. doi:10.1096/fj.202101217R
Obeid R, Schön C, Derbyshire E, Jiang X, Mellott TJ, Blusztajn JK, Zeisel SH. A narrative review on maternal choline intake and liver function of the fetus and the infant; implications for research, policy, and practice. Nutrients. 2024;16(2):260. doi:10.3390/nu16020260
Roeren M, Kordowski A, Sina C, Smollich M. Inadequate choline intake in pregnant women in Germany. Nutrients. 2022;14(22):4862. doi:10.3390/nu14224862
Derbyshire E, Obeid R, Schön C. Habitual choline intakes across the childbearing years: A review. Nutrients. 2021;13(12):4390. doi:10.3390/nu13124390
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