Choline is an important nutrient that needs more attention, especially during pregnancy. A 2018 study out of Cornell University found that doubling the nutrient choline in the diets of pregnant women improved IQ markers in their babies. The study suggests that more choline could mean a smarter baby! [1,2]
Researchers have known for years that adding choline to the diets of pregnant rodents produces offspring with life-long intelligence benefits. This new study shows that these same benefits may be available to humans. The study was published in the Journal of the Federation of American Societies for Experimental Biology (FASEB). [1,2]
“This study suggests that choline may be a more important nutrient in pregnancy than we once thought. The promising results of this study show that the effects of choline during pregnancy might translate to humans, and are not just seen in mice studies,” says Liz Sanders, RD, MPH, director of research and partnerships at the International Food Information Council Foundation in Washington, DC. 
Why Is Choline Important During Pregnancy?
Choline is an essential nutrient. You make some choline in your liver but not enough to meet your needs. You need to get the rest from your diet. You need choline to keep the walls of your cells healthy, but choline is especially important during brain development. It is needed to make a very important brain messenger (neurotransmitter) called acetylcholine. Acetylcholine is essential for brain cell development, brain growth, and brain signaling. [1,4]
According to the National Institutes of Health Office of Dietary Supplements, adequate intake of choline for a pregnant woman should be 450 milligrams per day (mg/day). During breastfeeding, the intake should go up to 550 mg/day. Here comes the important statistic. The average woman takes in less than 300 mg/day and up to 95 percent of pregnant women take in less choline than needed. One more thing, many prenatal vitamins do not include choline.  So, are we missing the boat on choline?
“Choline is on the radar of many registered dietitians and nutrition experts. But with the number of new nutrition rules to to follow during pregnancy, getting an adequate amount of choline can fall lower on the priority list. Also, many pregnant women may be getting their nutrition information from their personal healthcare professionals who might not have extensive nutrition training. This may be part of the reason why important nutrients, like choline, are sometimes overlooked,” says Sanders. 
The FASEB Study
In the study, 26 women in their third trimester were divided into two groups. Both groups were given the same diet. Diet nutrients were tightly controlled. Neither the women nor the researchers knew which women were in which diet group. This type of study is called a randomized, double-blind, controlled study, which is most reliable type of research. Here is how the study went: [1.2]
- Using diet and supplements, one group was given 480 mg/day of choline,
- Using the same diet and supplements, one group was given 930 mg/day of choline.
- After giving birth, the infants of all the women had brain function tests (cognitive testing) at 4, 7, 10, and 13 months of age.
- The researchers tested the babies for information processing (things like reaction time and visual memory). Past research shows that this type of cognitive testing correlates well with a child’s IQ.
- Both groups of children did well on the cognitive tests.
- The babies of the mothers in the 930 mg/day group had “significantly” faster information processing than the babies in the 480 mg/day group.
- The researchers concluded: “Even modest increases in maternal choline intake during pregnancy may produce cognitive benefits for offspring.”
The study seems impressive, but it is only one study. More research may follow. “As a double-blind randomized control trial, this study is rigorously designed so that the results are trustworthy. The authors do call out some limitations for the study that are important to keep in mind. The first is the sample size. There were only 26 women in this single study, so the results can’t (yet) be generalized for all pregnant women. Also, although the women’s diets were tightly controlled, there are other factors (like genetics) that could account for the difference in the infants’ cognitive abilities,” notes Sanders. 
What the Study Means for You: Key Takeaways
The researchers suggest that current recommendations for choline intake during pregnancy may not be high enough. The current recommendations are based on old studies done in men. One of the dangers of very low choline levels is liver damage. The choline levels we use now are based on preventing liver damage in men! They are not based on supplying the best level of choline for brain health in babies. [1,2]
Based on one small study, it is too early to say that all pregnant women should start taking choline supplements, but not too early to say all women should be getting enough choline in their diets. [2,3,4] Choline is not measured routinely as part of prenatal care.  You could ask your health care provider to check your choline level. You could talk to your health care provider about a choline supplement. You could see if your prenatal vitamin has choline. The researchers suggest that one thing you should do is increase choline in your diet. 
One reason why most women are low in choline during pregnancy is that they may avoid foods that are high in choline. These foods include egg yoks (women are told to avoid undercooked eggs), red meat (women may want to avoid saturated fats), and fish (women are told to avoid mercury in fish). But there are plenty of healthy choline foods you can add to your diet. [2,4]
“Animal sources (like eggs, red meat and fish) are still the best sources for choline during pregnancy. Unless you are following a strict vegan or vegetarian diet, these foods don’t need to be banned from your diet during pregnancy. Just eat your eggs well cooked (no runny parts), choose lean red meat, and only steer clear of the four types of fish that are high in mercury (tilefish, shark, swordfish, and king mackerel). If you’re a vegan or vegetarian, you can opt for plant sources of choline, including: tofu, soymilk, broccoli and quinoa,” advises Sanders. 
To learn more about choline and see a table of selected food sources for choline, check out this NIH website here.
- The FASEB Journal, Maternal choline supplementation during the third trimester of pregnancy improves infant information processing speed: a randomized, double-blind, controlled feeding study.
- Cornell Chronicle, Adequate choline in pregnancy may have cognitive benefits for offspring.
- Liz Sanders, RD, MPH Director, Research and Partnerships at the International Food Information Council Foundation, Washington, DC
- NIH, Choline.