Choline in Pregnancy

A recent, 2018, study by Cornell University has the prenatal nutrition world buzzing about choline, and it's not the only study showing the benefits of higher maternal intake of choline on fetal brain development.

What is Choline?

Choline is a dietary nutrient similar in structure to B vitamins. Your body has the ability to make some choline, but it is not enough to fulfill your needs and needs to supplement with dietary intake.

Choline plays a role in various body functions, including:

• Cell Membranes: Phosphorylated Choline makes the outer membrane of your cells
• Genetic Methylation: Along with Folate, B6, B12 and other methyl donors, choline is essential for genetic expression; important for fetal development
• Metabolism: Choline helps metabolize fats into energy, which is super important during the third trimester when most glucose is sent to your growing baby
• Mental Health: Choline makes up a neurotransmitter called Acetylcholine, which is important for memory, mood, and muscle control. 

There are two different forms of choline found in the diet: a water-soluble form and a fat-soluble form.

• Water soluble choline is absorbed through the small intestines and transported to the liver for storage, where it is phosphorylated into the fat-soluble form as needed to make up cell membranes. 
• The fat-soluble choline forms are more prominent in the diet and are the functional forms of the vitamin. These dietary nutrients are absorbed directly into the bloodstream and go to work throughout the body without needing to be processed in the liver.

How Common is a Choline Deficiency?

Several factors determine choline demand and risk of deficiency.

During pregnancy there is an increased demand for choline, with most of it going to the developing baby. A study from 2017 suggested that only 8.5% of pregnant women were meeting the choline demand in pregnancy, or over 90% of women were deficiency. As of this year, few prenatal vitamins contain choline.

There is also concern that the current AI for choline in pregnancy is too low, and that an increased demand during the third trimester warrants a change in the recommendations. 

Is there ENOUGH CHoline in YOur prenatal?

The current AI for choline in pregnancy is 450 mg/day. In 2017 the American Medical Association (AMA) announced their support of increasing prenatal supplements to contain the 450mg/day of choline. Sadly, most prenatal supplements, including the top selling brands, do not contain ANY choline. 

Supplementation is only a safety net, and in my opinion, should not account for the full intake of nutrition in pregnancy. Many vitamins and minerals are not absorbed as efficiently in supplemental form and are best consumed in the diet. 

Taking a prenatal supplement that contains adequate choline and increasing food sources is your best way of increasing functional choline in the body. 

But, where in the diet do you get Choline?
Your best sources are Eggs, and Liver!

Food Sources of Choline

One of my favorite foods for pregnancy is eggs. Eggs have, nearly, everything you need to grow a baby...that's what it does. In regard to choline, eggs give you a whopping 150 mg per egg. 

Eggs are also high in Vitamin A (needed for oxytocin receptor formation), Vitamin D (deficiencies associated with pregnancy complications), Vitamin E (an essential antioxidant found in the amniotic fluid), as well as protein and cholesterol (needed for estrogen and progesterone formation). 

In some traditional cultures, pregnant women were required to eat 9+ eggs per day to have healthy babies. I like to have my patients eat two per day with quality prenatal and other choline rich foods. 

Many women are nervous about consuming liver in pregnancy because they have been fed fearful information. Please read my other article on this subject. Consuming liver in the second and third trimesters is safe, and nutrient dense. 

3 oz. of Beef contains a whopping 350 mg of choline, not to mention everything you need to build blood - which is doubling in the second trimester. 

​Not everyone likes liver...I know, surprising, right? Sneaking it into food is sometimes easier on the pregnancy palate. Liver can be hidden in broth and ground meats easily. 

Vegans, Vegetarians & Choline

Vegans have a harder time accumulating enough dietary choline, as most sources are animal based...but it can be done! I'm not a practitioner that believes everyone should be paleo, I think all foods have a place in the diet. I am also not a practitioner that is going to try and changes someone's philosophy on diet. My job is to make sure that you can maintain a healthy nutritional density with your beliefs. 

Some of the foods we focus on are: 

• ​Fermented Soy: yes fermented, always fermented! Tofu, Miso, Tempeh, and Natto all fall into this group. Sources on total choline numbers in this food varies, with some sources showing tempeh having 250 mg/2 cups.
• Wheat Germ: 1 cup (that's a lot of wheat germ) provides 200 mg
• Cruciferous Veggies (Brussel Sprouts, broccoli): These guys provide around 60 mg per 1 cup serving
• Broad Leaf Greens (Spinach, Collard Greens): Cook well and they provide between 50-90 mg per 1 cup serving depending on type

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Sarah Thompson CFMP, L.Ac., Doula is the owner and lead practitioner at Sacred Vessel Acupuncture & Functional Medicine. As a Functional Medicine practitioner specializing in maternity, Sarah is passionate about helping pregnant woman achieve pregnancy and childbirth success through proper nutrition. Sarah as over 20 years of experience in health & wellness, nutrition, private practice alternative medicine, education and speaking.