Health Professional – Pregnancy and Lactation

Choline plays a critical role in brain development in the fetus and in infants, especially in the development of the hippocampus and basal forebrain, known to regulate memory. Choline also acts like folate in preventing neural tube defects in fetal development.

Folate, choline, and betaine serve as hydroxy methyl group donors, and are all important in the prevention of neural tube defects (NTD). results in birth defects, including anencephaly or spina bifida. These defects occur early in pregnancy, between the 21st and 27th days after conception, when many women do not realize that they are pregnant (Pitkin, 2007).

Clear Evidence of Insufficient Choline Intake in Pregnant Women

There is clear evidence of suboptimal intakes of choline for most individuals, especially pregnant and lactating women.

  • Human studies show that women in the highest quartile of choline intakes had a 72% lower risk of NTD-affected pregnancy and those with lowest levels of serum choline had 2.4-fold greater risk (Shaw et al, 2009).
  • Choline needs are greater for men [Adequate Intake (AI) 550 mg/day], than for women (AI 425 mg/day). However, choline needs increase in pregnancy to 450 mg/day and in lactation (550 mg/day). Large amounts of choline are delivered to the fetus across the placenta; choline concentration in amniotic fluid is 10-fold greater than that present in maternal blood (Shaw et al, 2004).
  • Plasma or serum choline concentrations are significantly higher in pregnant women than non-pregnant women, and are six to seven-fold higher in the fetus and newborn than in adults (Shaw et al, 2009).
  • Human milk is rich in choline, therefore, needs in lactation are greatest and maternal stores are generally depleted for extended periods of time.
  • Dietary choline intake among women ranges between less than 300 mg to over 550 mg/day.
  • In the Nurse's Health Study, the cutoff for the 95th percentile for choline intake was 411 mg/day, below the recommended level of 450 mg/day in pregnant women and 550 mg/day in lactating women (Shaw et al, 2009).
  • Data from 2007-2008 NHANES Evaluation showed that pregnant women consumed on average 337 mg/day (Shaw et al, 2004).


Pitkin RM (2007) Folate and neural tube defects. Am J Clin Nutr 85(1):2855-2885

Shaw GM, Carmichael SL, and Yang W (2004) Periconceptional dietary intake of choline and betaine and newural tube defects in offspring. Am J Epidemiol 160(2):102-109

Shaw GM, Finnell, RH, Blom, HJ, Carmichael, SL, Vollset, SE, Yang, W, and Ueland, PM (2009) Choline and risk of neural tube defects in a folate-fortified population. Epidemiol 20(5):714-719